Room designed for a case seminar
Preparing the facilitator
To be the teacher (facilitator) in a case seminar is quite different from engaging in the role as a traditional teacher or lecturer. The whole idea is to lead the discussion and get the participants to contribute their understanding to elicit as much experience, contradictions and different positions on a case as possible (sometimes also conflicting views).
The facilitator has to have a sufficient level of knowledge in the content area in order to be able to ask relevant questions, follow-up questions and to paraphrase different positions. If you do not know the area, this is very difficult.
A case facilitator can best prepare the case seminar by thinking through the questions he or she would like to address and, of course, how these relate to the overall learning objectives with the seminar. A seminar might have different sequences and the facilitator will have thought these through prior to the seminar in order to steer the seminar in a way that the learning objectives will be achieved (Table 10.1).
The facilitation plan
A facilitation plan might look something like this:
Opening question—5–10 min: What are the problems in this case?
Diagnosis of what is in the group, the groups understanding and reading of the group. Open question to get the seminar going
Next: What situation is the occupational therapist facing in this case?
Here, the seminar is starting to focus—more specific question: What is the occupational therapists’ problem? Here, the participants are forced to see the case from his or her perspective and define the problem through this lens
Next: What are the alternatives the occupational therapist has in this situation?
This question focuses on problem solving: Given the definition of his/her problem above, what are now the possible ways to handle the situation?—Problem solving
Next: What consequences could one predict acting upon the different alternatives just proposed?
Here, the idea is to force the participants to enter the “balconies” and evaluate different alternatives or proposals to solve the situation
Closing question: The learning objectives today were XXX—what can this case teach us about XXX? Have we, and if so how, reached the above learning objective?
This section brings the case back towards the learning objectives: What can the case teach us and have we, if so how, reached the learning objectives? The group is involved in concluding and summarizing of the seminar
In the seminar, the facilitator has to remember what “part” of the seminar to stay within and can then ask as many follow-up or clarifying questions as possible. The idea is to get as many points of views as possible to be expressed and then also to relate to those in different ways and “connect” participants in the seminar. The facilitator has to keep in mind approximately how much time to spend on each section in order to conclude the seminar on time. (For different facilitation styles, please see: Barnes et al. 1987; Mauffette-Leenders et al. 1997; Table 10.2).
Teaching with cases: a summary
In conclusion, to achieve the best results, you need to keep the following topics in mind when teaching with cases:
The learning outcomes
Formulate learning outcomes and make them visible to all participants
Participants need to make individual as well as group preparations before the case seminar to achieve the desired levels of learning
The facilitator needs to make preparations for the case seminar by formulation of his/her facilitation plan
The room should be set so that eye contact within the room can be established between participants as well as between individual participants and the facilitator
High-Quality Learning With Interactive Patient Cases
Education is quite different from biomedical sciences when it comes to evaluating effects and finding evidence for benefits of one specific learning method over another. The gold standard for collecting evidence in biomedicine is of course the double-blinded Randomized Control Trial (RCT) which aims at pinpointing clear cut, statistically proven effects which in turn can be generalized to other settings. However, this specific kind of trial and evidence is very difficult to achieve in the world of teaching and learning. A vast amount of confounding variables is making it more or less impossible to isolate and assess a specific learning activity in a way that traditional effect measurements have any value (Ringsted et al. 2011).
Thus, instead of measuring effects of this particular method in relation to, i.e. lectures or simulations, we will provide you with research-based educational arguments and show you how case-based learning is meeting these criteria. This does not perhaps leave you with the optimal generalizable evidence that case-based learning is the golden method for specific learning objectives, but you will be reassured that case-based learning has a strong evidence base in the current educational literature on the topic of high-quality learning. In addition, there is also specific research in the area of the results of case-based learning (Lundeberg et al. 1999) as well as on related problem-based learning (Albanese 2010; Schmidt et al. 2011; Tiwari et al. 2006).
From a constructivist perspective of learning, we know that new learning is integrated and incorporated into your previous knowledge and experience (Biggs and Tang 2007; Marton and Säljö 2008). Learning is not just adding new bits of information and then measuring retention after some period of time. Learning is how new pieces of information change your understanding of something, and this requires a different strategy in order to learn (Nordquist et al. 2011). Transfer of knowledge is clearly insufficient and you have to find other strategies as well. Having said that, new pieces of information are of course important, but what we are trying to express here is that in order to foster and cultivate high-quality learning, you need both new information and a process for integrating it with previous knowledge. This will in turn either influence your understanding of a new phenomenon or give a new perspective on an old phenomenon with which you already are familiar. Interactive patient cases are as a result an excellent instrument to use when wanting to achieve this (Nordquist et al. 2011).