Step 6. Introduce New Information and Continue to Next Clinical Decision Point The previous steps describe 1 cycle of a case study through the resolution of a clinical decision point. The case can be used in its current length as a short vignette, or it can be moved toward a second decision point on the same patient. Darrel's case can continue with new information from a follow-up appointment (eg, ongoing symptoms, adverse effects of medication, or laboratory results), leading the learner to another clinical decision point. These points can be designed to address either the same or different educational objectives. Slide 14 describes the next encounter with Darrel in the case study, and sets the stage for the second clinical decision point on Slide 15. The patient now has entered a methadone treatment program and attended an HIV clinic. Although his living situation remains unstable, he is interested in starting antiretroviral therapy. The treatment recommendation options listed on Slide 16 lead the discussion to adherence issues among substance users. One option is to set and meet an adherence goal before beginning HAART, such as getting a note on attendance from the
methadone clinic, attending three HIV clinic appointments, or completing a trial drug regimen with jelly beans.
The issue of adherence in substance users is likely to spark controversy and debate among the audience and evoke personal and professional attitudes toward substance users. This example demonstrates the importance of good facilitation skills in addition to traditional teaching/instructing skills. Inexperienced instructors make two common mistakes in facilitating discussion. They sometimes fail to provide the direction and leadership that a learning group needs or they become over-involved in the discussion and unable to maintain the critical role of facilitator. Some facilitation strategies are offered in Table 4. One benefit of following a single patient through a number of decision points is that it allows an audience or learner to quickly assimilate new information since the patient history is already known. Use of a continuing case reflects realistic dynamics of patient care. However, shorter vignettes with 1 or 2 brief decisions points have advantages, too. They may move a learner quickly through a variety of clinical situations. | Table 4. Strategies for Optimizing Group Discussion |
|---|
 | Briefly clarify the purpose at the outset |  | | Establish norms for group interaction at the outset; request ideas or suggest guidelines (ground rules) for effective small or large group functioning. Summarize or ask someone in the group to summarize the ground rules before moving on to another topic | | | Model the norms throughout (ie, respect for differences of approach or opinion when no single correct course of action is determined) | | | Do not reply or respond to each comment. Move to the next person wishing to comment or turn to the group for a response | | | Use the experience of the group as a resource for teaching | | | Actively invite ideas and suggestions | | | Plan your time to allow for real interaction | | | Do not introduce a controversial or emotionally laden topic without allowing sufficient time for a full discussion and resolution. If pressed for time, it is better to skip such content than to cut off discussion before opinions are expressed, full discussion has occurred, and a summary of points or ideas has been offered | | | Create a psychologically safe climate for learning that is free of threat and judgment. Showing patience and respect for differences of opinion, questions, comments, and responses and by avoiding disapproving, sarcastic or condescending reactions | |
|
|
Next: Effective Use of an Audience Response System |
