case teaching

CASE THEMES OF THE WEEK Cases: Week 2: Trauma, Substance abuse, Acute Stress Disorder Week 3: Parkinson’s Disease with Depression Week 4: Stroke with Adjustment Disorder Week 5: Panic Di

CASED-BASED TEACHING:

Models and Methods

Judy Garner, Ph.D., Department of Cell and Neurobiology

Keck School of Medicine Distinguished Fellow, CET

CASE BASED TEACHING:

Teaching by example or stories

 An alternative or adjunct to didactic lecturing

 Application of concepts to practical experience

 Or vice versa

What is a case?

often presented in narrative form,

that is based on a real-life situation

or event

multidimensional representation of the context, participants, and reality

of the situation.

What is a case?

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

Value of cases

recognize the benefits of research

and collaborative teamwork in

solving a problem

Value of cases

 Help connect concepts and practice

 Develop decision-making or problem-solving skills

 Raise the level of critical thinking

 Enhance listening/cooperative learning

 Understand the relevance of context

 A method of delivering multiple points of view

 As a learning technique:

– Active not passive!

– The student is the teacher

 Early use of Case-Based learning

– Law schools as early as late 1800s

– Business schools since early 1900s

– Parables and Fables—

”the moral of the story is…’

 Currently

– Professional schools: medicine, dentistry,

law, business, teachers

– General education, humanities

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:

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:

1 Know the chemical structure of a benzene ring

2 Determine how the benzene ring interacts with other organic chemical forms?

And may, through the use of a case (pharmaceutical case) take it further.

1 How do you chemically alter a benzene ring?

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 interaction

– Individual creativity vs group process

– Assessment of individual student’s ability

Learning Outcomes: What do you expect through use of

cases?

concepts

– Use it or lose it!

Elements of Case Design

– Mirroring professional experience/real

world context

– How complex or how simple?

SIMPLE CASE: Calculus 101

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.

IN FEET

10

4

2 sec

SIMPLE CASE: Calculus 101

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 chalk

– Length of time the chalk was in the air.

SIMPLE CASE: Calculus 101

 After the exercise there is a discussion about

chalk through this exercise even though not

explicitly requested?

This exercise then can be expanded by variations (dropping the chalk, bouncing the chalk off of the wall, velocity of the chalk over time, etc.)

COMPLEX CASES

CURRICULUM

Choice of cases

 Case selection must take into account

– How common is the case in real life

– Ability of the case to integrate multiple

subdisciplines

– Ability of the case to effectively teach

important learning objectives in the course

– The case must not be too burdensome in

the acquisition of data for the answers

CHOICE OF CASES

– PRIOR KNOWLEDGE

– LOGICAL ORDER

– EARLY CASES REVISITED AS SYSTEM

PROGRESSES AND KNOWLEDGE

INCREASES

CASE THEMES OF THE

WEEK

Cases:

Week 2: Trauma, Substance abuse, Acute Stress Disorder

Week 3: Parkinson’s Disease with Depression

Week 4: Stroke with Adjustment Disorder

Week 5: Panic Disorder (Brain tumor)

Week 6: Herpes Encephalitis, Status Epilepticus, Delirium

Week 7: Evidence based medicine (Stroke studies)

Week 8: Alzheimer’s Disease with Psychosis.

Week 1

INTRO to NS I ICM Resting

Membrane potential and Action potential

Cranial Cavity and Brain Reticular formation EEG

Sensory Physiology and receptors

Neuroanatomy

Lab

Pathology Lab Vascular

OverviewMental Status

Exam

Congenital defects of the CNS

Mentor Group INTRO to NS II ICM WORKSHOP: Students

receive case plus reading

Neuroanatomy Lab

MENTAL STATUS EXAM assignments

in case book

Microanatomy of

PPP Case 1: Trauma, substance abuse, Acute Stress Disorder PPP Case 2: Parkinson’s Disease with Depression Disorder PPP Case 3: Stroke with Adjustment Disorder

PPP Case 4: Generalized Anxiety Disorder (Brain Tumor) PPP Case 5: Herpes Encephalitis, Epileptic seizures, Delirium PPP Case 6: Alzheimers Disease with Psychosis

Development Series Autonomic Nervous System Series

KEY: Each Lecture/Laboratory that corresponds to:

Week 1

INTRO to NS I ICM Resting

Membrane potential and Action

potential

Cranial Cavity and Brain Reticular formation EEG

Gross Anatomy Lab Sensory Physiology

Exam

Congenital defects of the CNS

Mentor Group INTRO to NS II ICM

WORKSHOP:

Students receive case plus reading Neuroanatom

y Lab MENTAL STATUS EXAM assignments in case book

Microanatomy

of the CNS

The Orbit Psychological

r Motor Neurons

Gross Anatomy Lab

Endogenous Pain Pathways

y PPP CASE 1 DISCUSSION

Mentor Group Headache ICM

Workshops Neurological Exam

Sensory Cranial Nerves

Otolaryngolog

y Exam

Week 3

Motor Cranial

Nerves ICM Acetylcholine Innervation patterns to

the head and neck

Direct acting Parasympatho -mimetics

Motor Cranial

Nerve Lab

Autonomic Nervous System

Gross Anatomy Lab

Brain Tumors

Movement Disorders

Mentor Group Mood

Disorders ICM Workshops

Neurological Exam

Basal Ganglia Otolaryngolog

y Exam WORK ON PPP

Case 2

NA Lab Ophthalmolog

y Exam

Week 4

Cerebellum ICM Muscarinic

Blockers Fascia and Lymphatics of

the Head and Neck

Ganglionic Blockers and Stimulants

Mentor Group Cholinestera

se Inhibitors

Catecholamine s

Neuromuscula

r Blockers CNS

Vasculature

Week 5

NEUROSCIENCE SWRITTEN

MIDTERM EXAM

Infratemporal Fossa and TMJ Pathology of CNS Infections

Anatomy Lab

Pathology of CNS Infections Lab

mimetics

Sympatho-CASE 4 DISCUSSION

Microbiology

of CNS Infections NEUROSCIENCE

S PRACTICAL

MIDTERM

EXAM

Microbiology Laboratory

Week 6

Sympatho-mimetics ICM Adrenergic Blockers Middle Ear Indirect acting

Sympatho-mimetics Adrenergic

Blockers

Neuromuscula

r Disorders

Gross Anatomy Lab

Sympatholytic s

Seizures and

Seizure

Disorders

Visual Physiology

Mentor Group Vestibular

and Auditory Systems

ICM Workshops Neurological Exam

Otolaryngolog

y Exam Work on EBM Vestibular Ophthalmolog

Week 7

Pharmacology

of the Eye ICM Opiates and Neuropeptides Cranial Nerves IX and X Opioid analgesics and

antagonists Central Visual

Workshop

PPP Case #5 Discussion

Mentor Group Demyelinatin

g Diseases Serotonin, histamine and GABA Work on PPP

Case #5

Anxiety Disorders Thalamus

Cerebral Cortex and Higher

Cerebral Function

Dementia Disorders

Antipsychotic drugs

Limbic System Cortex

laboratory

Pathology of Dementia Disorders

Higher Cortical Function Limbic System

Laboratory

Seizure Cases and

Antiepileptic Drugs

PPP Case #6 Discussion

Mentor Group Drugs of

abuse, dependence, and addiction

1) Patient History and Symptoms:

emergency room at 1:30 (AM) after a 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

had been rendered briefly unconscious after the accident but had regained consciousness within a few minutes

would explode His friends had also told EMT personnel that Fred had been at a “rave” prior to driving home

was sleepy, and he was held for observation

EXAMPLE OF A CASE:

2) RELEVANT DATA

admission

CASE THEMES OF THE

 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?

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.

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.

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,

Case 2: Data

Case 2: Trauma with Acute Stress Syndrome: Learning Objectives

 After examination of this case, each student should

be able to:

and intraparenchymal hemorrhage (N, Npath, GA, NA, NRad)

in terms of CNS herniation (NA, GA, N )

Ophthal)

substance dependence (Pharm, Psych, NC)

SUMMARY:

life situations to be faced by medical students

to situations likely to be experienced by the students

and multiple points of view as it is focused upon a single problem

there is not always a “right” and a “wrong” answer

learning and working

 No courses

 Series of problems or cases solved by

student small groups

Problem based learning

(PBL)

plan of action in solving the case

situation.

Case Exercise:

Case writing exercise:

your students to achieve

one would use that learning goal

students towards achieving the goal