or select from Instructors' Area menu at left.
New CLIPP Case 15The CLIPP Editorial Board has created a new version of case 15 to address curricular coverage concerns. Once you are logged in to the instructors' area, you can learn more about the updated curriculum objectives for Case 15.
New Summary Statement Feedback FeatureiInTIME has introduced a new feature allowing instructors to review student summary statements and provide them with formative feedback. Identifying, interpreting, and summarizing the key findings in a case is a fundamental clinical skill. This feature will be a valuable formative assessment tool that clerkship directors can use to gauge the student's clinical reasoning thought process.
Teaching clinical reasoning is an important goal of MedU virtual patient cases. One component of the current Diagnostic Network approach to teaching clinical reasoning is the summary statement. Most MedU cases ask the student to write a summary statement after the history and physical exam components. Currently, there is no way for the clerkship director or other faculty to see these responses or to provide feedback to students on this important component of a virtual patient case. Integrating this feedback mechanism in the clerkship will allow you to give students the input they need to improve their clinical reasoning.For additional information on what a summary statement is and our Summary Statement Feedback Feature, please review our Summary Statement page.
About the Instructors' Area
To assist clerkship directors in integrating MedU virtual patient cases, we have developed an Instructors' Area. This password-protected site includes essential supporting materials you will need to effectively integrate MedU cases into your clerkship.
Key Pedagogical and Content Information
MedU cases present students with a patient and his/her chief complaint. The student then discovers findings and final diagnosis only by working through the case.
For faculty, however, it is helpful to have access to the important content within the case, and this is provided in the Instructors' Area.
Case Descriptions for each case include:
- A summary of the clinical scenario
- Key clinical findings in the case
- Differential diagnosis and final diagnosis
- Web links and other case highlights
- Key Teaching Points for each case, including the teaching points for the major curricular objectives and the clinical reasoning surrounding the key findings and differential diagnosis. These are particularly useful for students to have as a printout after completing a case.
- Learning objectives for each case, based on the learning objectives of the discipline's national curriculum.
Web Initiative for Surgical Education of Medical Doctors (WISE-MD) modules offer the opportunity to explore surgical patient care concepts that largely occur in an outpatient setting not accessible for the third year medical student. The modules provide a computerized linear narrative of the patient's illness and the patient-physician interaction from the patient's first visit with his or her physician, through the diagnostic process, into the operating room, through the laboratory studies, and finally to the postoperative visits.
Instructors using WISE-MD are invited to use their Administrative Interface to access information and useful tools for integrating WISE-MD Modules.
This area will detail the learning objectives for each of the main sections in a module, including:
- Physical Exam
- Laboratory Studies
- Imaging Studies
- Post-Operative Care
Written by the module authors and editors, these learning objectives will help to provide key teaching points for Administrators, and may act as a lesson plan when incorporating the modules into the medical curriculum.
Also included in the Instructors' Area:
Access to log data (module usage reports for WISE-MD) showing students' use of the MedU cases. Clerkship directors have access to data that includes the number of cases each student completed and how long each case was worked on. Please note that the data does not show answers given by the student to specific questions within the cases.
Integrating MedU Cases
Integrating computer-assisted instruction (CAI) into a clerkship is not as simple as telling students that the cases are available. Integration means:
- Making the CAI program an essential component of the course and a core component of the students' learning experience.
- Eliminating redundant teaching content to be certain that there is enough time in the student's day to achieve all of the learning objectives.
- Weaving the CAI content into other methodologies, such as lectures, small-group discussions or required assignments.
- Ensuring adequate access to the CAI program through the availability of computers and access to the Internet.
- Evaluating students on the learning objectives and content of the CAI program.
In developing a plan to integrate MedU cases in a clerkship it is helpful to begin by asking several general questions, such as:
- What advantage do you want to gain from using MedU cases?
- What incentive will students have to use MedU cases?
- How will you make MedU cases a core component of the students' learning experience?
After answering these questions, there are several more specific questions to ask:
- How many cases will your students be required to complete?
- Will you require proof of completion?
- What redundant teaching/content will you eliminate?
- How will you integrate MedU case content with other teaching, such as lectures, small-group discussions or required assignments?
- What testing/evaluation will you do?
Finally, it is helpful to try to predict problems and to identify solutions ahead of time:
- What is the biggest barrier to successful integration?
- What are your preliminary plans to overcome or work around this barrier?
- Will you do faculty development to achieve successful integration?
- How will you ensure adequate access to MedU cases?
In addition to these online integration tips and tools, iInTIME is committed to providing personal integration training throughout the year. We offer workshops and exhibit booths at annual national meetings of our collaborating professional associations such as AIM, COMSEP, CDIM, STFM, ASE, ACS, and others. While at the meetings, we distribute integration materials guiding medical educators on the most effective methods to integrate the cases into their clerkships. Please visit our News section for up to date information about our next workshop.
Materials and instruction are also available upon request by contacting iInTIME at firstname.lastname@example.org. iInTIME continues to work closely with each project development group to enhance the tools available to clerkship directors and instructors.
Meeting LCME Standards
An asset of MedU cases is that using the cases can assist in meeting many of the accreditation standards put forth by the Liaison Committee on Medical Education (LCME) at http://www.lcme.org/standard.htm and described below:
LCME ED-1: The objectives of the educational program must be stated in outcome-based terms that allow assessment of student progress in developing the competencies that the profession and the public expect of a physician.
Educational objectives state what students are expected to learn. Such objectives are statements of the items of knowledge, skills, behaviors, and attitudes that students are expected to exhibit as evidence of their achievement . . .
MedU cases are directly linked to the specific learning objectives of the discipline’s nationally accepted curriculum.
Each series of MedU case was developed to comprehensively cover a curriculum. The Instructors’ Area assists clerkship directors in identifying the specific learning objectives of each case and tying them directly to the "clinical learning experiences" (see ED-2 discussion, below).
LCME ED-5: The medical faculty must design a curriculum that provides a general professional education, and includes instructional opportunities for active learning and independent study to foster the skills necessary for lifelong learning.
MedU cases foster self-directed learning and independent study
The MedU Web site allows students to access and learn from the cases at a time that is convenient for them. The software facilitates students' ability to enter and leave a case as needed. Students may choose to review or completely re-visit a completed case as they wish. The interactive nature of the cases, and links to many additional Web-based resources, encourages self-directed and independent learning.
LCME ED-6: The curriculum must incorporate the fundamental principles of medicine and its underlying scientific concepts; allow students to acquire skills of critical judgment based on evidence and experience; and develop students' ability to use principles and skills wisely in solving problems of health and disease.
MedU cases teach an evidence-based and generalist approach
The cases were explicitly built on a generalist foundation: the nationally accepted core clerkship curriculum for each discipline. Each case models a general approach to common problems, including evidence-based references and multiple Web links to practice guidelines or other appropriate resources. Integration of basic science information is included where relevant. Peer review and ongoing maintenance of the cases by Editorial Boards ensures an up-to-date and well-accepted approach to the work-up and management of these common problems.
LCME ED-8: There must be comparable educational experiences and equivalent methods of evaluation across all alternative instructional sites within a given discipline.
Compliance with this standard requires that educational experiences given at alternative sites be designed to achieve the same educational objectives. . . . While the types and frequency of problems or clinical conditions seen at alternate sites may vary, each course or clerkship must identify any core experiences needed to achieve its objectives, and assure that students received sufficient exposure to such experiences. . . .
MedU cases can provide a comparable learning experience across training sites and times of year
The students' experiences do not need to be identical, just comparable. Using MedU cases also means that a clerkship director is not at the mercy of time (of year) or place (demographics). Because the cases are available on the Web, students have access to them from all training sites, which facilitates student placement in rural or community settings.
LCME ED-2: There must be a system with central oversight to assure that the faculty define the types of patients and clinical conditions that students must encounter, the appropriate clinical setting for the educational experiences, and the expected level of student responsibility. The faculty must monitor student experience and modify it as necessary to ensure that the objectives of the clinical education program will be met.
This standard requires that a system be established to specify the types of patients or clinical conditions that students must encounter and to monitor and verify the students' experiences with patients so as to remedy any identified gaps. The system, whether managed at the individual clerkship level or centrally, must ensure that all students have the required experiences. For example, if a student does not encounter patients with a particular clinical condition (e.g., because it is seasonal), the student can remedy the gap by a simulated experience (such as standardized patient experiences, online or paper cases, etc.), or in another clerkship.
MedU cases are considered a "simulated experience"
In addition to caring for real patients, computer-based simulations are considered by the LCME to be an acceptable clinical learning experience when necessary. However, if the cases are to "count," students should be given independent learning time to work through them, and the content of the cases should be integrated, or woven, into the clerkship curriculum in methods similar to patient care (i.e., didactics, bedside teaching, etc.).
MedU cases can be easily grouped into a variety of classification systems
The LCME will make no specific recommendations about how many patients or what types of patients should be seen by every student. This responsibility is left up to the individual clerkship director to determine. Instead, the LCME is most interested in a clerkship that has defined the appropriate learning objectives (see above), as well as the "kinds of patients" and the "variety of patient encounters" that each student must experience.
Classification can include:
- Ages/developmental stages
- Classification of illnesses
- Systems-based categories
MedU cases can then be assigned to students at the beginning of the clerkship to fulfill known clinical gaps, or assigned to individual students based on gaps identified in student clinical logs. Alternatively, all MedU cases may be assigned to ensure that students have learned about all of the major categories of a medicine discipline.
Student completion of a MedU cases can be documented
Not only do meaningful clinical experiences need to be clearly delineated in the clerkship curriculum, clerkship directors must also:
- Implement a tracking system to ensure that students meet the requirements
- Have a system in place to fill in deficiencies when students are not meeting the requirements
The most common problem encountered with this requirement is that simply having patient logs to document what students have done (emphasis on the past tense) at the conclusion of the clerkship is not enough. Clerkship directors must also be proactive in monitoring the progress of each student's clinical experience, and intervening in real time to provide additional experiences, if necessary, for a student who is not meeting clerkship objectives for whatever reasons. Again, the LCME leaves the responsibility for defining these objectives and requirements up to the individual clerkship director. The LCME is most interested in a clerkship that has defined appropriate objectives, a means of tracking the accomplishments of those objectives, and a means of intervening when students are not accomplishing them.
By assigning cases and documenting student completion, MedU cases can assist students and clerkship directors in meeting this requirement. Suggested methods for assigning cases:
- Assign cases at the beginning of the clerkship. All of the cases can be assigned, or just specific cases to fill known clinical gaps.
- Assign cases individually as needed mid-way through the clerkship, based on the results of student clinical logs.
- A combination of both.
Documentation of individual student completion of each MedU case can be achieved in 2 ways:
By using the case use log data. After logging in to the Instructors' Area, click on "Case Use Log Data." There you will find 4 links to your individual school data and as well as a detailed description of all of the log data. The most useful data for meeting this LCME standard is the "Individual Logs," which show each student's use of the cases, including:
- Time spent on each case
- Number of cards completed for each case
- Average time spent on the cases
- Percentage of all cards completed
- Average (benchmark) time spent on the cases and average percent of cards completed for your school, as well as the standard deviation.
- By using the Case Selection Page. When a MedU case is completed, the words "Case Session Completed" and the date of case completion appear under the MedU case title on the student's Case Selection Page. The student's unique login is also identified on this page. Many clerkship directors require students to print and submit their individual Case Selection Page and submit it to document case completion, either at the conclusion of the clerkship or at the time that a case is required (i.e., prior to a didactic session).
LCME ED-1 (cont): The medical school faculty must define the objectives of its educational program. " . . . Student achievement of these objectives must be documented by specific and measurable outcomes (e.g., measures of basic science grounding in the clinical years, USMLE results, performance of graduates in residency training, performance on licensing examinations, etc.). National norms should be used for comparison whenever available . . . It is expected that the objectives of the educational program will be used by faculty members in . . . developing plans for the evaluation of students. [Annotation adopted and effective October 2003]
Student learning from the cases can be evaluated
While individual student performance on the MedU cases is not available to clerkship directors, student learning from the cases can be evaluated. For CLIPP (and soon for all MedU cases), a series of single-best answer exam questions in the USMLE style are available for one institutionally designated individual. These questions were developed by CLIPP case authors, and refined and pilot-tested by the CLIPP Working Group (CWG): clerkship directors at 6 institutions (Boston University, Dartmouth, Morehouse, University of Illinois at Rockford, University of Utah and University of Washington). The CWG has validated the questions and defined multi-institutional norms. Clerkship directors can choose to use individual questions for ongoing quizzes based on the CLIPP case content, or may use the full series as a final examination. If you choose to use these questions, we ask that high standards of exam security be used to preserve the integrity of these questions for other clerkships.
Additionally, some clerkship directors have also chosen to assign weekly CLIPP cases and to have students print and turn in their completed "diagnostic network" on these cases as a means of documenting their work.
Limitations of MedU cases for meeting LCME accreditation standards:
Obviously, MedU cases alone cannot and should not be used to meet all of the LCME standards. Rather, MedU cases should be used to enhance student clinical experiences and faculty teaching. MedU Cases are an excellent vehicle for documented, self-directed learning, for acquisition of knowledge and for development of clinical problem-solving skills. When necessary, MedU cases are an effective substitute for clinical encounters. However, MedU cases cannot:
- Assess student data-collection ability (e.g., history-taking from a third party, physical examination)
- Measure student communication skills (e.g., adequacy of written records, oral explanations of diagnosis and treatment, oral presentation skills, cultural competency)
- Identify difficulties in professionalism (e.g., timeliness, dependability, interpersonal relations with patients, ethical behavior, self-reflection and evaluation ability)
- Evaluate real-time problem-solving from self-generated data
- Substitute for well-run didactics sessions or bedside rounds. While clinical teachers are certainly not going to be put out of business by MedU cases, the use of the cases in a clerkship may allow teachers to change to a focus on:
- Process over content
- Skills instruction and assessment
- Attitude modeling and evaluation
- Providing timely, specific, appropriate feedback to students
- Information also obtained from the 11/8/04 meeting of COMSEP leaders with Frank Simon of the LCME, summarized in the COMSEP Pediatric Educator, Winter 2005; Volume 12, Issue 1. See Page 2.
Case Development Process (CLIPP, SIMPLE, and fmCASES)
A critical component of case development for iInTIME is to solicit detailed feedback from a variety of sources including user feedback during an extended pilot-testing phase, an extensive editorial process based on collaboration between case authors and section editors, and an iInTIME medical editor review. In addition, MedU is committed to further refining cases through blinded peer reviews. Thanks to extensive outreach by COMSEP, CDIM, and STFM to their practitioners representing their respective disciplines nationwide, two reviewers – one content specialist and one expert educator – are identified and asked to evaluate each case based on its quality and accuracy of content and/or educational value and ease of use respectively. As peer reviews are completed, section editors and authors collaborate again to implement final changes to the cases. The peer reviewer role is vital to enabling authors and our project team in the development of the highest quality cases. To learn more about the case development process, please visit iInTIME.
To ask questions about MedU Virtual Patient Cases content or for technical assistance, write to email@example.com
Module Development Process (WISE-MD)
An Editorial Board of 15 nationally recognized surgical educators from the ASE determine the content of the modules and select authors and editors for specific topics. The module authors will confer with the production team, as well as the editors, so that the production team may both gather information and confirm the accuracy of the module content. From here, the author will create a primary PowerPoint and final module, which are all sent out for peer review by members of the WISE-MD Editorial Board and interested colleagues.
A robust multilayered assessment is being integrated into each module. Each section will contain multiple choice-type questions so students can independently evaluate their grasp of the material. At the end of the modules will be a more complex interactive assessment designed to capture the critical thinking of each student. For this section, a team of "Key Reviewers" has been established to peer review the modules, and to create self-assessment questions within each module. Each question will be reviewed by the team as well as the Editorial Board before being included in the modules.
Further assessments are being addressed through a research effort led by Dr. Adina Kalet, an internist and educator at NYU, who is the recipient of an R01 grant from the National Library of Medicine. This research trial involves testing the cognitive learning outcomes, confidence with clinical skills, and motivation to learn among seven collaborating institutions.