Maximizing Student Application in Advanced Health Assessment Through Case Based Learning

Maximizing Student Application in Advanced Health Assessment Through Case Based Learning Problem: The advanced assessment course must transition students to advanced assessment and diagnostic reasoning skills. The students transitioning from a tradition undergraduate program are not used to the challenges of case based learning. Purpose: To improve student outcomes with increased application instead of knowledge alone, students were challenged with patient case scenarios, requiring application of the subjective and objective assessments in a supervised lab setting. Emphasis was placed on critical thinking within the differential diagnosis process prior to starting clinical rotations. Background Case based learning was first introduced over 40 years ago at McMaster University. This instructional format continues to be the primary basis of the curricula in many schools (Neville, 2008). Evidence suggests graduates from programs using case based curricula demonstrate equivalent or superior professional competencies when compared with graduates of more traditional curricula (Neville, 2008). Winkelman, Kelley, Savrin (2012) state “Case methods of teaching promote the cyclic process of expert clinical knowledge development, consisting of intuitive and analytic processes for examining and evaluating information, adding to it, and reorganizing it to solve a problem, make a diagnosis, or develop a plan of care” (p. 2). Method Initial didactic instruction included how to obtain a comprehensive and problem focused history, development of differential diagnosis list, and utilization of diagnostic reasoning. In the lab, students completed “practice” case scripts containing age, sex, chief complaint, history of present illness, comprehensive history, review of systems, results of diagnostic tests, and occasionally a photograph. Students applied course content along with demonstration of advanced health history and physical exam skills, verbalizing the differential diagnosis process as with a patient in a timed clinic situation, Upon completion of the lab, students received immediate feedback from instructors and peers regarding their differential diagnoses, assessment, treatment and health promotion plans. Outcome Students demonstrated improved history and physical exam skills, when compared to previous years, as measured by a problem focused and comprehensive final exam. Students demonstrated increased confidence in application of this essential content prior to beginning their clinical rotations.