Using Computer-Simulated Case-Based Scenarios to Improve Learning

Department of Health ProfessionsCollege of Health & Public AffairsUniversity of Central Florida

David M. Segal PhDAssistant Professor

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. case-based learningb. problem-based learningc. team-based learningd. collaborative learninge. web-based instruction (WebCT, Blackboard)f. other

CBL Poll Question

What system do you use to implement case-based teaching?

a. paper-basedb. wordc. powerpointd. wimbae. animationsf. immersive (second-life, active worlds)g. mannequinsh. standardized patientsi. 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

Coursework

• Intro to Pharmacology HSC 3157 450 studentsOnline• Pathophysiology HSC 4550 150 students f2f• Medical Pharmacology 1 HSC 4148 80 students f2f

680 students

• Intro to Pharmacology HSC 3157 450 studentsOnline

• Pathophysiology HSC 4550 150 students Online• Medical Pharmacology 2 HSC 4149 45 students Online• Pathology/Pharmacology PHT 5306 35 students f2f

680 students

• Intro to Pharmacology HSC 3157 150 studentsOnline

150 students

FALL

SPR

ING

SU

MM

ER

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 text-based 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 systemVirtual charactersLibrary (50 avatars, 9 languages, 6 races, genders, 6 facial gestures)Multi-nodal casesSelf-assessmentReflective learningStudent-centered learningCritical thinking and decision-making triggers and activitiesCurriculum learning objectives and competencies mapping

Familial Case Studies

Improved Clinical Decision-Making Outcomesusing Case study Learning

SIMULATED CASES RESULTS

Pre- and post-examinations of clinical case scenarios

Group I: 11 +/- 2% (p<0.001)Group II: 19 +/- 3% (p<0.001)Group III: 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: Online interactive virtual character case scenarios (n=200)Group IV: No case scenario training (control; n=200)

Post-usage survey resultsparticipant opinions about validity, performance characteristics, and utility

for training

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?

1 2 3 4 5

Q5

Q4

Q3

Q2

Q1

Group I I IGroup I IGroup I

Improved Clinical Decision-Making Outcomesusing Case study Learning

stronglyagree

stronglydisagree

agreeor

disagree

* statistically significant difference (p<0.001)

**

*

*

*

*

*

*

*

*

Group I: Online static text case scenarios

Group II: Online interactive case scenarios

Group III: Online interactive virtual character

case scenarios

Group IV: No case scenario training (control)

Diagnosis

Initial history

Additional history

Laboratory &diagnostics

Treatments

Differentialdiagnosis

8%

92%

62%52%

23%

Sequential Decision-Making Processing

45%

30%

54%

5%

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%

Reflective Thinking Decision-Making

Collaborative Technology Poll Question

What technology have you used to promote collaborative learning in

your students?

a. classroom paper-basedb. videoconferencingc. classroom response systemsd. immersive environmente. 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 workGroup I: Medical Pharmacology 1 (n=29) 16 +/- 6%

Group II: Medical Pharmacology 2 (n=24) 18 +/- 8%

Group III: Pathophysiology (n=25) 26 +/- 8%

Collaborative case workGroup IV: Pathophysiology/Med Pharm 1 (n=80)37 +/- 8%

Group V: Pathophysiology/Med Pharm 2 (n=80) 44 +/- 6%

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, PhDdsegal@mail.ucf.edu