Development and Utilization of Cases for Instruction

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Development and Utilization of Cases for
Instruction

• Christina B. DeBiase, EdD
• West Virginia University School of Dentistry

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WHY ARENT STUDENTS USING AND INTEGRATING WHAT
THEY HAVE LEARNED
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Introduction

• Students do not learn much by just sitting in
  class listening to teachers, memorizing
  prepackaged assignments, and spitting out
  answers. They must talk about what they are
  learning, write about it, relate it to past
  experiences, apply it to their daily lives. They
  must make what they learn part of themselves.

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PRINCIPLES OF ADULT LEARNING THEORY

• WANT TO USE WHAT THEY LEARN SOON AFTER
• LIKE TO SOLVE PROBLEMS, NOT JUST LEARN FACTS
• LEARN BEST WHEN THEY SET THEIR OWN PACE
• WANT TO BE ACTIVELY ENGAGED IN THE LEARNING
  PROCESS
• LIKE TO TRANSFORM THEIR EXPERIENCES INTO LEARNING

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PBLProblem-based learning is the learning that
results from the process of working toward the
understanding or resolution of a problem. The
problem is encountered first in the learning
process.

• (Barrows and Tamblyn, 1980)

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CBLCASE-BASED LEARNING IS LEARNING WHICH
REQUIRES STUDENTS TO RETRIEVE PREVIOUSLY ACQUIRED
KNOWLEDGE TO SOLVE PROBLEMS DESIGNED TO MIMIC
FUTURE PROFESSIONAL PRACTICE VIA A CASE
FORMAT.(KASSEBAUM, 1991)
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The Scope of CBL

• This teaching method can run the gamut from a
  highly structured exercise to an unstructured
  problem purposefully designed to raise a variety
  of complex issues and alternative solutions.

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GOALS FOR CBL

• ACTIVATES PRIOR KNOWLEDGE (I.E., PHARMACOLOGY,
  NUTRITION)
• PROVIDES A CONTEXT FOR THIS KNOWLEDGE IN A
  CLINICAL SITUATION THEREBY PROMOTING THE
  INTEGRATION OF SCIENTIFIC PRINCIPLES AND PRACTICE
• ENCOURAGES CRITICAL THINKING AND ULTIMATELY
  LIFE-LONG LEARNING BY THE COMMUNICATION AND
  ELABORATION OF IDEAS THROUGH ACTIVE LEARNING

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CBL BRIDGES THE GAP BETWEEN AND
Scientific Principles Practice
Courses Competencies
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THE CONNECTEDNESS OF THINGS IS THE MOST
IMPORTANT GOAL OF EDUCATIONMark Van Doren
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Theoretical Foundation

• John Deweys book Democracy and Education in 1916
  challenged the traditional dualistic model of
  education which centered the power of education
  in the teacher and relegated the learner to a
  dependent, passive observer.
• Dewey believed in the power of the learning
  process and felt that the teachers role was to
  promote intellectual growth through learner
  empowerment.

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ROLE OF FACILITATOR

• DEVELOPS CASE
• PROMOTES DISCUSSION
• LISTENS
• CHALLENGES BYASKING QUESTIONS
• POSES HYPOTHETICALS TO ENCOURAGE ANALYSIS AND
  PROBLEM SOLVING

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Attributes of Good Case-based Teachers

• Knowledgeable
• Enthusiastic
• Secure and comfortable in being challenged
• Flexible
• Able to promote discussion and facilitate process

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Attributes of Good Case-based Teachers

• Able to tolerate discussion, dissention, and
  silence
• Skillful in giving ongoing feedback
• Perceptive of non-verbal learner behavior

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Attributes of Case-based Teachers

• Just as comfortable with the process of learning
  as they are with the outcome of instruction
• Willing to derive pleasure from the empowerment
  of the learner from the journey of discovery

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The timing of teacher input is critical to the
learning process and the promotion of a positive
learning environment
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Getting Started

• Prepare or borrow a case
• Model solutions to the case
• Begin with small groups of 2-3 students working
  on 1-2 paragraph cases
• Link other instructional methods to CBL
• Start a casebook
• Involve students in case creation and evaluation
• Log cases by content for future use

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Selecting a Case Topic

• Address issues encountered in practice
• Emphasize important concepts
• Include interdisciplinary learning issues
• Promote problem-solving
• Support course objectives

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Considerations for Case Design

• Learning objectives
• Type of patient
• Time constraints
• Room configuration
• Presentation format
• Number of students

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CASE ELEMENTS

• HEALTH HISTORY
• PHYSICAL ASSESSMENT
• RADIOGRAPHS
• LABORATORY FINDINGS
• PHOTOGRAPHS
• PATIENT DIALOGUE

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STEPS FOR CBL1. Identify the issues of the
case2. Clarify analyze the issues3. Develop
hypotheses4. Define goal5. Generate
solutions6. Prepare a plan of action
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Components of Case-based Learning proposed by
Dewey

• A genuine, plausible and meaningful situation of
  experience
• A genuine problem in that situation which
  provokes thought and interest
• Information and observation about the situation
  (data)
• Suggested solutions for which the learner is
  responsible
• Opportunity to test ideas by application, to make
  the meaning clear, and to discover validity
  Plan of action

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Case-based Learning Constructsfor Healthcare
Education

• A real clinical scenario that is likely to be
  encountered
• An imbedded problem or question that stimulates
  thought or poses a challenge
• Clinical data and descriptors which build upon
  basic clinical knowledge
• Development of differential diagnoses or
  hypothetical solutions
• Narrowing and then finalization of diagnosis
  based upon evidence and probability
• Formulation of treatment plan

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Examples of Case-based Teaching and Learning

• Written cases
• Analysis by individual learners
• Analysis by small groups
• Verbal versus written discussion
• Standardized Patient Cases
• Live interview
• Videotaped viewings
• Web based cases
• Interactive
• Links to multiple resources

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Examples of Case-based Teaching and Learning

• Clinical cases
• Bedside teaching
• Lecture teaching
• Iterative teaching

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INTEGRATES KNOWLEDGE FROM VARIOUS
SOURCESMAKES RELEVANT THE TRANSFER OF THEORY
INTO PRACTICEMAKES CONTENT MORE
MEANINGFULENHANCES PROBLEM - SOLVINGPROMOTES
SELF DIRECTED - LEARNINGPROMOTES ACTIVE
LEARNINGENHANCES RETENTIONSTRENGTHENS
CLINICAL REASONING SKILLSPROMOTES TEAM LEARNING
ADVANTAGES OF CBL
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IMPROVES COMMUNICATION INTERPERSONAL
SKILLSENHANCES RECALL OR THE RETRIEVAL OF
INFORMATIONADDRESSES SOCIAL, MORAL OR ETHICAL
ISSUESADDRESSES MULTIPLE VIEWPOINTSFOSTERS
COLLABORATION BETWEEN DISCIPLINESDEVELOPS
SENSITIVITY TO PATIENT NEEDSDECREASES TEST
ANXIETYMOTIVATES STUDENTS TO LEARNFOSTERS
LIFE-LONG LEARNING
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Challenges of Case-based Teaching

• Format may make faculty/students uncomfortable
  initially
• Faculty concern about covering material
  adequately
• Investment in time
• Teacher creativity
• Clinical scenarios that are well constructed and
  provocative
• New teaching skill sets
• Different measures of outcome and learner success
  and may be difficult to evaluate

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Challenges of Case-based Teaching

• Often done in small groups
• Requires teacher skilled in group facilitation
• Requires both structure and flexibility on part
  of both teacher and learner
• Need to know where you are going
• Need to recognize that the journey is just as
  important as the educational destination
• Calls for ongoing feedback to learners

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Summary

• Case-based teaching is a technique well suited to
  the graduate and post-graduate health sciences
  curriculum. It provides the learner an
  opportunity to integrate and apply core
  knowledge, build critical thinking skills,
  practice data analysis, and implement clinical
  skills within a safe and facilitated learning
  environment.