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INTERACTIVE LEARNING
ACTIVITIES IN THE CV COURSE
Richard Klabunde
MU-COM Active Learning Roundtable
May 6, 2015
Types of ILAs
• Case discussions (led by clinical and biomed panel)
• Computer simulations
• Clinical problems
• Clinical journal article discussions
General pedagogical approach to ILAs
• Large classroom activity (entire class in each session)
• Students asked to huddle together to generate ideas
• In some cases, students are asked to present their ideas using the doc camera
(consultants permitted)
• Required learning elements prior to ILA (a.k.a., “flipped” classroom)
• Reviewing lectures and required readings
• Solving problems, answering questions
• Graded ExamSoft quizzes
• Pre-ILA quiz (5 min) assess student preparation
• Post-ILA quiz (5 min) assess student learning
• Both quizzes permit open notes and computer resources
CASE DISCUSSIONS
Integration of biomedical knowledge and clinical skills
Conducted with a clinician
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Recent Onset Hypertension in 27-yearold Woman
Richard Schuster, DO
Richard Klabunde, PhD
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Chief Complaint and History of Present Illness
Mindy Portman is a 27-year-old female who complains to
her primary care physician that her blood pressure is
abnormally high. Mindy is a physically active young woman
who recently had her blood pressure taken at the fitness
center where she works and exercises. Her blood pressure
was found to be 166/112 mmHg. She was concerned
because several months earlier her blood pressure was
115/72.
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Outline of Case Discussion
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Chief complaint and history of problem
Past medical and surgical history
Current medications
Family and social history
Review of systems
Vital signs
Physical exam
Differential diagnosis (student generated)
Diagnostic tests with rationale (student generated)
Test results
Diagnosis
Treatment plan (student generated)
Patient education
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Types of questions asked during case
discussion:
1.
2.
3.
4.
5.
6.
7.
What is normal blood pressure in a woman of this age?
Why is heart rate not depressed by the baroreflex?
What are the risks of high blood pressure?
What can cause elevated arterial pressure?
What information is provided that might narrow your
suspicions regarding the cause?
What is your differential diagnosis?
What diagnostic tests would you order? Provide the
rationale for each test.
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8.
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10.
11.
12.
Based on the objective findings, what is the diagnosis?
What mechanisms contribute to the increase in blood
pressure?
Why is hypokalemia present?
What pharmacologic and non-pharmacologic treatments
should be considered for this patient?
What should be discussed with this patient prior to
treatment and after successful treatment?
COMPUTER SIMULATION
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Computer Simulation Protocol
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1.
2.
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5.
Discuss drug pharmacology
Predict what responses should occur
Collect data
Compare actual responses with predictions
Explain the results
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High Dose Epinephrine Infusion Simulation
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Computer Simulation Protocol
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75
7.2
95
14.5
112
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7.6
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Discuss drug pharmacology
Predict what responses should occur
Collect data & add to table
Compare actual responses with predictions
Results discussed/explained by students
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CLINICAL PROBLEM:
VALVE DISEASE
• Hemodynamics of valve stenosis
• Cardiac pressure and volume changes associated
with valve defects
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Sample question:
Assume that a mitral valve with a cross-sectional area of 4
cm2 normally has a peak pressure gradient of 1 mmHg
across the valve during diastole when a person is at rest,
and that LAP and PCWP are normally 10 mmHg.
a.
What will be the peak pressure gradient if the valve
cross-sectional area is reduced from 4 cm2 to 1 cm2
and the peak flow across the valve remains the same?
How will this affect pulmonary capillary wedge
pressure?
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Key Relationships:
P  F  R
P  F  1
A2
By the above relationship, if valve area is reduced to ¼
its original area, then the pressure gradient across the
valve will increase 16-fold, which will be an increase
from 1 to 16 mmHg in this problem.
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Which of the following will occur if the cross-sectional
area of the aortic valve is reduced by 50%? (assume
stroke volume is unchanged)
1.
2.
3.
4.
Diastolic murmur intensity will increase
because of increased turbulence
Peak pressure gradient will be doubled
Peak pressure gradient will be increased by
at least 4-fold
Peak velocity of flow will be increased 4-fold
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Data
A
B
C
D
E
110/80
115/75
140/60
100/65
135/90
88
82
75
90
84
110/4
115/30
140/20
100/5
195/25
20
30
20
5
25
PAP
45/25
55/35
45/25
20/8
50/30
RVP (sys/dias)
45/5
55/10
45/6
45/10
50/10
RAP
5
10
6
10
10
LVEDV
90
240
280
100
140
LVESV
50
108
140
40
77
EF
44
55
50
60
45
AP (sys/dias)
HR
LVP (sys/dias)
PCWP
DIAGNOSIS:
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Case A: Based on the data, what is the
valve defect?
1. Aortic regurgitation
2. Mitral regurgitation
3. Mitral stenosis
4. Pulmonic regurgitation
5. Tricuspid stenosis
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Case A – Mitral Stenosis
Students discuss/explain data
AP (sys/dias)
HR
LVP (sys/dias)
PCWP
PAP
RVP (sys/dias)
RAP
LVEDV
LVESV
EF
110/80
88
110/4
20
45/25
45/5
5
90
50
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A student is asked to draw PV loop
for the valve defect based on the
data using the doc camera
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JOURNAL ARTICLE
REVIEW
An interactive learning activity
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Purpose
• This interactive learning activity is designed to:
• Acquaint students with clinical research that
investigates the potential benefits of long-term exercise
training in heart failure patients
• Help students learn how to critically evaluate a
published research study
• Reinforce fundamental concepts related to the
pathophysiology of heart failure
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Evaluating a Research Article
What is the rationale for conducting this study? What problem(s) is being
investigated?
2)
What is the hypothesis being evaluated by this study?
3)
Describe the study design and be able to discuss the rationale for this design.
What other ways might this study have been designed?
4)
What inclusion and exclusion criteria are used in this study and what is the
rationale for using these criteria?
5)
What methods were used in this study? Were they appropriate and reliable?
6)
How were the data evaluated statistically?
7)
What were the principle findings of this study?
8)
Were the results adequately discussed in terms of internal consistency of data,
relationship to hypothesis, and relationship to other published studies?
9)
Were the conclusions supported by the data?
10) What were some of the limitations of this study and how might these limitations
affect a more general application of the conclusions?
11) What is the significance of this study in terms of treating heart failure?
1)
Value of interactive learning activities
• Promote critical thinking skills by challenging student
understanding of important concepts
• Graded in class quizzes incentivize preparation prior to
ILA
• Provide an opportunity to apply basic science knowledge
in a clinical context