Studying published cases and the medical literature curriculum

Abstract

Context and setting Benefits of case study in the pre-clerkship curriculum include enhanced motivation, a sense of integration and relevance in studying the basic sciences, and an opportunity for independent learning. Although these benefits are probably achievable with any case-based method, they are widely used as justification for the problem-based learning approach. Why the idea was necessary Problem-based learning uses a methodology that is expensive, logistically challenging and is based on a goal – to develop skill at solving clinical problems – that is unrealistic at pre-clerkship level. We suggest that educational rather than instrumentalist goals should be emphasised at this stage of professional development and define such ‘education’ as initiation into the authentic discussion of medicine. As the medical literature represents the most refined and developed form of this discussion, we utilise case study to promote entry into this literature. Doing this, we opt to model excellent clinical reasoning and sophisticated discourse rather than to engage students who lack the requisite background knowledge in the pretence of ‘clinical problem solving’. What was done We developed a course that features the reading of published cases as part of an overall programme at our institution that we call the ‘medical literature curriculum’ (MLC; see http://www.upstate.edu/mlc/). Students independently study an assigned case report such as a clinico-pathological conference in its entirety in anticipation of an ‘open notes’ quiz prior to class discussion. Quizzes cover general objectives that ensure background study of the diseases and therapies discussed as required to understand the rationale of the authors with regard to diagnosis and management. Class discussions take place in large-group format (> 150 students) and are led by faculty experts in the relevant disciplines. Following the initial class discussion, each student prepares a written pathophysiological hypothesis outlining the mechanisms linking the patient’s disease process to the clinical manifestations. These hypotheses then provide a framework for a subsequent class discussion. Evaluation of results and impact The programme has grown progressively as a feature of the curriculum over the past 5 years, largely as a result of student advocacy. It currently runs throughout the 2 pre-clerkship years in parallel with basic science and ‘practice of medicine’ courses. Although it is generally regarded as challenging, the vast majority (> 90%) of students deny that published cases are too difficult to read at their level, even in the first weeks of medical school. Students report that the approach integrates the curriculum and is highly relevant to their future goals. Moreover, > 80% rate their level of satisfaction with the course as 4 or 5 (using a standard Likert scale of 1−5, where 5 = most satisfied) and more than two-thirds state that they learn more from this experience than from any other. The MLC is a series of formal courses running in parallel with the standard curriculum. Its primary goal is to engage students in reading and discussing the medical literature. It initially balances the study of basic sciences with case reading and later balances clerkship experience with the study of clinical and translational research papers. We show here that published case reports provide an accessible means of entry into the medical literature for beginner students and that studying them provides the same psychological and integrative benefits as other forms of case-based learning.