Changing the Culture Preparing for the Case Discussion Importance of questions and non-question techniques Setting the stage for Case Discussion Initiating Case Discussion Continuing the Case Discussion Barriers to Discussion Closing the Case Discussion Being a "reflective" practitioner of the Case Method

Facilitating Case Discussion: Continuing the Case Discussion

Each case teaching guide suggests times to distribute the succeeding parts of the narrative as the discussion proceeds. Additional notes are included about the use of handouts, diagrams and references where applicable to the case. These notes are simply guidelines and are flexible; modification should occur as deemed appropriate for various situations and settings. Consider your modifications carefully, however, since most of our suggestions have come from compiling feedback, suggestions and observations during our previous experience with the case.

There are many helpful techniques for facilitators to practice that ultimately help promote excellent case discussions—making statements, referencing, redirecting, polling, asking questions, keeping silent, and active listening. Each skill can be continuously improved with reflective practice and experience. It is helpful to explicitly choose a technique to practice after attempting a case discussion for the first time. Enlist a trusted friend to observe you and provide you with feedback. Be sure to let them know what your teaching and content goals are. Ask the person to write notes during the observation process.

Summarize and emphasize important points by making statements. It is best if you can tie participants’ remarks together by cross-referencing another participant’s idea that promoted a follow up comment. Redirect questions asked to you as the facilitator back to the group. Helpful suggestions might include: What do others think? or I’d like to hear what other residents think?

Who said, silence is golden? It applies here too. If a facilitator allows silence, case discussion is promoted. Often silence means your learners are reflecting on a difficult question, especially if there is not a single correct answer, or the dilemma is a weighty one. Give them time to think and respond. Three to five seconds is the minimum. Great facilitators will wait up to 20 seconds. If you have never done this, try timing yourself or someone else after a question is posed. The average wait time is far less than ideal.

Active listening is a tough skill to develop. Being an active listener means that you listen for:

1. Content of answers: facts, logic, intellectual information
2. Continuity of answers: Who spoke? What was said? In what context? Were there unspoken assumptions used when making statements?
3. Mechanics of answer: body language, statements mumbled versus spoken loudly
4. Emotion within answer: Not only identifying its category but also its strength. Are absolutes or conditionals used? Are emphatic statements made? Active listening also depends on your practical listening ability. If you struggle with this, ask people to re-state the question or statement prior to responding.

Facilitators can use brief statements to declare a factual item. Statements are also useful to emphasize a principle by repeating it as stated. Synthesis of a core concept can be promoted by the facilitator by paraphrasing a statement in a different form. The most important use of statements in case facilitation is to summarize key items.