Case based teaching

I am always happy to try to give an answer to questions from twitter such as this from Rachel Roberts on case based teaching.

My advice would that every presentation is the product of the data (p1), the supportive media (p2) and its delivery (p3). The p2 in a clinical discussion should be no different from any other presentation. It should be illustrative, not annotative; supportive, not distracting and neither a script nor handout. It is important to make the presentation more than simply reading a slide deck to the audience.

Make it clear from the outset how the p1 will flow and what the purpose of the discussion will be, the nature of audience engagement and, my suggestion, tell them the punchline. The commonest type of clinical presentation is a shaggy dog story– a long rambling discussion designed to lead or mislead the audience to the (wrong) conclusion and then, as drama, to reveal an alternate ending. This leaves the audience both slightly ashamed at having made the “obvious” mistake but, with frequent repetition of the technique, many recipients intentionally take a contrary view of information seeking the common scoter rather than the duck. The attention is then focussed on looking for the trick, the obvious mistake or weird and wonderful and not engaging with the presentation as it flows.

There is a tendency in such situations to list on slides the signs, symptoms and examination findings. No audience will pay attention to a speaker when such annotative detail is provided, they will read ahead and try to figure out the diagnosis or catch. Worse still is the approach of putting the data on the screen and asking the audience to read along, like primary school children. This is not an effective educational strategy, it is deeply patronising. Line by line show only worsens this. Textual detail on p2 is a challenge. Consider, as with every slide, if the detail is required

(p2) for such a presentation should be supportive. It should add to the p1, not represent either the script or the handout. Advice to the audience that key journal articles and information is available afterwards then allows more direct engagement with the presentation as delivered. Personalising and humanising such discussion are valuable and effective tools. Maintaining appropriate confidentiality is mandatory but the story of “Lance, a 27 year old student” is more engaging and effective than “27 year old male”. The use of a photograph always adds connection to a clinical scenario and whilst it may not be possible to get permission from the specific patient, even an image such as below connects the audience to a person rather than abstract concepts. Confidentiality can be maintained by intentionally changing the personal details.As humans we respond to people and faces, not facts. It stimulates cortisol and that affects learning.

Data slides must be clear in highlighting information. Construct an appropriate table, don’t simply offer data. Avoid the pie chart fashion faux pas. Use single, high quality images, never multiple images on one slide. Obtain originals of histopathology, radiology and blood tests but remain alert to data protection and confidentiality issues as well as the clinicians desire to assess everything despite that which they are directed to focus on. Red boxes are counterproductive.