Doug Brock

A conceptual framework for developing teaching cases : a review and synthesis of the literature across disciplines

Context  Case‐based teaching is regarded as a superior instructional method compared with lectures in promoting a learners critical thinking skills. While much is known about the role a discussion facilitator plays in case‐based teaching, the debate on the influence of the format and structure of cases on learning is controversial.

Dermatological Diagnostic Acumen Improves with Use of a Simple Telemedicine System for Underserved Areas of South Africa

OBJECTIVE Telemedicine holds promise as a tool for improving the delivery of specialty care, especially in underserved regions, including those in South Africa. However, data that demonstrate the extent of its sustainable benefits to referring providers are currently insufficient. This study investigates whether utilization of a teledermatology network enhances the diagnostic acumen of primary care providers (PCPs) in underserved areas of South Africa. MATERIALS AND METHODS A longitudinal descriptive pilot study was conducted after establishing a telemedicine network linking University of Cape Town dermatology consultants to six providers from five underserved primary care sites using store-and-forward technology between October 2004 and January 2007. Of 120 total referrals, trend analysis was performed using 72 sets of patient histories, digital images, and corresponding consultant responses to evaluate the diagnostic concordance between six PCPs and teleconsultants over 12 consecutive referrals. RESULTS Strong positive Spearman rank-order correlations were observed between the number of referrals sent per PCP and proportion of primary diagnostic agreement with teledermatologists, rs=0.86 (p <0.001). The mean primary diagnostic concordance trend that started at 13% for the first four referrals increased nearly fourfold after referring as few as nine patients to the network. CONCLUSIONS If a simple and inexpensive teledermatology solution is carefully implemented in a resource-limited setting, an improvement of PCP diagnostic acumen can be achieved with a relatively small number of referrals. This educational benefit to referring PCPs could be sustainable and would ultimately enhance the quality of dermatological care in these underserved regions.

A web-based team-oriented medical error communication assessment tool: Development, preliminary reliability, validity, and user ratings

Background: Multiple-choice exams are not well suited for assessing communication skills. Standardized patient assessments are costly and patient and peer assessments are often biased. Web-based assessment using video content offers the possibility of reliable, valid, and cost-efficient means for measuring complex communication skills, including interprofessional communication. Description: We report development of the Web-based Team-Oriented Medical Error Communication Assessment Tool, which uses videotaped cases for assessing skills in error disclosure and team communication. Steps in development included (a) defining communication behaviors, (b) creating scenarios, (c) developing scripts, (d) filming video with professional actors, and (e) writing assessment questions targeting team communication during planning and error disclosure. Evaluation: Using valid data from 78 participants in the intervention group, coefficient alpha estimates of internal consistency were calculated based on the Likert-scale questions and ranged from α = .79 to α = .89 for each set of 7 Likert-type discussion/planning items and from α = .70 to α = .86 for each set of 8 Likert-type disclosure items. The preliminary test–retest Pearson correlation based on the scores of the intervention group was r = .59 for discussion/planning and r = .25 for error disclosure sections, respectively. Content validity was established through reliance on empirically driven published principles of effective disclosure as well as integration of expert views across all aspects of the development process. In addition, data from 122 medicine and surgical physicians and nurses showed high ratings for video quality (4.3 of 5.0), acting (4.3), and case content (4.5). Conclusions: Web assessment of communication skills appears promising. Physicians and nurses across specialties respond favorably to the tool.

Elizabeth: Typical or Troubled Teen? A Training Case for Health Professionals to Recognize and Report Child Maltreatment

Introduction Training on the recognition and reporting of child maltreatment is a critical component of any health professional education program. Unfortunately, it is nationally recognized that health care professional training on recognition and reporting suspected child maltreatment is insufficient. Similarly, recent attention has been given to the need for interprofessional learning opportunities targeting to advanced health profession trainees such as doctor of nursing practice, masters in social work, physician assistant, and family medicine residents. Methods An interprofessional case-writing faculty team convened to develop this case and the affiliated materials, including video vignettes, faculty training, comprehensive faculty guide, evaluations, and trainee resources. Trainees were divided into interprofessional teams and advised to develop a prioritized plan of care for a complex patient case, though it was not revealed that the case involved child maltreatment. An initial video vignette showed an adolescent female and her mother during a provider visit to establish care. Teams developed a prioritized plan of care following the vignette. Additional case details unfold during the second vignette, and teams revised their initial plan based on this new information. Interprofessional faculty facilitators guided discussions using prompts from the faculty guide. Results Postsession surveys revealed that the learning objectives were met, and that both facilitators (N = 20) and trainees (N = 69) were very satisfied with the overall curriculum. Challenges centered around focusing on care priorities rather than provider critique. Discussion This curriculum is relevant for a variety of trainees and is an important complement to the curricula of many professions.