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NS121 Human Biology: Selected Topics in Medicine
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LEARNING HUMAN BIOLOGY BY THE CASE METHOD

In this course you will be working with a case-based method of instruction adapted from materials used in the Human Biology course at Harvard Medical School (Waterman, 1995; Waterman, Matlin, and D'Amore, 1993; Matlin, 1992; Hafler, 1991)* In Matlin's (1992) introduction to his Cell Biology course, he states his objectives for students:

The primary objective of this course is to enhance your abilities to be self sufficient and critical learners while learning a lot of cell biology. Specifically, we hope that you will develop skills to identify key elements of scientific problems, to determine the essential information needed to attack those problems, to seek out and find that information, to clearly and concisely discuss your findings with your peers, and to work together to synthesize experimental approaches to a solution. It is expected that your strategy will also take into account conduct-of-science issues such as family and gender considerations, student/post-doc/advisor relationships, and scientific politics. (Matlin, 1992)

The case approach has been used in medical schools for years both as a teaching tool and as a problem solving tool. In "clinical pathology conferences," physicians bring cases which puzzle them to teams of doctors and medical students. The idea is to use this team to get fresh approaches to problems that have puzzled the attending physicians. The team role-plays the doctor's interactions with the patient from the beginning, presenting initial symptoms reported by the patient and letting the team ask follow-up questions and request particular tests. Test results and subsequent symptoms or responses to treatments are only given to the team when they request them. Because members of the team have different areas and levels of expertise, their questions and the directions they follow-up may be different from the initial physician and they may lead to new diagnoses or treatments.

We have used this approach in the Human Biology course at Hampshire College since 1995 (Bruno and Jarvis, 2001).

You may have been involved in similar kinds of study groups; sometimes in other fields they are called "simulations" or "problem-based learning." If you have engaged in such group work, your experience will contribute to the success of this class.

You will work in a study group of 4-6 students. Your instructor or a teaching assistant will wander from group to group and listen in; but our roles will not be to provide information during that time. We will help when asked by your group to help, but it won't be to provide answers, partly because we won't have all the answers. Glance at the cartoon of a study group (given out in class) (Waterman, 1995). What does that say about roles we all will play? We will encourage critical thinking, help guide you towards resources when necessary, and help with the group process when asked. But we are not in charge of the groups--you are.

Here's a general outline for how it works (Waterman, 1995):

  • Everyone in the group receives a copy of Part I of the case, and one person in each group is asked to read the case to the group. Then the group brainstorms a problem list:

* What is the problem to be solved?
* What do we know so far?
  • On the basis of this discussion, the group generates hypotheses:

* What do we think might be happening?
* What further data do we need to test these hypotheses?
* List and assign learning tasks (who will find out about which things)
  • Between classes, team members explore their learning tasks and gather information to report back to the group:

* Share results of learning tasks
* Continue the discussion
  • Recycle to the first item as many times as needed to resolve the case:
* If available, receive and read aloud Part II of the case
* Redefine problems
* Generate further hypotheses
* List additional data needed
* Identify learning issues/assign tasks
* Receive references/objectives/part II of case when available


Some background lectures will be presented as appropriate, but, unless a lot of questions are brought to us by all the teams early on, these lecture/discussions will probably occur after a case is resolved or near the end of a case study and will be tied to assigned readings.

Any of you who have worked in groups before know that, from time to time, some groups may not function as effectively as everyone would like. In order for us to help groups through such periods effectively, we will ask you to designate a group liason person. Someone in your group who will meet with us and the other group liasons to discuss how things are going and what we might to do improve group work in all groups. But if you feel your concerns are not being heard by your liason person, please talk to one of us directly. We will also ask you to fill out feedback forms that assess all team members' contributions.

Operational guidelines

1.Team Roles. Each team will have a large pad of newsprint or be near a blackboard, and each member of the group will be responsible for certain tasks. These responsibilities will rotate from one class to the next. It's easy to start to feel comfortable with certain people taking on certain roles, but it's important to avoid that trap. You may feel awkward at first in one role, but as time goes on it will be more comfortable. Team members should help one another gain confidence in each role.

Often students say that the roles seem awkward and everyone in their group sort of does everything. It's ok for everyone to do everything, but we have found that if one person isn't formally responsible for seeing that (for instance) everyone in the group gets a chance to contribute in ways that are comfortable for them, that job might get lost as everyone gets caught up in other roles. So please take the assignment of these roles seriously

  • Recorder: will list on the board or newsprint* so everyone can see, the lists of
What do we know?
What do we need to know?
What do we think we know?
*Using newsprint, blackboard, or something else that all team members can see is more important than it sounds. If everyone is looking at the same organization of ideas, it's easier to understand what others are thinking. It also makes it possible for everyone in the group to suggest better ways of organising information and ask questions that help clarify the problem.
  • Facilitator: will ensure that everyone in the group gets a chance to speak AND that everyone in the group does contribute. It is the group's responsibility to ensure that each member participates fully. This isn't always simple to achieve; if you feel your group needs help in functioning better, let us know through the reflection sheets, e mail, or speaking with us.

    Sometimes a person who appears to others not to be contributing sufficiently actually is doing a lot of work but feels that others always jump in too fast and don't give the person a chance to say anything. Conversely, someone who seems to take over all the time sometimes is doing that because he or she feels others haven't done their work. Try to accomodate the variety of work styles by giving each person a chance to present her or his work and to answer questions about it.
  • Skeptic (or Accuracy Coach): helps keep the group "honest." It's sometimes easy to hear someone's report and just accept what was said as being the only answer. The skeptic needs to ask
How do we know that?
Could there be any other explanations?
Why might that happen?"
The most important role of the skeptic is to keep the team from falling into narrow thinking. If you focus too early on one diagnosis, you might miss something important. The team needs to keep an open mind and to keep looking for additional information and asking for more evidence (test results, etc.) to eliminate certain diagnoses and support others. The details of how diagnoses were eliminated are important to include in the final reports.
We've found that people who are not very secure in their knowledge about a topic are often very good in the skeptic role if they can be brave enough to ask what they really want to know. If something isn't clear to you or you think the speaker is assuming you know more than you do, ask the speaker or anyone else in the group to explain in more detail or more clearly.
  • Accuracy Coach. This is very like the skeptic role, and if you only have four people in your group, the skeptic can take on these questions. That person asks

    • Where did you get that information?
    Did everyone understand that explanation?

This role, arguably, is the most important in the group and the one that is least automatic for most students. Please work on making this a strong role and helping others do it too.

  • Task Manager: helps keep the group "on task." Some digressions in discussions are helpful, but some keep the group from completing its work. If you have fewer than six people in your group, the facilitator can take on this role. But the tasks of both roles are important, so be certain that at least one person keeps track of these questions.

Have we listed everything we know?
What hypotheses (or diagnoses) are we considering?
What do we need to do next?
What learning assignments are you each taking?
The task manager needs to list each person's name at the end of the meeting and what learning assignments they are taking on.

2. Case Logs. Each team member will keep a case log (in something like a journal or composition book). Keep in this log your brainstorming lists, notes to remind yourself of ideas to follow up, references and other resources you consult during the case, your speculations, insights, frustrations, questions, etc.

3. Resources at your disposal:

  • Your textbook (but remember not to believe everything you read--keep asking "What's the evidence?"
  • Resources on reserve in the library (we'll provide you with a list, but we may add to it).
  • Your loyal and talented teaching assistantl who will have "office hours" and will help with everything from homework assignments to understanding text material to finding resources to knowing which faculty to approach for particular information to helping think out project ideas.
  • Other books in the library: texts, medical dictionaries, annual reviews, etc.
  • Research journals (you will be introduced to the use of database such as MedLine)
  • Friends (remember to ask "What is the evidence?")
  • Any faculty you can get to help (remember to ask "What is the evidence?")
  • Fellow group members! Listen carefully to everyone.
  • Occasionally we'll give you handouts if we know the information you are seeking is hard to find.

Remember, it's quite sensible to return to your group with more questions than you left with. In fact, if you've done your research well, you'll always have more questions than you started with.

Bibliography

Bruno, M.S. and C.D. Jarvis. 2001. It's Fun, But is it Science? Goals and strategies in a problem-based learning course. The Journal of Mathematics and Science: Collaborative Explorations. 4(1):9-24.

Matlin, Karl S. (1992) Cell Biology by the Case Method, Department of Pathology, Harvard Medical School.

Hafler, Janet (1992) The Role of the Tutor and Learning Agenda in Problem-Based Tutorials, in: Tutoring Excellence: Faculty Development for the New Pathway, 1(2):4,5, Harvard Medical School Office for Educational Development.

Waterman, Margaret A. (1995) Introduction to Case Writing for the Life Sciences, presented to the Coalition for Education in the Life Sciences, Madison, WI.

Waterman, Margaret A., Karl S. Matlin, Patricia A. D'Amore (1993) Using Cases for Teaching and Learning in the Life Sciences: An Example from Cell Biology, presented to Coalition for Education in the Life Sciences, Woods Hole, MA.

For further information on using cases in the curriculum, (problem based learning), check some of the resources below:

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