Writing CBCR Cases

Abstract

Case-based teaching is considered a superior method of teaching for a variety of professional domains. Its success depends both on the way education is enhanced by adequate facilitation by teacher and on the quality of cases used (Kim et al. 2006). Dolmans et al. and Kim and colleagues have provided guidelines for effective case writing in health professions education (Dolmans et al. 1997;Kim et al. 2006). Working with adequate cases in problem-based learning is considered to stir situational interest in students during education, more than direct instruction (Schmidt et al. 2011). In a broad literature review, Kim and co-workers conclude that written clinical cases are most effective if they show five core attributes (Kim et al. 2006). They should be:(a) Relevant (adjusted to the level of the learner, aligned with goals and objectives, and with an adequate setting of the case narrative) (b) Realistic (showing authenticity, including distractors, providing a gradual disclosure of content) (c) Engaging (providing a rich content with multiple perspectives and with branching of content) (d) Challenging (sufficiently difficult, being new or atypical cases for the level of the learner, with adequate case structure, and including multiple cases) (e) Instructional (building upon prior knowledge, incorporating feedback, and using educational or didactic aids where possible and adequately assessed). CBCR cases should meet most, if not all, of these conditions. The authors provide 21 more detailed distinct and useful recommendations. There is one exception. While the authors recommend using atypical cases, in CBCR training for preclinical students, with a focus on establishing core illness scripts, we believe that atypical cases should be avoided.The choice of cases for CBCR courses is determined by the objectives of intended illness scripts to be acquired and internalized by preclinical students. They should cover important medical conditions that serve as a strong clinical knowledge foundation, even in its inherent limitations at this stage of training, for students before they start with clinical clerkships. Writing cases for CBCR sessions must be done by clinicians with practice experience in the theme of the case, but may be edited by experienced CBCR consultants or CBCR course developers. This chapter explains how to write CBCR cases. OverviewCBCR cases consist of an introductory text describing a patient case in the way it is presented to a clinician. As a variant, two cases with similar presentations but different diagnoses within a differential may be worked through in one session. Alternatively, one case can be spread over two sessions, although that rarely happens. The start of the case may be at a primary care doctor's office, at an emergency department, at an outpatient clinic, or on the clinical ward after referral. The case description, after the initial vignette, continues with questions and assignments, at fixed moments with the provision of findings from further history, supplementary physical examinatio...