CASE DISCUSSIONS Random Problem and Case Based Discussions

CASE DISCUSSIONS Random, Problem and Case Based Discussions

Case discussions • • Rooted real life + personal experience Relevant to learner Practical solutions – reality based Flexible – explore beyond the immediate Efficient and economical Never ending supply of cases! Johari’s window – blind spots & unknowns (RCAs), open and hidden areas (PCAs) @NHS_Health. Ed. Eng

• Home visit to 89 year old lady with SOB, pitting odema and productive cough, lives alone, refusing admission but not coping – neighbour requested the visit @NHS_Health. Ed. Eng

Areas to explore • • • Attitudes Decision making Problem solving Communication Consultation skills – includ record keeping Ethics Knowledge Use of guidelines and protocols Health promotion and prevention Dealing with uncertainty/risk @NHS_Health. Ed. Eng

Areas to explore • • Prescribing issues Safety netting Handing over Housekeeping IT issues Service issues Resource issues Etc etc @NHS_Health. Ed. Eng

Beware…. • • Lack of focus Potential for confrontation Needs to challenge – what they did and why Not a cosy chat • Zone of proximal learning @NHS_Health. Ed. Eng

Random Case Analysis • Blind spots and unknown areas • Can focus on attitudes • Look at behavioural aspects – eg dealing with the late patient, remarks re “trivia” etc • Can explore hypothetical issues with “what if” questions • Only impacts learning if sufficient level of challenge (without pushing beyond limits) @NHS_Health. Ed. Eng

RCA • Aim to help trainee construct their own knowledge • Find out where they are and build on it! • Sharing your own experience and cases will have little relevance for the trainee • Assess learning needs • Increase self awareness @NHS_Health. Ed. Eng

RCA practicalities • Randomly select case from surgery list • Allow trainee to outline the case uninterrupted (golden minute!) • How do they feel it went? • Whilst listening list subjects which can be used as teaching areas • Negotiate agenda of 2 or 3 areas to discuss • Use role play at any time @NHS_Health. Ed. Eng

RCA process • Challenge! • Probing questions – what, why, how etc • Widen the agenda if approp eg health promotion, QOF • Summarise learning points (trainee or trainer) • Note if learning needs to be addressed (set specific dates if going to review) @NHS_Health. Ed. Eng

RCA alternatives • • Review only prescriptions issued (NESCAFE) Review use of resources eg tests, time Focused RCAs eg safety netting Focused on Professional Competence areas @NHS_Health. Ed. Eng

Management questions • What were your thoughts regarding this choice of medication • Were there other drugs that you considered and ruled out? • What factors influenced this decision? • Similar for choice of investigations requested • What influenced your choice of follow up time? @NHS_Health. Ed. Eng

Diagnostic questions • What specific features led you to the diagnosis of…… • What was your differential diagnosis • Were there any other conditions you ruled out? How? • Was there anything unique about this patient that influenced your decision-making? @NHS_Health. Ed. Eng

Hints for conducting RCAs • • Get the context and setting right Ensure you have a good rapport Keep it short and concise 20 -30 mins Clarify the reasons for decisions made Be aware of other agendas Summarise learning points at the end Set some follow up tasks Remember rules of feedback – positives too @NHS_Health. Ed. Eng

Problem Case Analysis (PCA) • Trainee brings something that they perceive to be a problem • May be problem with patient care or difficulty for the Dr • Feelings as well as facts should be explored • Problem identified by trainee should be addressed – can widen tutorial • Why did they select the case? E. g. hide their weaknesses • Mainly tackles open and hidden difficulties – may fail to identify blind spots @NHS_Health. Ed. Eng