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Overview: Structure of the Cases The structure and format of the case teaching modules have evolved over the past 5-6 years based on our own teaching experiences and feedback from other faculty, fellows, and resident facilitators. During the early years, we prepared simple case narratives with a list of questions for discussion at the bottom of the page. We learned that narratives are best when brief, and designed to lead the learner naturally to further inquiry. As the target group of learners for our project included residents at different levels, we determined that narratives should be broken into several parts, each of which is designed to help the discussion move from information gathering, to testing and assessment, diagnostic formulation, treatment planning, and clinician-patient communication. We quickly discovered that learners also needed handouts and lists of references for further reading. More recently, facilitators at sites other than our own continuity clinic expressed a need for detailed teaching guides, which include step-by-step instructions and “answers” to discussion guide questions. These advances are now incorporated into each case. Each module contains a 2-3 part case narrative, handouts, an annotated bibliography, a comprehensive facilitator's (or teacher's) guide specific to the individual case, and evaluation forms. The materials are designed in a manner that allows teaching sessions to be conducted by either faculty or properly prepared trainees. The best way to understand the construction of these cases is to read through one, and then use this page to guide you through each section. Case Narrative Most case narratives are divided into three parts. Part I describes how the patient first presented in the primary care setting and prompts a discussion of the differential diagnosis. Part II presents additional history, results of the physical examination and diagnostic tests, and prompts a discussion of treatment possibilities. The third part of the case is the Epilogue, designed to give learners a general idea of the patient's outcome. Handouts Handouts may supply supplemental information to the case narrative (e.g., Growth chart, Denver II screening test, psychological test results) and are distributed during the course of the case discussion or they summarize key teaching points and are distributed at the end of the teaching session. Specific suggestions on how handouts should be used are included in the Facilitator’s Guide. References and Annotated Bibliography Each case includes a bibliography. Several citations, usually general reviews or book chapters, are chosen for brief annotation and listed under "Suggested Readings." Where appropriate, the reference page includes contact information for national organizations (e.g., National Down Syndrome Congress) and educational resources on the World Wide Web. Facilitator’s Guide The guide begins with the abstract page, on which is listed the case title, authors and advisors, and topic covered. A one-paragraph abstract describes the importance of the case topic, why the case was written and what content will be covered. The goal statement and a list of two to four specific learning objectives for the case follow. Below this are listed themes, key words, Bright Futures key concepts, materials provided, and activities suggested for facilitator preparation. The following pages present a step-by-step guide to teaching the case. Prompts for the facilitator (e.g. Distribute Part II of the case narrative) are indicated by boldface type. Brief discussions of key teaching points are included after each guide question. This guide is intended for use by facilitators (teachers) and not designed to be handed out to learners (students). The Facilitator’s guide ends with a suggested exercise for learners, which may be conducted either within the group (e.g., arrange a visit by a family with an adopted child) or individually (e.g., visit a special educational class). Facilitators are also encouraged to design their own exercises for learners, particularly those which encourage health promotion and disease prevention in the community. Evaluation Forms Sample evaluation forms for both facilitators and learners, are included in the “Resources” section of this manual. John R. Knight, M.D.
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