CASE-BASED LEARNING: A POSSIBLE APPROACH TO THE CREATION OF CASES IN AN INSTITUTION OF HIGHER MEDICAL EDUCATION - Наукові конференції
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CASE-BASED LEARNING: A POSSIBLE APPROACH TO THE CREATION OF CASES IN AN INSTITUTION OF HIGHER MEDICAL EDUCATION

24.07.2024 14:49

[4. Педагогічні науки]

Автор: Iryna Tyshchenko, Candidate of Medical Sciences, Dnipro State Medical University, Ukraine



In recent decades, the use of the case method, Case-study, as one of the variants in the system of interactive learning methods, has become quite widespread in higher medical education in Ukraine. The essence of the method, the method of creating cases, categorical types of cases that can be used during the study of medical disciplines, especially clinical ones, the methodology of application in the educational process are sufficiently widely and deeply analyzed in a number of publications by Ukrainian authors. The expediency of using the method in the classes of medical students [1], its value for improving the quality of specialist training, increasing the professional level and professional ethics of doctors [2], the value of case technology for the formation of certain personal qualities and competencies of students [3], the effectiveness case method of learning for the development and consolidation of knowledge, for the formation and development and making of independent decisions by students [4], etc., have been shown.

The case method involves not only familiarization with the clinical situation, development of certain skills of working with the patient (survey, physical examination, appointment of additional examination and treatment programs based on a certain diagnostic hypothesis) and assessment of students' knowledge. This is not just the usual classic work with a thematic patient. The requirements for the case method are such that, on the basis of a real clinical case, it is necessary to create a whole scenario in which to set the goal of education, outline problematic issues, lead students to make certain independent decisions, inspire the group to participate in the discussion, think over the plan of this discussion and manage it.  In addition, at the end, evaluate the activity of the group and individual students, draw conclusions about the achievement of the goal, discuss possible mistakes, shortcomings and emphasize the achievements in solving cases regarding the deepening of theoretical knowledge, the acquisition of practical skills, first of all, the formation of clinical thinking, and regarding the development of certain competencies, first of all, teamwork.

Classically, creating cases is the teacher's task. Indeed, the leading role of the teacher cannot be doubted. However, senior students and, especially, interns can be involved in the creation of cases. Interns, who already have more clinical experience than students, can take an active part in creating the basis of clinical scenarios. You can count on their interest in a new type of work, on the desire to prove themselves already as specialists, to demonstrate the medical knowledge level and the volume of acquired skills, as well as on the desire of modern youth to implement additional skills in the field of digital technologies when creating cases in the form of video or multimedia presentations.

In the 2023-2024 academic year, at the Department of Endocrinology of the Dnipro State Medical University, an attempt was made to create cases together with interns in the 2nd year of training in the specialty "Internal Diseases". During practical classes at the clinical base in the endocrinology department, cases related to patients’ management difficulties were observed. Observation of these patients, analysis of medical history and clinical data led to a lively discussion in the group of interns, which led to a desire to share information with other applicants for higher medical education. The teacher offered to prepare these clinical cases in the form of modern scenario for use in the educational process. After getting acquainted with the main principles of the Case-study method, the interns were given the task of first creating textual versions describing the clinical situation, demonstrating medical history data and the results of clinical and additional examinations, highlighting problematic issues that arose before doctors in the management of patients. The co-authors additionally familiarized themselves with the medical and regulatory literature regarding the nosologies that became the subjects of observation, as well as with the literature regarding the cases creation. The interns showed great interest in this process, showed motivation to deepen their knowledge and expand their experience in practical, scientific and methodological work. Under the guidance of the teacher, the texts were corrected, supplemented, acquired the necessary characteristics and volume, which will allow applying the created tasks in the educational process with senior students in the next academic year.

Case variants were also prepared in the form of multimedia presentations. Patients’ photos and copies of the results of additional examinations obtained with the written consent of the patients during their treatment at the hospital and with the agreement of the hospital administration were used. Multimedia variants were demonstrated during the students' scientific conference at the end of the academic year, and it caused considerable interest among those present. In addition, multimedia cases were used in the educational process of interns of the 2nd year of study in the specialty "General practice-family medicine" and in the specialty "Internal diseases". Interns were informed about such study component in classes on certain topics, were introduced to a list of problematic issues for discussion, which enabled the teacher to conduct a very active discussion, determine the degree of interns' possession of theoretical knowledge, skills in managing patients with demonstrated pathologies, understand the level of the clinical thinking of actually trained specialists, to assess their ability to see shortcomings and mistakes in the management of difficult patients and readiness for collegial work.

It must be said that the same case can be used during classes with different groups of applicants for higher medical education (4 and 6 years of study), with interns, as well as during cycles of thematic improvement of doctors. At the same time, for different categories of persons who are studying or improving their professional level, a case should be shown from different positions, different problematic questions should be asked, and groups should be led to solve different tasks depending on the training goals. In the multimedia versions, we emphasized other questions and tasks than in the text versions. The final stage of creating cases is the direct work of the teacher, based on his clinical and pedagogical experience, on understanding the goals and methods of the educational process, and it also requires a certain amount of time, thinking, finding ways to improve the final result, and improving personal skills in the use of digital technologies.

Conclusions. The Case-study method is not only an effective option for interactive learning, which is confirmed by international and national experience. Participating in the cases preparation can be a means of additional training for students and specialists and improving the pedagogical skills of teachers. Involvement of interns who have certain clinical experience in the creation of cases at the initial stages of the process (selection of clinical cases, initial description) contributes to their motivation to increase the medical training level and master the skills of scientific and methodological work. The leading role and responsibility for the final result of the cases creation and their implementation in the educational process belong only to the teacher.

Literature

1. Павлишин Г.А., Бігуняк Т.В., Саварин Т.В. Кейс-метод навчання у медичній освіті. Медична освіта. 2015. № 3. С. 67-69. DOI:10.11603/me.v0i3.4975 

2. Годованець Ю.Д., Бабінцева А.Г. Актуальність впровадження моделі «case-based learning» (cbl) у систему фахової підготовки та безперервного професійного розвитку лікарів. Неонатологія, хірургія та перинатальна медицина. 2019. Т. ІХ, № 2(32). С. 9-15. DOI: 10.24061/2413-4260.IX.2.32.2019.2

3. Рева Т.В., Рева В.Б., Трефаненко І.В., Шупер В.О., Шумко Г.І. Застосування методу case study при викладанні клінічних дисциплін за умов дистанційного навчання. Український журнал медицини, біології та спорту. 2022. Том 7, № 6 (40). С. 167-171. DOI: 10.26693/jmbs07.06.167

4. Скрипник І.М., Сорокіна С.І., Шевченко Т.І., Кудря І.П., Шапошник О.А. Кейс-метод як приклад інтерактивного навчання студентів-медиків клінічним дисциплінам. 2012.  URL:https://repository.pdmu.edu.ua/server/api/core/bitstreams/ 0731b035-1794-418f-8746-21b4c5277d8e/content



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