Case Based Teaching

Implementation: Resident Perspective

I have been involved with Bright Futures for quite some time. During my residency training, our weekly continuity clinic session was preceded by an hour-long talk on a particular topic. Often they would be grouped monthly according to subject; for example, February was always “adolescent health month.” Sometimes the talks would be in didactic format; other times the leader would use case presentations to facilitate group discussion. Although for some of the talks we would have experts from outside our clinic circle address the group, for many of them the residents were expected to become “the expert.” Individuals would sign up in advance to lead a particular topic. As the date approached, the resident leaders would attend coaching sessions led by the person who was the real expert. For example, an adolescent fellow would come and help us prepare the case presentation and discussion. The leaders from all five days would get together at a chosen time with the fellow or attending and go over the case in detail for an hour so that we would be comfortable presenting it.

The great thing about the Bright Futures cases is that they are all written in a similar format so that once you learn how to use them, it is very easy to teach any of the cases to a larger group. The facilitator’s guide has goals and objectives listed on the front page. A section of the case is presented, and then following that are guiding questions for discussion with possible answers included. Even as an intern or junior resident it was very easy to become quite knowledgeable about a subject with these materials handy.

Still, even with all this advance preparation, I was a bit nervous when the time came to present my first case discussion. What if the group went off on a tangent not covered by the facilitator’s guide? What if someone knew, absolutely knew, her answer was correct and I didn’t have it as an option? What if I couldn’t even remember how to start the case? What if no one participated in the discussion? Luckily, all these fears were manageable and easily taken care of. The case was right there in front of me. I remembered to obtain the learning goals and objectives of the group first. Funny, but after I supplied the first possibilities, people had things they really wanted to accomplish by going over this case! I could barely get them all written down and realized it may have been smart to employ a fellow resident as the “scribe.” I would do that next time and recommend it to others.

Second, instead of asking for a volunteer, I chose someone to read the first part of the case aloud. After that section was completed, we dove headfirst into the supplied questions. Although the group quickly went off in a particular direction, with the questions handy I was able to redirect everyone back on track to their learning goals if the discussion went far afield for too long. Using the suggested time limits for each section, we were able to actually complete the whole case in time. Calling on individuals or giving suggestions when things slowed down was just what my group needed to keep going with confidence. If someone asked a question that wasn’t covered, I jotted it down and either looked up the answer myself or spoke to the fellow after we were finished to get an accurate reply.

All in all, I think the whole case teaching project went well. I definitely feel that the Bright Futures cases are a fabulous way of having the learners teach themselves by teaching others. Plus, it’s not the same old lecture!
Traci Brooks, M.D.

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