Evolving the traditional case study using simulated clinical documents Faculty Spark - View, reflect and apply

Last updated on 25/02/2020

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Description

Sean Alcorn discusses the use of web-based patient cases using simulated clinical documents to enhance traditional patient cases. This allows them to develop analytical skills in order to make critical judgements about patient care.

Challenge

Pharmacy students have difficulty making critical decisions and forming strong professional opinions with respect to pharmaceutical interventions.

They are good at finding problems, but not so good at making judgments on management options in order to form justified solutions to problems. In addition, many students cannot write in the narrative style required to produce comprehensive case reports at a professional level.

Current resourcing of simulated medical record teaching environments is prohibitive to development of clinical “detective work” and interpretation of clinical documents.

Approach

Traditionally, students are ‘spoon fed’ case based problem based learning scenarios via clinical case summaries. Existing work by academics in the School of Pharmacy and Pharmacology had developed strong methods for students to pull apart these cases to identify pharmaceutical problems.

However, these cases were one dimensional with all necessary case information described on a single sheet of paper in a summarised form. Clinical parameters such as blood pressure readings were seen as single points in time rather than the dynamic measurements that are read in clinical practice in the context of trends, patterns and correlation with other observations in the medical record or associated practitioner reports.

As a consequence students were not able to develop analytical skills necessary to comprehend clinical documents such as medical records, medication charts, observation charts, allied health referrals and medical consultation notes during problem based learning.

I investigated methods of delivering case study education so that the requisite analytical skills could be developed in students. Existing solutions using simulated electronic medical records focused on reporting and documentation, and not so much on analysis and comprehension.

Available low cost open source medical records systems focussed on simulating GP practice environments and patient appointment scheduling. Hospital based systems were cost prohibitive with educational instances requiring full licensing to simulate these environments..

Given the available options, I implemented a web-based application where simulated clinical documents could be delivered to students in a simulated medical record environment. Analysis of these documents enabled students to develop their “detective skills” and produce patient profiles and comprehensive pharmaceutical reviews based on this analysis.

The simple nature of this web based resource enables HTML publication and simple integration as embedded web content in existing Learning@Griffith course sites.

The web application was produced using Adobe Muse a WYSIWYG (what you see is what you get) website builder. A case site was built and populated with fictional case studies which were an amalgam of real-life cases. These included referral letters from doctors, admission notes, blood pressure charts, medical images, medication charts and associated documents.

This enabled students to follow trends and remove outliers in observations, interpret discrete observations from nursing and medical notes and relate them to clinical documents such as medication charts, dispense histories.

Students were finally able to see that patients summaries were the sum of many individual documents that add a complexity and diversity to pharmaceutical review seen in clinical environments but not simulated in university teaching.

Outcomes

Anecdotal feedback from students is that they can see the importance and relevance of developing analytical skills. Interesting themes reflect that some students appear to compartmentalise their teaching focus from their graduate skill set with students preferring to be “spoon fed” teaching case summaries for ease of problem identification whilst still acknowledging the need to develop the ability to create these summaries via comprehension once they graduate. This may correlate with the level of passion and engagement with their developing professional identity.

Initial teaching and learning studies are currently ongoing but initial data indicates that students value and enjoy using the resource and believe it is a more realistic simulation of the environments they have experienced during clinical placements.

Enabling Technology

Adobe Muse via Creative Cloud

Next Steps

The resource has been piloted in one course in combination with traditional case formats. Initial teaching and learning research in this course cohort is under way. Once complete it is hoped that the site can be refined in the hope of improving the usability and aesthetics to suit student preference.

It would be great for someone that is more skilled in design to perfect the look and feel of the site. It will then be rolled out in a second iteration of the course as a stand alone case presentation format with the hope to expand to other therapeutics courses within the school dependant on continued positive student response and further research findings.

Once this is complete the next step is to investigate ways to provide individual logins and progressive case restriction to enable students to utilise the resource as part of flipped learning classrooms. The end goal is to create a suite of case modules that enables problem based learning to be conducted in modular forms with credentialing and progression dependant on the engagement and individual skill development of independent learners outside of traditional teaching modalities.

Longitudinal goals include:

  • The integration of these cases with my other teaching projects to support the implementation of electronic Antimicrobial Stewardship Systems in university teaching.
  • Incorporation of write access web documents to create clinical documentation areas to facilitate multi user interaction with cases in the hope of utilising the resource in Interprofessional learning environments.

Griffith Graduate Attributes

The use of simulated clinical documents develops students' critical and professional judgement. It also develops their narrative style for the creation of comprehensive case reports at a professional level. This aligns with the following Griffith Graduate Attributes:

1. Knowledgeable and skilled with critical judgement

2. Effective communicators and collaborators

3. Innovative, creative and entrepreneurial

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Licence

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Creative Commons Attribution NonCommercial International License (CC BY-NC 4.0)

The Griffith material on this web page is licensed under a Creative Commons Attribution NonCommercial International License (CC BY-NC 4.0). This licence does not extend to any underlying software, nor any non-Griffith images used under permission or commercial licence (as indicated). Materials linked to from this web page are subject to separate copyright conditions.

Preferred Citation

Alcorn, S., and Learning Futures (2020). Evolving the traditional case study using simulated clinical documents. Retrieved from https://app.secure.griffith.edu.au/exlnt/entry/7025/view