Authentic Clinical Cases Research Articles

Evaluation of an interprofessional education workshop about common ocular conditions for pharmacy and optometry students

ABSTRACT Clinical relevance Interprofessional education and collaborative working are known to improve patient outcomes. The evidence to support this approach in optometry is lacking. Background There is no published evidence into the effectiveness of interprofessional education for pharmacy and optometry students. This study aimed to evaluate the effectiveness of an interprofessional case-based learning session that took place between third year pharmacy students and final year optometry students at the University of Manchester. Methods Students worked together in a 1.5-hour workshop to help each other gain an understanding of common ocular conditions that may present to primary care. Students were randomised into two groups; the control group answered all the pre and post questions before the teaching session. The intervention group answered the pre questions at the beginning and the post questions immediately after the teaching session. Nonparametric statistics were employed to look for differences in the two groups. Results The control groups of pharmacy and optometry students did not significantly differ in their pre and post test scores (p = .069 pharmacy and p = .082 for optometry). The post scores for the intervention group were significantly higher than the control group. For pharmacy students the control group post score average was 44.9% (±20.5) and the intervention group was 63.2% (±15.9). For optometry students the control group post score average was 35% (±21.2) and the intervention group was 57.5% (±19.9). Conclusion Interprofessional education is a useful way to increase student knowledge of the management of authentic clinical cases in primary care.

Exploring the thoughts and feelings of novice speech-language pathology students: A qualitative investigation

Purpose To explore the thoughts and feelings of novice Australian speech-language pathology students about undertaking their first therapy placement. Method Data was collected with Australian novice graduate-level speech-language pathology students immediately prior to their first therapy placement via open-ended responses to two questions on a questionnaire. The data was analysed using inductive qualitative content analysis. Result 265 students participated in the study. Data analysis led to the construction of two themes: “I hope that my placement will support me on my way to becoming a confident speech-language pathologist” and “I hope my clients do well, but I fear that I might be inadequate”. The analysis of these results led to the development of guidelines for supporting novice students on clinical placement. Conclusion Novice speech-language pathology students are keen to apply their knowledge to authentic clinical cases but are concerned about their own personal circumstances and whether they will receive sufficient support during their placement. An enhanced understanding of students’ concerns and hopes may help practice educators implement appropriate support strategies.

Evidence for a case-based module in the low-resource setting to teach ectopic pregnancy management.

Case-based learning (CBL) utilizes authentic clinical cases that connect theory to practice. CBL has been shown to result in deeper learning and high engagement of adult learners. An open-source, web-based CBL module was created to help learners develop the cognitive foundation of ectopic pregnancy management in the low-resource setting. We present psychometric evidence that supports the use of this web-based CBL in the low-resource setting. The case scenario comprising 20 topics in ectopic pregnancy management was created by an Ethiopian team member and hosted on an interactive web-based platform. The module was reviewed by Ethiopian, Cameroonian, and US surgeons and OB/GYN team members for content, relevance, and clarity, followed by a psychometrician for clarity, bias, relevance, and alignment. Twenty participants (3-Mbingo Baptist Hospital-Cameroon, 6-Soddo Christian Hospital-Ethiopia, 3-Southern Illinois University (SIU), and 8-University of Michigan (UM)) then completed the module. Four attending surgeons (2 OB/GYN, 2 general surgery) were designated experts while 10 medical students and 6 residents were designated novices. The module included a 10-item dichotomously scored pre-test, the CBL content, and the same, but shuffled, post-test. Pre- and post-test summed scores were compared using paired Student's t-tests, while differences in scores across participants' experience levels and sites were analyzed using a many-facet Rasch model. Findings indicated a statistically significant improvement in participants' mean summed scores from pre-test (M=6.7, SD=2.2) to post-test (M=9.0, SD=1.5), t(20)=- 4.76, P < 0.0001 and confirmed by Rasch analysis, P < 0.001. An adequate distribution of difficulty was demonstrated and 80% of questions had high discrimination value between experts and novices, d=| 0.87, 1.40 |. There was no difference in scores across specialties. Following the module, expert scores (M=9.7) were higher than novice scores (M=9.0), but the difference was not statistically significant. Our findings suggest that using a web-based CBL module could be used to effectively improve understanding of the management of ectopic pregnancy in the low-resource setting, especially for nascent surgeons. The concept of a web-based CBL module has special attraction in the low-resource setting as it may target the adult surgical learner in remote regions where established technologies and existing experts are unavailable.

Are preprofessional undergraduate students ready for authentic clinical case studies? An empirical study of students' perceived relevance and motivation.

Increasingly, the curricula of many clinical programs have been restructured to an integrated model in which foundational sciences such as physiology, pathophysiology, and pharmacology are taught side by side with clinical reasoning. Case studies are an excellent pedagogical strategy for enhancing such integration, especially if such cases are authentic, that is, they include a broad range of information that could influence the individualization and optimization of patient care. However, authentic cases may be too advanced and thereby dissuade preclinical students. We offered an optional semester-long authentic pharmacotherapy case study to undergraduate students in an introductory pharmacology class in a liberal arts college in the United States Midwest and sought to know what might motivate students to complete this challenging task. Connection with and relevance of the case study were assessed with an anonymous survey. Open-ended questions were analyzed qualitatively. Exploratory factor analysis and nonmetric multidimensional scaling were employed to investigate underlying commonalities and patterns in the motivations for participating in and relating to the case study. Students were motivated more by the perceived relevance and transferability of knowledge acquired to their future career than by their current clinical technician jobs or their personal lives. Rather than causing an information overload and dissuading students, this complex pharmacotherapy case assignment harnessed preclinical students' experiences from cognate cocurricular activities, created numerous points of relevant engagement with instructional content, and therefore motivated students to deeper learning.NEW & NOTEWORTHY Early introduction to clinical reasoning is widely advocated. Case studies are frequently used to enhance integration of foundational sciences with clinical reasoning. Preclinical students may be overwhelmed by complex cases because of the higher-order cognitive tasks involved. We find that complex cases permit connection with students' own experiences and aspirations. These preclinical students were motivated to engage in such challenging academic work because of the perceived transferability of knowledge to their future careers.

Case analysis in ethics instruction: bootlegging theory in a topical structure

Robert Veatch was a notable and prolific author in a variety of areas in philosophy, health care practice, and policy. However, it is evident by the sheer number of case study in ethics books, eighteen editions of case collections in all, that this approach to teaching ethics in the health sciences was especially important to him. A few of these case study collections he wrote alone, but the majority were written with co-authors from nursing, dentistry, pharmacy, allied health, and medicine, drawing on their respective areas of disciplinary expertise and experience as educators. The aim of this article is to focus on the pedagogy and framework Veatch developed to expose students to the rudiments of philosophical ethics so they could understand the conflicts between values, principles, and ethical theories. Authentic clinical cases, he believed, were a useful way to engage students. Putting the two ideas together, Veatch argued the best method of structuring cases is "bootlegging theory in a topical structure" (Veatch, Robert M., Case analysis in ethics instruction. In: Amy Haddad (ed) Teaching and learning strategies in pharmacy ethics, Creighton University, Omaha, 85-97, 1992). Veatch's rationale for this carefully planned systematic arrangement between case topics and philosophical ethics content are presented. The influence and input of co-authors from different disciplines are explored regarding case development and commentary content. Finally, the impact of these interdisciplinary case study textbooks on ethics instruction in the health sciences is evaluated.

Sacral Prosthesis Substitution as a System of Spinopelvic Reconstruction After Total Sacrectomy: Assessment Using the Finite Element Method

Following total sacrectomy, the continuity between the spine and pelvis is necessary for ambulation and to enable patients to resume daily living activities sooner during rehabilitation. Reconstructing spinopelvic stability after a total sacrectomy is a challenge that has not yet been overcome. Thus, the objectives of the present study are as follows:Establish a new system of reconstructing the spinopelvic region after a total sacrectomy using a rapid prototyping technique to design the sacral replacement pieces.Evaluate the biomechanical properties of this system.Study a new reconstruction system for the spinopelvic joint that reduces reconstruction failures after total sacrectomy, reducing postoperative complications and allowing early sitting and standing of these patients. A sacral replacement implant was designed according to an authentic clinical case of a patient who had undergone a total sacrectomy. Using the finite element method, a biomechanical study was carried of 2 reconstructions that had been performed using the new prosthetic. The results of the study were compared with 4 other reconstruction models. A maximum von Mises stress of 112 MPa and a vertical displacement of -0.13 mm in L5 were observed in the models of the sacral implant that had been generated. A maximum rigidity of 861.5 Nm/mm was observed in the models when assuming a reduction in rigidity of more than 85% with respect to the other models assessed. In all models, maximum tension was concentrated in the rods joining L5 with the screws anchored to the pelvis. The sacral prosthesis substitution after a total sacrectomy produced a profound reduction in stress in the instrumentation and the bone structure as well as smaller vertical displacement, the lowest values ever reported. These results indicated that the assembly was rigid and stable and would prevent the collapse of the spine in the pelvis. According to stress values, the replacement piece was not likely to rupture as a consequence of static load or implant fatigue.

Authentic Pharmacotherapy Case Study Enhances Learning Outcomes in Pharmacology in Preprofessional Undergraduate Students

Introduction: Professional health training curricula that integrate basic and clinical sciences are associated with improved learning outcomes. Authentic clinical case studies that capture the complexity of a typical patient are frequently used in clinical training programs to model to students how to integrate information across disciplines to justify management plans. The value of such authentic case studies in preclinical students is less studied. This study seeks to know (i) if preclinical students in a large midwestern liberal arts college would be interested in participating in an optional case study assignment and (ii) if participation is associated with improved learning outcomes in a third-year pharmacology course. Material and Methods: Demographics, motivation, and vocational experience were assessed by an online survey. Binary multivariate logistic regression was used to assess the relationship between participating in the voluntary case study and performance on case-related and noncase-related questions. Results: More than two-thirds of the students participated in the case study, and their decision was driven largely by interest and/or experience in a healthcare vocation. Completing the case study was associated with better performance on case-related multiple-choice questions on midterm exams (Wald’s χ2 = 2079; P &lt; 0.001). Conclusions: This study suggests that there are potential benefits to using case studies in preclinical curricula to drive improved student outcomes by underscoring the link between prerequisite courses and clinical practice. It also proffers a potential tool for assessing the efficacy of case study interventions.

Establishing an ORL virtual outpatient Dept. during the COVID-19 pandemic

The COVID-19 pandemic changed medical education: teaching has been mostly converted to online mode. Our aim is to offer a complete high-quality curriculum despite the fact of worldwide cutbacks in education. The department of otorhinolaryngology introduced case-based learning (CBL). CBL is a learning and teaching approach that prepares students for clinical practice through the use of authentic clinical cases and places them in the role of decision maker. CBL combines theory and practice to prepare students as good as possible without intern shadowing. The students were asked to evaluate CBL as a digital format and as a teaching tool for future clinical work and preparation for the ORL exam. The majority of students (>90%) rated the CBL as a successful digital format. Most students also strongly agreed or agreed that CBL is a good preparation for their future clinical work (>90%) and the ORL exam (>80%). 100% of students CBL confirmed, that they learned something new. Following successful introduction of CBL we will implement a new teaching format. The "ORL virtual outpatient Dept." will include information from virtual, anonymized case studies. We choose diagnosis included in the "ORL virtual outpatient Dept." according to the most common ORL disorders encountered by primary care physicians. The "ORL virtual outpatient Dept." can only bridge the absence of practical training, and, in the future, serve as an additional preparation.

Scaffolding medical student knowledge and skills: team-based learning (TBL) and case-based learning (CBL)

BackgroundTwo established small-group learning paradigms in medical education include Case-based learning (CBL) and Team-based learning (TBL). Characteristics common to both pedagogies include the use of an authentic clinical case, active small-group learning, activation of existing knowledge and application of newly acquired knowledge. However, there are also variances between the two teaching methods, and a paucity of studies that consider how these approaches fit with curriculum design principles. In this paper we explore student and facilitator perceptions of the two teaching methods within a medical curriculum, using Experience based learning (ExBL) as a conceptual lens.MethodsA total of 34/255 (13%) Year 2 medical students completed four CBLs during the 2019 Renal and Urology teaching block, concurrent to their usual curriculum activities, which included weekly TBLs. Questionnaires were distributed to all students (n = 34) and CBL facilitators (n = 13). In addition, all students were invited to attend focus groups. Data were analysed using descriptive statistics and thematic analysis.ResultsIn total, 23/34 (71%) of students and 11/13 (85%) of facilitators completed the questionnaires. Twelve students (35%) participated in focus groups. Findings indicate their experience in CBL to be positive, with many favourable aspects that built on and complemented their TBL experience that provided an emphasis on the basic sciences. The learning environment was enriched by the CBL framework that allowed application of knowledge to solve clinical problems within the small groups with consistent facilitator guidance and feedback, their capacity to focus discussion, and associated efficiencies in learning. ConclusionWhile the TBL model was integral in developing students’ knowledge and understanding of basic science concepts, the CBL model was integral in developing students’ clinical reasoning skills. The strengths of CBL relative to TBL included the development of authentic clinical reasoning skills and guided facilitation of small group discussion. Our findings suggest that delivery of a medical curriculum may be enhanced through increased vertical integration, applying TBL in earlier phases of the medical program where the focus is on basic science principles, with CBL becoming more relevant as students move towards clinical immersion.

Management guideline for Werner syndrome 2020. 6. Skin ulcers associated with Werner syndrome: Prevention and non-surgical and surgical treatment.

To provide guidelines on the diagnosis, treatment, and prevention of skin ulcers in Werner syndrome. This article was based on literature from 1996, when WRN was identified as a gene responsible for Werner syndrome, and we evaluated several authentic clinical cases of genetically diagnosed patients. There were 63 patients with Werner syndrome in the Japanese reports retrieved from Medical Online between January 1996 and December 2017. There were 56 patients with Werner syndrome in English reports written by Japanese authors and retrieved from PubMed during the same period. Records on skin ulcers were found in 27 (43%) out of 63 patients and 22 (40%) out of 56 patients from the Japanese and English reports, respectively. The reported ulcers were often located at the distal one-third of the lower legs. There were 8 patients with callosities in the foot in the Japanese reports and 9 patients in the English reports. A skin ulcer in Werner syndrome is generally intractable. Weight-bearing ulcers or callosity should be critically assessed in surgical procedures because they have effects on patient pain and gait. By adopting a recently advanced technique to facilitate wound healing, the cases of ulcers that were difficult to treat and those requiring major operations can be closed with minimally invasive surgery. Skin ulcers in Werner syndrome are refractory, and they lead to reduced quality of life of patients. A callosity in Werner syndrome is an important therapeutic target for the prevention of ulcers. Geriatr Gerontol Int 2021; 21: 153-159.

Western University Schulich School of Medicine & Dentistry.

Western University Schulich School of Medicine & Dentistry.

Integration of case based learning and bedside teaching in undergraduate students in pediatrics

Background: Teaching undergraduate students by bedside clinics has remained cornerstone of medical education because it imparts knowledge, teaches proper behaviour and can be used to teach skills effectively. Case based learning (CBL) is a newer modality of teaching in medical education. CBL involves preparing students for clinical practice through use of authentic clinical cases. Aim of the study is to study the effect of integration of case based learning and bed side clinic on motivation, deep thinking and cognitive improvement in final MBBS studentsMethods: The study group was undergraduate students of final MBBS posted for clinical posting in pediatric ward. The study was carried out on 59 students posted from March 2018 to September 2018. MCQ based pretest was done initially. The students were taught the topic by case based learning method for one hour. They were asked to take the case and bedside clinic was conducted. Relevant clinical examination was demonstrated to the students. Students were asked to practice the skills in front of the teacher. This was followed by the post-test and questionnaires.Results: 88.67% students thought that this method was motivating. 82.7 % students perceived that it increases deep thinking. 52.83% students showed more than 20% improvement in score of pre-test and post-test.Conclusions: Integration of case based learning with bed side clinic was associated with Better motivation of final year MBBS students and development of deep thinking in students. 3. Significant change in cognitive learning in final MBBS students.

Assessing Diagnostic Reasoning Using a Standardized Case-Based Discussion.

Background:Development of diagnostic reasoning (DR) is fundamental to medical students’ training, but assessing DR is challenging. Several written assessments focus on DR but lack the ability to dynamically assess DR. Oral assessment formats have strengths but have largely lost favour due to concerns about low reliability and lack of standardization. Medical schools and specialist medical colleges value many forms of oral assessment (eg, long case, Objective Structured Clinical Examination [OSCE], viva voce) but are increasingly searching for ways in which to standardize these formats. We sought to develop and trial a Standardized Case-Based Discussion (SCBD), a highly standardized and interactive oral assessment of DR.Methods:Two initial cohorts of medical students (n = 319 and n = 342) participated in the SCBD as part of their assessments. All students watch a video trigger (based on an authentic clinical case) and discuss their DR with an examiner for 15 minutes. Examiners probe students’ DR and assess how students respond to new standardized clinical information. An online examiner training module clearly articulates expected student performance standards. We used student achievement and student and examiner perceptions to gauge the performance of this new assessment form over 2 implementation years.Results:The SCBD was feasible to implement for a large student cohort and was acceptable to students and examiners. Most students and all examiners agreed that the SCBD discussion provided useful information on students’ DR. The assessment had acceptable internal consistency, and the associations with other assessment formats were small and positive, suggesting that the SCBD measures a related, yet novel construct.Conclusions:Rigorous, standardized oral assessments have a place in a programme of assessment in initial medical training because they provide opportunities to explore DR that are limited in other formats. We plan to incorporate an SCBD into our clinical assessments for the first year of clinical training, where teaching and assessing basic DR is emphasized. We will also explore further examiners’ understanding of and approach to assessing DR.

Application of a utility analysis to evaluate a novel assessment tool for clinically oriented physiology and pharmacology.

Multiple-choice questions are a gold-standard tool in medical school for assessment of knowledge and are the mainstay of licensing examinations. However, multiple-choice questions items can be criticized for lacking the ability to test higher-order learning or integrative thinking across multiple disciplines. Our objective was to develop a novel assessment that would address understanding of pathophysiology and pharmacology, evaluate learning at the levels of application, evaluation and synthesis, and allow students to demonstrate clinical reasoning. The rubric assesses student writeups of clinical case problems. The method is based on the physician's traditional postencounter Subjective, Objective, Assessment and Plan note. Students were required to correctly identify subjective and objective findings in authentic clinical case problems, to ascribe pathophysiological as well as pharmacological mechanisms to these findings, and to justify a list of differential diagnoses. A utility analysis was undertaken to evaluate the new assessment tool by appraising its reliability, validity, feasibility, cost effectiveness, acceptability, and educational impact using a mixed-method approach. The Subjective, Objective, Assessment and Plan assessment tool scored highly in terms of validity and educational impact and had acceptable levels of statistical reliability but was limited in terms of acceptance, feasibility, and cost effectiveness due to high time demands on expert graders and workload concerns from students. We conclude by making suggestions for improving the tool and recommend deployment of the instrument for low-stakes summative assessment or formative assessment.

Using complexity theory to develop a student-directed interprofessional learning activity for 1220 healthcare students.

BackgroundMore and better interprofessional practice is predicated to be necessary to deliver good care to the patients of the future. However, universities struggle to create authentic learning activities that enable students to experience the dynamic interprofessional interactions common in healthcare and that can accommodate large interprofessional student cohorts. We investigated a large-scale mandatory interprofessional learning (IPL) activity for health professional students designed to promote social learning.MethodsA mixed methods research approach determined feasibility, acceptability and the extent to which student IPL outcomes were met. We developed an IPL activity founded in complexity theory to prepare students for future practice by engaging them in a self-directed (self-organised) learning activity with a diverse team, whose assessable products would be emergent creations. Complicated but authentic clinical cases (n = 12) were developed to challenge student teams (n = 5 or 6). Assessment consisted of a written management plan (academically marked) and a five-minute video (peer marked) designed to assess creative collaboration as well as provide evidence of integrated collective knowledge; the cohesive patient-centred management plan.ResultsAll students (including the disciplines of diagnostic radiology, exercise physiology, medicine, nursing, occupational therapy, pharmacy, physiotherapy and speech pathology), completed all tasks successfully. Of the 26 % of students who completed the evaluation survey, 70 % agreed or strongly agreed that the IPL activity was worthwhile, and 87 % agreed or strongly agreed that their case study was relevant. Thematic analysis found overarching themes of engagement and collaboration-in-action suggesting that the IPL activity enabled students to achieve the intended learning objectives. Students recognised the contribution of others and described negotiation, collaboration and creation of new collective knowledge after working together on the complicated patient case studies. The novel video assessment was challenging to many students and contextual issues limited engagement for some disciplines.ConclusionsWe demonstrated the feasibility and acceptability of a large scale IPL activity where design of cases, format and assessment tasks was founded in complexity theory. This theoretically based design enabled students to achieve complex IPL outcomes relevant to future practice. Future research could establish the psychometric properties of assessments of student performance in large-scale IPL events.Electronic supplementary materialThe online version of this article (doi:10.1186/s12909-016-0717-y) contains supplementary material, which is available to authorized users.

Nurse interrupted: Development of a realistic medication administration simulation for undergraduate nurses

Medication errors are a global phenomenon. Each year Australia-wide there are up to 96,000 preventable medication errors and in the United States there are approximately 450,000 preventable medication errors. One of the leading causes of errors is interruption yet some interruptions are unavoidable. In the interest of patient safety, nurses need to not only understand the impact of interruptions, but also be empowered with the knowledge and skills required to develop effective interruption management strategies. Well-planned simulation experiences have the potential to expose students to authentic clinical cases, otherwise unavailable to them, building critical thinking and clinical reasoning skills and preparing them for practice. This paper describes a simulated role-play experience that was developed to enable undergraduate nurses to experience, reflect on and analyse their responses to interruptions during medication administration. The simulation design presented in this paper was underpinned by both nursing and educational theorists, in combination with established simulation frameworks. Embedded within a clinical subject in 2013, the simulation experience was run over two campuses within a large Australian University. Participants included 528 second year undergraduate nursing students and 8 academic teaching staff. To stimulate reflective learning debriefing immediately followed the simulation experience. Written reflections were completed and submitted over the following 4weeks to extend the reflective learning process and review the impact of the experience from the student perspective. Undergraduate student nurses often have limited experiential background from which to draw knowledge and develop sound clinical judgements. Through exposure to clinical experiences in a safe environment, simulation technologies have been shown to create positive learning experiences and improve deductive reasoning and analysis. The heightened awareness of interruptions and their impacts on the medication administration process, along with techniques to manage interruptions more effectively serves to better prepare nurses for practice.

Case-Based Learning in Athletic Training

The National Athletic Trainers’ Association (NATA) Executive Committee for Education has emphasized the need for proper recognition and management of orthopaedic and general medical conditions through their support of numerous learning objectives and the clinical integrated proficiencies. These learning objectives and integrated clinical proficiencies are designed to prepare athletic training students to become competent professionals. In fact, the educational competencies and integrated proficiencies related to orthopaedic clinical assessment and diagnosis are just one of the vital links in becoming either a successful or an unsuccessful athletic trainer. However, this success is not accomplished overnight; rather, it is accomplished gradually over time, as students progress through the higher levels of Bloom’s taxonomy.

Advancing medicine one research note at a time: the educational value in clinical case reports

A case report—a brief written note that describes unique aspects of a clinical case—provides a significant function in medicine given its rapid, succinct, and educational contributions to scientific literature and clinical practice. Despite the growth of, and emphasis on, randomized clinical trials and evidenced-based medicine, case reports continue to provide novel and exceptional knowledge in medical education. The journal BMC Research Notes introduces a new “case reports” section to provide the busy clinician with a forum in which to document any authentic clinical case that provide educational value to current clinical practice. The aim is for this article type to be reviewed, wherever possible, by specialized Associate Editors for the journal, in order to provide rapid but thorough decision making. New ideas often garnered by and documented in case reports will support the advancement of medical science — one research note at a time.

Names and Narcissism: A Clinical Perspective on How Parents Choose Names for Their Newborn

AbstractParents express themselves through the names they give to their children. This article, based on clinical background and practice, looks at the names parents give their children in order to examine the emotional and psychological processes motivating these parents. Specifically, we will look at narcissism, since patients with narcissistic deprivation, in particular, tend to give their children names which often reflect their own deprivations.After a short presentation of healthy and pathological narcissism, and an onomastic-linguistic description of Hebrew given names as the semantic and morphological product of condensation and displacement, we merge the two presentations. We analyze authentic clinical cases to illustrate the interplay within this framework between early self, self-object experiences, and conflicts that emerge in the process of providing names and vice versa.The data for this paper is drawn from psychotherapeutic encounters with Israeli — Jewish patients.

Rush Medical College

Rush Medical College