Casebased Teaching Geoffrey Barnes MD MSc Brazil TraintheTrainer

Case-based Teaching Geoffrey Barnes, MD, MSc Brazil Train-the-Trainer Kickoff Course February 23, 2019

Why use cases? Storytellin g Assess and Adapt to Learners Challenge s Learn Why & Why Not

Our goals • Engage adult learners • Convey important information • Meet the needs of our audience • Feel confident as presenter

Engagement: Adult Learning Theory • Explain why specific content is being taught • Focus learning on commonly performed tasks Casebased • Address different levels of prior experience Learning • Use self-directed approaches, when possible

Convey Key Information: Teaching Points “Tell them what you are going to tell them… Tell them what you’ve just told them” Strategies: • Learning objectives and summary points • Cases with “key questions”

Audience Needs: Questions and Material Audience Response Questions • Assess baseline knowledge • Directly address knowledge gaps • Adapt presentation to audience needs Presentation Material Design • Include some fundamentals • Focus on routine clinical decision-making (e. g. guidelines) • Touch on higher-level nuance material

Sample Presentation Structure 1. 2. 3. 4. 5. 6. 7. 8. Introduce topic and presenter Present a brief case Highlight 3 -5 “key questions” Present an audience response question Present didactic material Return to audience response question, present answer Return to case, highlight key questions Open up for additional question

Summary Goals of case-based presentations • • Engage audience Convey important information Meet the needs of our audience Feel confident as presenter

Teaching Goals and Learning Objectives

Objectives EXAMPLES Vague Doctors will know more about medications for managing HF. Specific At the end of the session, doctors will be able to list the 5 most common medications for managing HF.

Be SMART and Meet Your Goal S M A R T Specific Measurable (& Manageable) Achievable Relevant (& Realistic) Targeted to the Learning Situation Think about your session goal and individual learning objective. Are they SMART?

Word Selection Matters Bloom’s Taxonomy

Evaluation Framework Performance Competence Knowledge

Example Teaching Goal Learning Objectives • Doctors will implement new ACC/AHA Lipid guidelines while selecting best lipid management for high-risk cardiovascular disease patients At the end of this session, doctors will be able to: • Identify high-risk characteristics for secondary ACS prevention • Demonstrate knowledge of advanced lipid management by selecting appropriate non -statin therapies

Tips for Designing Cases • Start with learning objective(s) – Make sure case is designed to address those objectives • Present a realistic case, not too complicated • Ok for case to “develop” during the presentation – Match to didactic material – Analogous to clinical practice

Example Case Mr. S is a 65 year old man • New patient in cardiology clinic • “What can I do to prevent a heart attack? ” Family History • Brother recently had bypass surgery • Father died of “heart problems” at age 67 Medical and Social History • Diabetes and Hypertension • Former smoker, quit 5 years ago Medications • Metformin, lisinopril

Example Case (cont. ) Laboratory Studies Vital Signs: • Cholesterol 220 • HR 72, BP 142/88, RR 18, Sp. O 2 98% Physical Examination: • Well developed and nourished • No JVD • Cardiac exam RRR, no murmurs • Lungs CTAB • Abdomen was obese, non-tender • No lower extremity edema • 2+ pulses in both ankles/feet • • HDL 45 LDL 140 Glucose (fasting) 120 Hg A 1 c 7. 8 Key Questions • How to assess cardiovascular risk? • Role of aspirin for primary prevention? • Role of statin for primary prevention?

Tips for Creating Audience Questions • Avoid “all are true except” questions – Best to say “which of the following is the best…” • Do not try and trick your learners – Make question and answer simple and clear • Have a single correct best choice – Avoid “A and B”, “A, B, and C”

Example Audience Response Question Which of the following statements is true regarding the role of aspirin for primary prevention of cardiovascular disease? 1. Use of full dose aspirin (>300 mg daily) is superior to the use of “low dose” aspirin (80 -100 mg daily) regardless of a patient’s weight 2. All patients with diabetes should receive low dose aspirin for primary prevention of cardiovascular disease 3. The use of low dose aspirin has been proven to reduce the risk of developing colon cancer 4. Any benefit of low dose asprin might be offset by the risk of bleeding when used for primary prevention of cardiovascular disease

Example Case Which of the following statements is true regarding the role of aspirin for primary prevention of cardiovascular disease? 1. Use of full dose aspirin (>300 mg daily) is superior to the use of “low dose” aspirin (80 -100 mg daily) regardless of a patient’s weight 2. All patients with diabetes should receive low dose aspirin for primary prevention of cardiovascular disease 3. The use of low dose aspirin has been proven to reduce the risk of developing colon cancer 4. Any benefit of low dose asprin might be offset by the risk of bleeding when used for primary prevention of cardiovascular disease

Example Audience Response Question (2) Which of the following is true about using aspirin for prevention? 1. Full dose aspirin is usually better than “low dose” aspirin 2. Diabetic patients should get aspirin 3. Aspirin can reduce cancer risk 4. Aspirin might reduce heart attacks but also can cause bleeding

Example Audience Response Question (3) Over a 6 month treatment period, Mr. S (from our case) developed severe myalgias from 3 different statins. What would you do next? • Check Vitamin D level • Focus on diet and exercise • Discuss ezetimibe therapy • Discuss PCSK 9 inhibitor therapy

Case and Didactic Connection • Connect answer choices with didactic content • Be sure to review WHY answers are right/wrong – Another form of repetition for key points

Summary: Cases and Audience Response Questions • Start with learning objectives first (select higher order actions) • Make case realistic, provide enough detail (not too much) • Make questions clear and straightforward • Connect answer choices with didactic content • Be sure to review WHY answers are right/wrong – Another form of repetition for key points