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PEDAGOGICAL SCIENCES / <<ШУШетУМ~^©У©Ма1>>#22(174)),2©2©
PEDAGOGICAL SCIENCES
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Глубоченко О.В., Глубоченко В.Г.
Буковинський державний медичний унгверситет, м. Чертвцг, Украша
DOI: 10.24411/2520-6990-2020-12127 НАВЧАЛЬНЕ ВИКОРИСТАННЯ ЯК ПЕДАГОГ1ЧНИЙ МЕТОД В НАВЧАНН1 ВНУТР1ШНЬО1
МЕДИЦИНИ
Glubochenko O. V.,
MD, PhD, Associate professor Glubochenko V.G.
MD, PhD, Associate professor Bukovinian State Medical University, Chernivtsi, Ukraine
CASE-BASED LEARNING AS PEDAGOGICAL METHOD IN TEACHING OF INTERNAL
MEDICINE
Abstract.
The article deals with a discussion about the place of case-based method in educational process. It is accentuated that case-based learning is an instructive method that uses clinical cases to develop skills of discussion, questioning, and diagnostic thinking in the study of internal medicine. It is discussed history of using, advantages of method, main stages of implementation. Has been shown that case-based method to strengthen students learning, make the learning more real and relevant to clinical practice.
Анотацш.
У cmammi обговорюеться мгсце кейс-методу у навчальному процеа. Шдкреслюеться, що це е iнстру-ктивний метод, який використовуе клШчт кейси для розвитку навичок обговорення, опитування, дiагно-стичного мислення в процеа вивчення внутршньо'1 медицини. Обговорюеться iсторiя використання, переваги методу, основнi етапи впровадження. Показано, що кейсовий метод ттенсиф^е навчання сту-дентiв, робить його бшьш релевантним до клШчног практики.
Keywords: interactive technology, teaching strategies, case-based learning, higher medical education, propedeutics of internal medicine.
Ключовi слова: тформацшно-комуткацшт технологи, стратеги навчання, кейс-метод, вища меди-чна освта, пропедевтика внутрiшньоi медицини.
Case-based learning (CBL) with real patient cases is a widespread pedagogical method in medical school curricula that provides benefit of simulating real-world cognition. Case-based teaching methods have been demonstrated to lead to improved satisfaction of health professional students with their clinical education [1, 2].
CBL may have been introduced to medicine in 1912 by James Lorrain Smith, the first full-time pathology professor at the University of Edinburgh in what he called the "case method of teaching pathology". Students were asked to correlate the clinical history of patients, including their symptoms and signs, with the findings at post mortem by researching the patients' cases from their clinical records [3]. Case-based clinical reasoning was designed at the Academic Medical Center of University of Amsterdam in 1992, when a new undergraduate medical curriculum was introduced [4].
So many studies have also reported on the effectiveness of CBL in achieving learning outcomes and integrating cases into curricula has been shown to enhance clinical knowledge [4, 5, 6].
CBL method involves guided inquiry and is grounded in constructivism whereby students form new
meanings by interacting with their knowledge and the environment [7].
Case-based clinical reasoning has most of the features that are recommended by Kassirer et al.: "First, clinical data are presented, analyzed and discussed in the same chronological sequence in which they were obtained in the course of the encounter between the physician and the patient. Second, instead of providing all available data completely synthesized in one cohesive story, as is in the practice of the traditional case presentation, data are provided and considered on a little at a time. Third, any cases presented should consist of real, unabridged patient material. Simulated cases or modified actual cases should be avoided because they may fail to reflect the true inconsistencies, false leads, inappropriate cues, and fuzzy data inherent in actual patient material. Finally, the careful selection of examples of problem solving ensures that a reasonable set of cognitive concepts will be covered" [8].
Students more early should start developing the habit of diagnostic verification, as that will enhance the retrieval of patient cases and enriched illness scripts from long-term memory in the future. Olle ten Cate et al. suggest including in the definition of diagnostic ver-
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ification all actions that lead to confirmation of the correctness, to the extent possible, of the final diagnosis even if only to learn from a case and to store a case in memory, contributing to an enriched personal repository of illness scripts. As the skill of clinical reasoning is highly dependent on this repository, any solidification should enhance this skill [4].
We actively use case-method in our work with students in teaching of propedeutics of internal medicine in third-year students, courses of internal medicine in six-year graduated students and when conducting student's scientific club. By using this method, we provide transition from method of knowledge's accumulation to active, practical and oriented approach related to the actual activity of students. Our purpose is to teach students to analyse clinical information, identify key issues, to choose alternative ways of solutions, evaluate them and formulate a program of action. Such work allows students, who have "little luggage" of clinical knowledge, on practice to enhance and acquire knowledge, to get acquainted with the psychology of the patient, find the contact with him, develop the skills of communication arts.
The classes with using of the case studies method are divided into three stages:
1. Stage of organization work on the case (introduction session). The teacher chooses a topic on which the group will work and then announces this information at the previous before the case-class meeting with explanation of purposes and giving the instructions for the sessions, setting rules and regulations. We pay attention not only to the curricula topics but submitted for independent extracurricular work of students, as well as on the in-depth study of topics for workshops.
2. The stage of directly work on the case scenarios. For this, the teacher chooses thematic patients in therapeutic departments of the hospital. Students are divided into subgroups (depending on the number of patients), collect information from patients (conducting their inquiry and physical examination) and then summarizes the clinical data. The teacher creates a logical series of questions to which students have to answer and proposes to detail the data from the inquiry and objective examination with the wording of main, additional symptoms and syndromes of disease. Also, students offer the list of diagnostic plan to clarify the main and concomitant diagnosis, summarize the mechanisms of diseases, set the etiological factors of diseases, and conduct a comparison of the clinical picture of a concrete patient with typical disease. To enhance the individual participation of each student, we ask them to give a written answer to some questions of the case. Classes are held in the form of competition-dispute, which ultimate goal is to solve situational clinical tasks.
The teacher acted as a facilitator and moved among the groups checking on their progress. In time of discussion the teacher's work becomes an "invisible game" that supervising discussions, regulates the process of case-situation analysis and providing guidance to students groups as needed. The teacher monitors the discussion process and asks questions in a timely manner to help students take a step forward. At the same
time, the teacher evaluates the significance of the proposed ideas and connects students' answers for better understanding their importance by whole group. It must be a sense of time that tells the teacher that the discussion is too slow or too fast, for optimizing the learning process.
It is important the gradual involvement of all students in the discussion through work in small groups. Students will receive collective support for their thoughts and will feel more psychologically comfortable, expressing not just individual, but collective opinion.
At this stage can be used the following methods of group discussion: brainstorming and general morphological analysis. Brainstorming is a quick way to solve the problem based on the promotion of creative activity. The teacher offers for students to express the largest possible number of solutions and then select the most successful ideas from total number.
Brainstorming rules are:
- Any idea should be heard regardless of the reality;
- All members shall refrain from criticism of the speaker;
- After ideas delivered all members of the group performed their consistent discussion.
General morphological analysis provides the division of the object that being studied on the characteristics and attributes. Essentially, this is a method for identifying and investigating the total set of possible relationships contained in a given problem complex. This is accomplished by going through a number of iterative phases which represent cycles of analysis and synthesis - the basic method for developing (scientific) models [9]. The rules of morphological analysis must be observed. Elements of object for analysis are distributed among participants of the discussions. Then all decisions are coordinated with adjustments and total proposed solution is discussed in general.
3. The final stage of work on the case and summarize. At this stage, students express their opinion on the correctness of the inquiry and physical examination of the patients and plan of the diagnostic. Only after reports of all students, the teacher begins analysis of each patient, explains the correct version of the issue, and compares the work of each student. Following the presentation of each report offered a discussion in the form of answering questions and solving unusual situ-ational tasks (prepared by teachers and unknown for students) about a particular aspect of the problem. This clinical tasks are taken from the real practical experience, can be composed of insufficient data, sometimes with errors in formulating of diagnosis and (or) in the doctor's tactics. Students are encouraged to find mistakes and search for necessary information.
So, the use of CBL greatly complements the theoretical aspects of the subject, strengthen student learning, and make the learning more real and relevant to clinical practice. CBL help to formed clinical decision-making, reasoning and judgment in medical students, provides a unique opportunity to study complex and professionally important issues in an emotionally favorable atmosphere of the educational process.
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References:
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2. Waliany S, Caceres W, Merrell S.B.et al. Preclinical curriculum of prospective case-based teaching with faculty- and student-blinded approach. BMC Med Educ 2019;19(31) Available from: https://doi.org/10.1186/s12909-019-1453-x.
3. Sturdy S. Scientific method for medical practitioners: the case method of teaching pathology in early twentieth-century Edinburgh. Bull Hist Med. 2007;81(4):760-792. doi:10.1353/bhm.2007.0093
4. Olle ten Cate, Eugène J.F.M. Custers, Steven J. Durning Principles and Practice of Case-based Clinical Reasoning Education Cham (CH): Springer; 2018.2018, Vol. 15 208 p. Available from: https://link.springer.com/book/10.1007/978-3-319-64828-6
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