Abstract

Bravender T, Goodman E, Knight J, Frazer
C, Luoni M, Blaschke G, Emans SJ. Use of a case-based teaching exercise
in adolescent medicine: quantitative and qualitative evaluations. Presented
at the annual meeting of the Society for Adolescent
Medicine, Los Angeles, 1999. Poster Presentation.

Journal of Adolescent Health.

Abstract:

Objective: Over the past 15 years, pediatric
residency programs have increased training in adolescent medicine. A 1997
residency survey found that many programs felt certain subject areas were
poorly covered and desired more learner-centered teaching materials, including
written cases. The objective of this study was to evaluate use of a newly
developed teaching case for residents covering health screening issues
for a middle adolescent.

Design: We constructed a written case with
teaching materials concerning a 16 year old with a chronic disease who
was being seen for a health supervision visit. The materials included
a three part case presentation, guide questions, facilitator’s discussion
guide, and annotated references. Case facilitators were also expected
to bring Bright Futures and GAPS materials to the session. Learners completed
a 13 item evaluation of the 1 hour session. Evaluation items pertained
to the stated objectives of the case: understanding periodic health screening
for adolescents; listing health risk screening questions; counseling about
risky behavior; and providing primary care for the adolescent with a chronic
disease. Evaluations included the level of training of the learner, 5-point
Likert scales, and written comments. Qualitative observations were noted
by the facilitator. Data was analyzed with Mann-Whitney U tests utilizing
SPSS 7.5.

Results: The case was presented to 61 learners
(64% residents, 3% fellows, and 19% faculty) at 7 different sessions at
three different sites (2 hospital-based pediatrics clinics and 1 hospital-based
internal medicine clinic). Most felt the case covered the stated objectives;
no one answered “not at all/poor,” and 79.5% of the responses
were either “quite well/very good” or “very well/excellent.”
The internal medicine learners felt that, as a result of the session,
they were better able to list health risk behavior questions (p=0.039)
and rated the case higher than the pediatrics learners (p=0.032). Other
responses were similar between the 2 groups. Qualitatively, the internists
were more interested in the basic approach to adolescents, stating that
they had not had much exposure to such patients. In contrast, the pediatricians
were interested in more advanced behavioral interventions. When comparing
faculty and resident responses, the faculty gave the facilitators significantly
lower evaluations (p=0.026), although they rated the case similarly. Written
comments from faculty members tended to offer constructive criticism of
the case and facilitator such as “high risk behaviorsshould be separate
from routine health maintenance,” and “facilitator should project
and summarize more clearly.” Residents’ comments tended to be more
general and positive, such as “excellent talk” and “great
session.” Conclusions: This case-based teaching exercise was generally
well received by learners at different levels of training. These data
suggest that written teaching cases and facilitator discussion guides
should be targeted at both the level of training and the specialty of
the learners.