Presentation on theme: "CASED-BASED TEACHING: Models and Methods"— Presentation transcript:
1 CASED-BASED TEACHING: Models and Methods Judy Garner, Ph.D.,Department of Cell and NeurobiologyKeck School of MedicineDistinguished Fellow, CET
2 Teaching by example or stories CASE BASED TEACHING:Teaching by example or storiesAn alternative or adjunct to didactic lecturingApplication of concepts to practical experienceOr vice versa
3 What is a case?“a case is a descriptive document, often presented in narrative form, that is based on a real-life situation or event.“It attempts to convey a balanced multidimensional representation of the context, participants, and reality of the situation.Katherine Merseth, ERIC digests, ERIC clearinghouse on Teaching and Teacher Education, Washington, D.C.
4 What is a case?“Cases are created explicitly for discussion and seek to include sufficient detail and information to elicit active analysis and interpretation by users with differing perspectives.”Katherine Merseth, ERIC digests, ERIC clearinghouse on Teaching and Teacher Education, Washington, D.C.
5 Value of cases Engaging stories Open-ended and challenging Engender controversyComplex enough to allow students to recognize the benefits of research and collaborative teamwork in solving a problem
6 Value of cases Help connect concepts and practice Develop decision-making or problem-solving skillsRaise the level of critical thinkingEnhance listening/cooperative learningUnderstand the relevance of contextA method of delivering multiple points of viewAs a learning technique:Active not passive!The student is the teacher
7 Background Early use of Case-Based learning Currently Law schools as early as late 1800sBusiness schools since early 1900sParables and Fables—”the moral of the story is…’CurrentlyProfessional schools: medicine, dentistry, law, business, teachersGeneral education, humanitiesReally confined to higher education
8 Learning Outcomes: What do you expect your students to achieve? In establishing goals, using cases may require a subtle modification of how learning goals are phrased:Example:From “Know the chemical structure of a benzene ring.”To “What is the value of knowing the structure of a benzene ring?”
9 Learning Outcomes: What do you expect? Example:What is the value of knowing the chemical structure of a benzene ring?To get an answer the student must:Know the chemical structure of a benzene ringDetermine how the benzene ring interacts with other organic chemical forms?And may, through the use of a case (pharmaceutical case) take it further.How do you chemically alter a benzene ring?Would that be useful in attempting to alter the efficacy of a particular pharmaceutical compound?
10 Learning Outcomes: What do you expect from students in your field? Collaborative learning and working in groups:Is this of value in your field?Cases can be used with variable degrees of student-student interactionIndividual creativity vs group processAssessment of individual student’s ability
11 Learning Outcomes: What do you expect through use of cases? Increased student engagementRetention time of facts vs skills and conceptsUse it or lose it!
12 Elements of Case Design Selection of appropriate casesMirroring professional experience/real world contextHow complex or how simple?
13 SIMPLE CASE: Calculus 101 Chalk toss. Draw a graph of the height of the chalk relative to the floor over time, with the height being the vertical axis of the graph, and the time being the horizontal axis of the graph.
15 SIMPLE CASE: Calculus 101After finishing, students exchange their graphs. They are asked to write a brief paragraph describing the position of the chalk based on the graph they are looking at. Each paragraph should include:Maximum height of the chalkLength of time the chalk was in the air.
16 SIMPLE CASE: Calculus 101After the exercise there is a discussion aboutthe importance of scales and units in graphs.do they get a sense of change in velocity of the chalk through this exercise even though not explicitly requested?communicating information in generalThis exercise then can be expanded by variations (dropping the chalk, bouncing the chalk off of the wall, velocity of the chalk over time, etc.)
17 COMPLEX CASESCASES IN AN INTEGRATED MEDICAL CURRICULUM
18 Neurosciences in Medicine NeuroanatomyNeurophysiologyNeurochemistryGross anatomy of the Head and NeckNeuropathologyNeurologyOphthalmologyNeuroradiologyNeurosurgeryPsychiatryCNS and Autonomic Pharmacology
19 Choice of cases Case selection must take into account How common is the case in real lifeAbility of the case to integrate multiple subdisciplinesAbility of the case to effectively teach important learning objectives in the courseThe case must not be too burdensome in the acquisition of data for the answers
20 CHOICE OF CASES SEQUENCE OF CASES: PRIOR KNOWLEDGE LOGICAL ORDER EARLY CASES REVISITED AS SYSTEM PROGRESSES AND KNOWLEDGE INCREASES
21 CASE THEMES OF THE WEEKCases:Week 2: Trauma, Substance abuse, Acute Stress DisorderWeek 3: Parkinson’s Disease with DepressionWeek 4: Stroke with Adjustment DisorderWeek 5: Panic Disorder (Brain tumor)Week 6: Herpes Encephalitis, Status Epilepticus, DeliriumWeek 7: Evidence based medicine (Stroke studies)Week 8: Alzheimer’s Disease with Psychosis.
22 Week 1 ICM Mentor Group Students receive case plus reading INTRO to NS IICMResting Membrane potential and Action potentialCranial Cavity and BrainReticular formation EEG and SleepNeural Cell BiologyCNS DevelopmentTissue response to injuryGross Anatomy LabSensory Physiology and receptorsNeuroanatomyLabPathology LabVascular OverviewMental Status ExamCongenital defects of the CNSMentor GroupINTRO to NS IIICM WORKSHOP:Students receive case plus readingNeuroanatomy LabMENTAL STATUS EXAMassignments in case bookMicroanatomy of the CNS
23 KEY: Each Lecture/Laboratory that corresponds to: PPP Case 1: Trauma, substance abuse, Acute Stress DisorderPPP Case 2: Parkinson’s Disease with Depression DisorderPPP Case 3: Stroke with Adjustment DisorderPPP Case 4: Generalized Anxiety Disorder (Brain Tumor)PPP Case 5: Herpes Encephalitis, Epileptic seizures, DeliriumPPP Case 6: Alzheimers Disease with PsychosisDevelopment SeriesAutonomic Nervous System SeriesSpecial Senses SeriesNeuromuscular series
24 Week 1INTRO to NS IICMResting Membrane potential and Action potentialCranial Cavity and BrainReticular formation EEG and SleepNeural Cell BiologyCNS DevelopmentTissue response to injuryGross Anatomy LabSensory Physiology and receptorsNeuroanatomyLabPathology LabVascular OverviewMental Status ExamCongenital defects of the CNSMentor GroupINTRO to NS IIICM WORKSHOP:Students receive case plus readingNeuroanatomy LabMENTAL STATUS EXAMassignments in case bookMicroanatomy of the CNS
25 Week 2 Chemical Neurotrans-mission ICM Motor Neurons and Spinal ReflexesThe OrbitPsychological TraumaLimb-Axial Somatosensory PathsUpper Motor Neurons/Lower Motor NeuronsGross Anatomy LabEndogenous Pain PathwaysNA LabNeuroradiologyPPP CASE 1 DISCUSSIONMentor GroupHeadacheICM WorkshopsNeurological ExamSensory Cranial Nerves and PathsOtolaryngology ExamWORK ON PPP CASE #1Ophthalmology Exam
26 Week 3 Motor Cranial Nerves ICM Acetylcholine Innervation patterns to the head and neckDirect acting Parasympatho-mimeticsMotor Cranial Nerve LabAutonomic Nervous SystemGross Anatomy LabBrain TumorsMovement DisordersPath LabCorticobulbar pathsMovement disorders CasesPPP CASE 2 DISCUSSIONMentor GroupMood DisordersICM WorkshopsNeurological ExamBasal GangliaOtolaryngology ExamWORK ON PPP Case 2NA LabOphthalmology Exam
27 Week 4 Cerebellum ICM Muscarinic Blockers Fascia and Lymphatics of the Head and NeckGanglionic Blockers and StimulantsCerebellar Pathways and DisordersCerebrovascular DiseaseGross Anatomy LabDeliriumNA LabPathology LaboratoryDevelopment of the Head and NeckCASE 3 DISCUSSIONMentor GroupCholinesterase InhibitorsCatecholaminesNeuromuscular BlockersCNS VasculatureWORK ON PPP CASE #3
28 Week 5 NEUROSCIENCESWRITTEN MIDTERM EXAM Infratemporal Fossa and TMJ Pathology of CNS InfectionsSTUDY TIMEGross Anatomy LabPathology of CNS Infections LabSympatho-mimeticsCASE 4 DISCUSSIONMicrobiology of CNS InfectionsNEUROSCIENCES PRACTICAL MIDTERM EXAMMicrobiology Laboratory
29 Week 6 Sympatho-mimetics ICM Adrenergic Blockers Middle Ear Indirect acting Sympatho-mimeticsNeuromuscular DisordersGross Anatomy LabSympatholyticsSeizures and Seizure DisordersVisual PhysiologyMicroanatomy of the EyeNeuromuscular CasesEBM Case DiscussionMentor GroupVestibular and Auditory SystemsICM WorkshopsNeurological ExamOtolaryngology ExamWork on EBM CaseVestibular and Auditory LabOphthalmology Exam
30 Week 7 Pharmacology of the Eye ICM Opiates and Neuropeptides Cranial Nerves IX and XOpioid analgesics and antagonistsCentral Visual PathwaysHypothalamusGross Anatomy LabNA LabHypothalamus LabAntidepressants, Mood StabilizersCase WorkshopPPP Case #5 DiscussionMentor GroupDemyelinating DiseasesSerotonin, histamine and GABAWork on PPP Case #5Anxiety DisordersThalamus
31 Week 8 Stimulants ICM Stupor and Coma Sleep Disorders Schizophrenia CasesSedative-hypnoticsCerebral Cortex and Higher Cerebral FunctionDementia DisordersAntipsychotic drugsLimbic SystemCortex laboratoryPathology of Dementia DisordersHigher Cortical FunctionLimbic System LaboratorySeizure Cases and Antiepileptic DrugsPPP Case #6 DiscussionMentor GroupDrugs of abuse, dependence,and addictionWork on PPP Case #6Substance AbuseAnxiolytic Drugs
32 EXAMPLE OF A CASE:1) Patient History and Symptoms:Fred Hoskins, a 17-year-old boy, was admitted to the emergency room at 1:30 (AM) after a car accident.Fred’s friends, who had also been involved in the car accident, had told EMT personnel that Fred had been trapped in the car upside down, suspended from his seatbelt, and it took the firemen over an hour to release him from the wreckage.During the accident, Fred had received a blow to the head and had been rendered briefly unconscious after the accident but had regained consciousness within a few minutes.He had been terrified throughout the entire ordeal that the car would explode. His friends had also told EMT personnel that Fred had been at a “rave” prior to driving home.In the emergency room, his examination was normal but he was sleepy, and he was held for observation.
33 2) RELEVANT DATA Vital Signs on admission Test Results: Drug screen, Blood Alcohol, CTFurther sequelae: time courseSurgeryPost surgical interview after hospital admissionDetailed post-release interview
34 CASE THEMES OF THE WEEK Fridays: Written case with ~6 general discussion questions receivedExamples:What is your differential diagnosis? Include in your answer a discussion of how you would differentiate among the different types of intracranial hemorrhages.What psychiatric disorder does this patient manifest after the accident that wasn’t present before it? How is it diagnosed? It appears to be a good predictor of what other major psychiatric disorder?
35 CASE THEMES OF THE WEEK Monday afternoon: Small groups meet after doing reading. Discussion of general diagnosis, and negotiation for answer “responsibility” of individual students. Later in the week the students share answers so each has a complete set.
36 CASE THEMES OF THE WEEK Monday through Thursday: Students share answers so each has a complete set.Friday morning:Students present answers to the questions to their peers and instructor (experts) with discussion as different answers are discovered.
37 Web posting: Detailed answers to questions. How can one distinguish among subdural, epidural, subarachnoid, or intraparenchymal hemorrhage? Which of these types of hemorrhage is evident in the CT scan?1) Epidural bleeds (between the dura and the cranium) are usually confined to the limits of the overlying cranial bone (the dura adheres to the suture points). The smooth contour of the hematoma in the CT suggests the blood is confined in the space between the bone and dura. Patients with epidural bleeds are often characterized as experiencing a brief period of unconsciousness, followed by a conscious lucid period, then later lapsing back into unconsciousness.
39 Case 2: Trauma with Acute Stress Syndrome: Learning Objectives After examination of this case, each student should be able to:Distinguish among subdural, epidural, subarachnoid, and intraparenchymal hemorrhage. (N, Npath, GA, NA, NRad)Discuss the pupillary light reflex and oculomotor signs in terms of CNS herniation. (NA, GA, N )Describe the progression of herniation. (GA, NA, N)Explain the significance of papilledema. (N, GA, Npath, Ophthal)Define the difference between substance abuse and substance dependence (Pharm, Psych, NC)Define the criteria for Acute Stress Disorder (Psych)Describe, in general, the treatment plan for epidural hematoma (N, Nsurg, GA)Describe, in general, the treatment plan for Acute Stress disorder (Psych, GA, Pharm)
40 SUMMARY: The use of complex cases: Facilitates understanding of the complexity of real life situations to be faced by medical studentsAllows abstract conceptual information to be applied to situations likely to be experienced by the studentsIntegrates information from multiple subdisciplines and multiple points of view as it is focused upon a single problemHelps the students recognize that even in sciences there is not always a “right” and a “wrong” answerUnderscores the professional value of cooperative learning and working
41 PROBLEM-BASED LEARNING (PBL) No coursesSeries of problems or cases solved by student small groupsFacilitators/ TutorsSmall group (6-10)Self-directed study
42 Problem based learning (PBL) Identification of learning issuesData acquisitionCase solution or development of a plan of action in solving the case
43 “PERFORMANCE” IN THE CLASSROOM Cases don’t necessarily have to be narrative or didacticUse of AV aidsUse of performance (skits)Use of unexpected changes in a situation.
44 Case Exercise: Form small groups Generate learning issues Data acquisition (if possible)Presentation of case
45 Case writing exercise: Think about a learning goal you wish your students to achieveIdentify a “real-life” situation in which one would use that learning goalWrite a short vignetteDesign a ‘stem’ that will direct the students towards achieving the goal through examination of the case