Table 1. Needs Assessment: Learn More About Your Audience

During the planning phase Send an email query to those likely to attend a session (ask 2-3 key questions) Make a 10-minute phone call with several probable attendees Have a discussion with a key informant about the group's general characteristics Write a formal, short needs-assessment questionnaire On the spot: As the presentation begins ask a few key questions; use a show of hands or an ARS What is your educational training (MD, RN, NP, PA, etc)? How many years have you been an HIV care practitioner? What percent of your caseload is HIV-related? Do you work with patients with HIV infection and substance abuse? Injection drug use?

The focus of the case will depend on learners and on the specific skills relevant to their medical practice. For example, in the case study used to illustrate this guide, a patient with active substance abuse problems is admitted to the hospital through the emergency department with a diagnosis of PCP. The first clinical decision point the learner is asked to make concerns the discharge plan. The elements of the discharge plan of greatest concern to social workers are different from those of concern to an audience of HIV physicians. The focus of the case, therefore, depends on the needs and interests of the learners.

The actual design of a case begins with the creation of specific learning objectives once the learners and topic are defined. It is often more difficult to design objectives to fit an existing patient case scenario than to start with learning objectives and build a new case around them. The specific objectives of the case should be identified even if the case is not part of an activity that carries CME credit (which requires the publication of objectives).

Table 2. Writing Strong Objectives

Strong objectives are specific. They are constructed by stating a performance that describes specific knowledge, attitudes, or skills that a student should be able to demonstrate following exposure to a learning activity. They do not describe the teaching strategy used to achieve a learning outcome. Strong objectives are measurable. They use active verbs that can be measured by test items, observation, problem-solving exercises, or other evaluation methods. If the performance behavior is covert (will recognize, will identify), then an indicator behavior (will recognize by circling, will identify by underlining) should be stated. See Table 3 for a list of measurable verbs for assessing achievement. Strong objectives are achievable and realistic. They describe expectations of knowledge, attitude, or behavior change that are realistic given the conditions for instruction (ie, time and size of the group). Adapted from Mager1.

A case study should have more than one objective. Often a series of objectives are addressed as the case unfolds. The clinical decision points of the case focus on the issues identified in the objectives. The case study included in this guide was designed to address the issue of HIV treatment for patients with drug addiction. The specific educational objectives are listed in Slide 1.