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Creating a Clinical Case Study: A 10 Step Model
“It is much more important to know what sort of a patient has a disease than what sort of a
disease a patient has.” -- Osler (Hippocrates)
Step
1. Consider what of the
diagnostic or problem
solving process you’ll
introduce or review.
2. Plan the content and
objectives:
What will you teach?
What will students
learn? What do you want
them to do with it?
Select a topic for a case
study. Determine the
learning objectives for
the case study.
3. Develop the narrative
portion of the case. 4. Develop the case
materials to be used by
students to solve
problems or to debrief
after group activities.
5. Identify the problem and
present it to engender
multiple viable solutions
(Slide or Handout)
Example
Plan the Case
Patient presentation--Differential Diagnosis—Clinical
Assessment—Investigations—Diagnosis—Management
May:
• be a cluster of foundational knowledge sessions,
• be a specific presentation
• incorporate a specific condition, scientific issue or problem
• incorporate a specific action, process, procedure, etc.
What will students know and know how to do after this case
study? What will they value after this case? Be specific,
especially as to purpose for study. For example, students will
learn the differential diagnosis of dyspnea. At the end of the
session/unit, students will defend a reasonable diagnostic
hypothesis of an unknown case of a patient presenting with
dyspnea.
Relate to Course Objectives.
Students will: apply, analyze (compare, break down into
components), evaluate or predict, solve a problem, etc.
Create a “real life,” believable patient, and determine the initial
facts about this patient. These would be name, age, marital
status, ethnicity where relevant, gender, family, background,
dialogue and narrative or story of the patient.
Plan the rest of the “scene,” where the students will work. TIP:
use a clinical case you recall, fictionalized to protect privacy, for
authenticity.
Facts are presented in an iterative style (e.g. chronologically, as
they present, or as the patient describes them, or with
complications arising.)
Use the steps below to develop materials such as slides, actual
charts and test results, and handouts such as:
a. The beginning narrative (5)
b. Model(s) for diagnosis (6.1-6.3)
c. Results from initial tests, examinations (7) for debrief
d. List of tests (8)
e. Results of tests (9)
Define initial presentations, crisis or catalyst for problem.
This may include basic information presented to you as a
physician in Emergency, clinic, physician’s office or consultation.
Student Task: Begin to create a differential diagnosis by
creating a “diagnostic decision tree*”. Consider further questions
and requests for information.
Sheila
Pinchin,
Office
of
Health
Sciences
Education,
September,
2009
Build in Student Tasks for diagnosis, and initial management: Choose an approach that
you can explain.
6.1 Allow students to develop e.g. Draw upon 9 Sources of Human Disease: Congenital,
Infectious, Inflammatory, Ischemic, Metabolic, Nutritional,
a method to relate to key
Neoplastic, Toxic, Traumatic
scientific concepts
Student Task: Identify the key components that apply to this
condition, or that have caused this condition, etc.
6.2 Create the opportunity to Student Task: Identify: 3 components of Illness Scripts:
consider Illness Scripts
Predisposing Conditions, Pathophysical Insult, Clinical
Consequences
6.3 Create an opportunity to
Student Task: Consider Defining and Discriminating Features
of a Set of Diagnostic Hypotheses:
compare similar or
Defining features are descriptors that are characteristic of the
possible diagnoses
diagnoses (e.g., gout, septic arthritis, osteoarthritis).
Discriminating features are descriptors that are useful for
distinguishing the diagnoses from one another. (e.g. Multiple
joints involved; Long-term decline in functioning)
Student Task: Students request History of Present Illness,
7. Create an opportunity to
relevant Past Medical History, Family History and Social
get more information for
Circumstances and Systems Review. Key findings from
diagnosis. Keep slides
Physical Examination would also be appropriate.
or handouts of these for
de-brief of group work
NOTE: role play between a “doctor” and “patient” may allow
8. Provide the opportunity to
request tests and data.
9. Provide an opportunity for
analysis of tests—have
“test results” available on
slides/handouts/in group
folders
10. Provide the opportunity to
determine initial
management concepts.
students to determine what questions to ask during these
inquiries. Give hidden instructions to patients—“I don’t
understand your terminology…” A third student observes with a
checklist.
Provide a list of all possible tests to students from which to
select. Allow more senior students to brainstorm tests.
Student Task: Students select only the most appropriate tests
for this presentation and are prepared to defend their selection.
Points may be taken away for potentially harmful, invasive
tests. Discuss the cost and impact of tests.
Student Task: Consider scientific concepts in analysis of tests.
Analyze: real life” examples of test results: eg. EKG, X-Ray,
blood count, chemistry panel, etc.
Student Task: What initial treatment would you suggest for
this patient?
What will be the key components of her long-term
management?
What scientific principles of pharmacology and therapeutics will
you consider?
--Edited by Dr. Lindsay Davidson
Sheila
Pinchin,
Office
of
Health
Sciences
Education,
September,
2009