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Using Computer-Simulated Case-Based Scenarios

to Improve Learning

David M. Segal PhD


Assistant Professor

Department of Health
Professions
College of Health & Public
Affairs

Case-based Learning
The effectiveness of case-based instruction in education is
supported by a significant body of research
Teaching health science students how to work in teams in the
classroom with members of varying experience and skill levels
offers valuable real-life simulated learning which will better
prepare them for the healthcare workplace
Students with strong critical thinking skills make better clinical
decisions
Focus shifts towards higher order processing skills rather than
merely content
How can we assess context-specific critical learning?
How can technology mediate this?

Pedagogy Poll Question


How many use the following teaching methods to deliver your
content?
a.
b.
c.
d.
e.
f.

case-based learning
problem-based learning
team-based learning
collaborative learning
web-based instruction (WebCT, Blackboard)
other

CBL Poll Question


What system do you use to implement case-based teaching?
a.
b.
c.
d.
e.
f.
g.
h.
i.

paper-based
word
powerpoint
wimba
animations
immersive (second-life, active worlds)
mannequins
standardized patients
role-plays (students)

What is critical thinking?

Students demonstrate the ability to think by being able to:


Analyze complex issues and make informed decisions;
Synthesize information in order to arrive at reasoned conclusions;
Evaluate the logic, validity, and relevance of data;
Solve challenging problems;
Use knowledge and understanding to generate and explore new questions;
Distinguish between observation and inference;
Identify the axioms/assumptions in any argument and judge their validity;
Identify the nature of the reasoning being used. Know when inductive or deductive
reasoning is required;
Use circular reasoning to reflect on decisions.

Program Decision-Making
Learning Outcomes
Demonstrate proficiency with scientific content
Demonstrate critical thinking skills in critically evaluating context-specific data
for relevance, consistency, and fidelity
Demonstrate proficient decision-making skills to determine the best diagnosis
and treatment for simulated patient
Demonstrate proficiency with integration of scientific content to identify the
etiology, pathogenesis, clinical manifestations, diagnosis, and treatment for patient
Demonstrate information fluency by retrieving, interpreting, and critically
evaluating published literature for most relevant evidence-based scientific studies
Articulate clinical expertise by communicating the risks and benefits for different
courses of action to treat patients

Kim et al, Medical Education, 40:867-876, 2006

FALL

Intro to Pharmacology HSC 3157

SUMMER

Intro to Pharmacology HSC 3157

SPRING

Coursework

Online
Pathophysiology HSC 4550
Medical Pharmacology 1 HSC 4148

Online
Pathophysiology HSC 4550
Medical Pharmacology 2 HSC 4149
Pathology/Pharmacology PHT 5306

Intro to Pharmacology HSC 3157

450 students
150 students
80 students
680 students

f2f
f2f

450 students
150 students
45 students
35 students
680 students

Online
Online
f2f

150 students

Online
150 students

ANNUAL TOTAL: 1,510 students

WebCT Limitations

How can you assess critical thinking and decision making skills
in WebCT environment?
How can you implement critical thinking exercises in large
online classes?
How can you grade asynchronous activities with large online
classes?
How can you conduct group collaborative work with textbased synchronous chatrooms?

Patient Case Library


Over 300 cases are available
Initial history, additional history, differential diagnosis,
laboratory & diagnostics, diagnosis, treatment, subsequent
history
Primary System disorders
Immunity (25)
Oxygen transport (15)
Cardiopulmonary (35)
Fluid/electrolyte (15)
Acid-base (15)
Renal/bladder (35)
Urogenital (30)
Gastrointestinal (35)
Endocrinology (25)
Musculoskeletal (35)
Integumentary (20)
Neurological (35)

MyCaseSpace

CBL dynamic, interactive, learning management system


Virtual characters
Library (50 avatars, 9 languages, 6 races, genders, 6 facial gest
Multi-nodal cases
Self-assessment
Reflective learning
Student-centered learning
Critical thinking and decision-making triggers and activities
Curriculum learning objectives and competencies mapping

Familial Case Studies

Improved Clinical Decision-Making


Outcomes
using Case study Learning
SIMULATED CASES RESULTS
Pre- and post-examinations of clinical case
scenarios
Group I:
Group II:
Group III:

11 +/- 2% (p<0.001)
19 +/- 3% (p<0.001)
31 +/- 4% (p<0.001)

*positive improvements in scores relative to control group


IV
Group I:

Online static text case scenarios (n=200)

Group II:

Online interactive case scenarios (n=200)

Group III:
(n=200)
Group IV:

Online interactive virtual character case scenarios


No case scenario training (control; n=200)

Improved Clinical Decision-Making


Outcomes
using Case study Learning
Post-usage survey results

participant opinions about validity, performance characteristics, and utility


for training
* statistically significant difference (p<0.001
*

1. Are the scenarios enjoyable?


2. Do the scenarios address important
clinical competencies?

3. Do participants view the simulation


as a learning tool?
4. Is improved technical fidelity required
for authenticity?

*
*
*

5. Was the session realistic?


Group I:

Online static text case scenarios

Group II:

Online interactive case scenarios

Group III:
character

Online interactive virtual


case scenarios

Group IV:

No case scenario training

strongly
agree

agree
or
disagree

strongly
disagree

Sequential Decision-Making Processing

Initial history

5%

8%

Diagnosis

Additional history
23%
45%
Differential
diagnosis

Treatments 92%
54%

52%

30%

62%
Laboratory &
diagnostics

Reflective Thinking Decision-Making

Case Simulation Scoring


Means by Iterations
1: 35 +/- 10%
2: 48 +/- 12%
3: 55 +/- 10%
4: 69 +/- 8%
5: 78 +/- 9%
6: 83 +/- 6%
7: 85 +/- 5%
8: 91 +/- 5%
9: 94 +/- 5%

Collaborative Technology Poll


Question
What technology have you used to promote collaborative
learning in
your students?
a.
b.
c.
d.
e.

classroom paper-based
videoconferencing
classroom response systems
immersive environment
other

iLinc Virtual classroom

Inter-disciplinary, inter-institutional
Team-based Cooperative Active learning
Synchronous interactions
Group discussions with Q&A
Virtual Grand Rounds

Multi-disciplinary Collaborative Groups


Individual case work
Group I: Medical Pharmacology 1 (n=29)

16 +/- 6%

Group II: Medical Pharmacology 2 (n=24)

18 +/- 8%

Group III:
8%

Pathophysiology (n=25)

26 +/-

Collaborative case work


Group IV:
Pathophysiology/Med Pharm 1 (n=80)
37 +/- 8%
Group V: Pathophysiology/Med Pharm 2 (n=80)
6%

44 +/-

RESULTS:
Students prefer computer simulated case studies for convenient access,
collaboration, and varied attributes
Cases can be designed with multi-nodal decision points to enhance interactive
experience
Improvements in student critical thinking and decision-making skills are observed in
cases which are relevant and realistic cases compared to challenging and engaging
attributes
Most significant improvements observed in cases with basic science and clinical
aspects
Computer-simulated case scenarios can be developed for any discipline using this
system and these case-building concepts

Contact:
David Segal, PhD

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