fmCASES Update August 2011

Maintenance and ongoing development of fmCASES

During the past year, fmCASES completed its first comprehensive evaluation and improvement of the original fmCASES. The Editorial Board and 29 case editors reviewed each case to ensure accuracy and consistency of information, conveyed with a consistent style. The editors also responded to many inquiries and suggestions for improvement from preceptors and students.

We conducted a detailed analysis of the content covered by fmCASES, and compared the coverage to national curricular guidelines. The national objectives used were primarily from the Society of Teachers of Family Medicine’s (STFM’s) Family Medicine Clerkship Curriculum (originally entitled C4) and the STFM’s Family Medicine Curriculum Resources (FMCR) family medicine clerkship curriculum. This detailed analysis guided edits to all the cases this year and also led to the creation of four new cases that are available as of July 2011:

  • Case #30: 27-year-old female - Labor and delivery - Mrs. Gold
    Author: Wetona Suzanne Eidson-Ton, M.D., M.S., University of California, Davis
    Editor: Jason Chao, M.D., Case Western Reserve University
  • Case #31: 66-year-old female with shortness of breath - Mrs. Hernandez
    Author: Ellen Miller, M.D., New York Medical College
    Editor: David Anthony, M.D., M.Sc., Brown University
  • Case #32: 33-year-old female with painful periods - Ms. Tomlin
    Author: Jessica Servey, Lt. Col, USAF, MC, Uniformed Services University
    Editor: Katherine Margo, M.D., University of Pennsylvania


  • Case #33: 28-year-old female with dizziness - Mrs. Saleh
    Author: Theresa Woehrle, M.D., M.P.H., Keck School of Medicine at University of Southern California (USC)
    Editor: Stephen Scott, M.D., M.P.H., Weill Cornell Medical College in Qatar

Beginning July 2011, subscription to fmCASES includes the 29 original cases and the four newly developed fmCASES, in addition to 5 CLIPP and 2 SIMPLE cases that covered core objectives. These cases were assembled to represent the full breadth of care of family medicine, to the depth of knowledge expected by a 3rd year medical student.

Currently, we have 82 institutions subscribing to fmCASES, including 72 allopathic schools, 7 osteopathic schools, 1 PA program, and 2 Canadian schools.

Written exam questions and a final exam created

A team of family medicine educators led by Roger Berkow and Kent Sheets constructed a database of 300 multiple-choice questions during the first half of 2010, so that subscribers to fmCASES will be able to create written examinations that test student mastery of this content. These questions were validated during 2010-11, and revised based upon item analysis. New questions were constructed to cover all 40 cases in the fmCASES’ curriculum.

As of this academic year, fmCASES subscribers have the option to use the 360-item exam bank, free of charge, as part of their fmCASES subscription. A clerkship director can use these questions to create an institution-specific exam that assesses the student's understanding of the cases used at that school. Alternately, a clerkship director may choose to subscribe to a standardized 100-item exam that covers the complete content of all 40 cases in the fmCASES’ curriculum.  iInTIME provides an exam-scoring service for this exam for a fee of $250.  iInTIME will be able to provide comparison data to institutions that use the scoring service.

We are investigating solutions to address the variance in clerkship lengths and curriculum coverage.  With programs that range from 4 to 8 weeks, a single standardized exam, whether a shelf exam or the fmCASES exam, may not meet the specific needs of each individual clerkship program, as the fmCASES exam is intended to cover a student's knowledge of the entire curriculum.  The fmCASES Editors-in-Chief are working with the Society of Teachers of Family Medicine (STFM) to evaluate potential solutions to this challenging problem. 

To learn more about the fmCASES exam, please visit MedU at http://www.med-u.org/virtual_patient_cases/fmcases_final_exam_faq.

Keeping STFM community informed of the fmCASES

At both of the 2011 STFM meetings, the medical student education-focused conference and the annual spring conference, we held an integration workshop and a poster session to inform STFM members about the progress of fmCASES and to assist users to integrate fmCASES effectively into clerkships.  We plan to continue this outreach during 2012. And, also in 2012, we will offer a special invitation workshop at STFM’s Conference on Medical Student Education to help case editors understand their role within the larger project, as well as to provide an opportunity for the Case Editors to meet and work with the Associate Editors and Editors-in-Chief.

Looking to the future

To enhance the value of fmCASES, the editorial board has been developing plans to improve the polling questions and to create precepting tools.

Polling questions are designed to force the learner to make one choice, but there is no one absolutely right answer. These questions can help the student expand the repertoire of behavior appropriate in clinical care, and to build new approaches to managing complexity, uncertainty, and ambiguity. We will use student feedback as well as interviews and focus groups to learn how students are viewing the polling questions, and then convene the case editors and associate editors to generate a plan for improvement.  

In recent years, a significant portion of medical education has shifted to the ambulatory setting. Many of the family medicine clerkships in the U.S. depend upon volunteer, community preceptors. It can be difficult enough to have a student working side-by-side with you in a busy outpatient practice, and so how can this physician have time to pull in content from fmCASES? Using interviews and focus groups, we plan to identify the needs of ambulatory preceptors and develop tools and resources to facilitate their teaching of medical students. We hypothesize that well-designed tools based on fmCASES will improve student learning and enhance the preceptor’s pride in ensuring that the student learns the required content. We hope that the preceptors will also find increased efficiency in teaching if they can integrate fmCASES’ content into discussion about patients' health.