Clinical Case Study, CCS

Prof. Vladimir J. Šimunović

Teaching methodologies

Lectures Tutorials Seminars Small group learning Clinical cases scenario Clinical skills laboratory practice Interactive software Multimedia

Clinical case study (CCS) prepare the students to solve the problems in the real

world of clinical practice

CCS – methodology based on learning through problem-solving or clinical

procedures execution

CCS:•Enhance the efficiency of analytical thinking•Capacitate students for decision making•Capacitate students for complex situation solving in real clinical practice•Influence to the development of oral communication skills•Enhance the capability of the team work

Clinical case study

Augmentation of the knowledge is not a priorityFocus is on understanding of the problem, capacity to

analyze, synthesize and assessment of treatment efficiency

CCS methodology

Traditional lectures are focused on the facts and data

Students are overcharged with too many data

CCS intention is:•To develop the thinking abilities•Students learn solving the provblems by joint team effort•They are not served by ready-to eat information package•CCS increase the self-confidance and trust to colleagues

CCS example: Introduction

This clinical case, based on the real one from our practice, is allocated to your group

Your task is to study this case and give us a feed-back with answers to questions.

Anamnesis

• Patient A.A is a 45-years old male.• Principal complain is a general ailment, pronounced in the

lower extremities• Patient walk with difficulty and clumsy, and speech

disorder were noted• Problems started 6 months ago and at present he has

problems in writing, stairs climbing and he is not able to comb the hair.

• Muscle strength in hands is diminishing, he has problem to dress, button up or to close the zipper

Physical examination

• Twitching and trembling movement of tongue• Difficult swallowing• Babinsky reflex prominent, all other are normal• Generalized muscular weakness, spasticity,

more pronounced in the legs

Diagnostic procedures

• Nuclear magnetic resonance is normal• Electromyography: denervation• Blood tests: increased level of glutamate

Physician’s recommendation

(1) Baclofen and Riluzole to alleviate the symptoms

(2) Physical therapy and

(3) Speech therapy.

Questions to be answered

1. Which ailment is presented here?2. Is there brain damage;? Any particular

disease?3. Is there any non-neurological reason

influencing the patient’s walking ability?4. Which brain region is damaged?5. What influence the movement function?

Questions to be answered, cont’

6. How the recommender treatment will influence the brain function?

7. How will influence the existing symptoms?

8. Are you able to explain the present symptoms and signs?

9. Are you able to connect the clinical picture to any particular part of the brain or to neurotransmitters?

10. What else can be done for this patient?

Sources of supplied information have to be documented

Differential diagnosis

Neurodegenerative disesases of CNS

1. Multipl sclerosis

2. Alzheimer disease

3. Amiotrophic lateral sclerosis (ALS)

4. Parkinson disease

5. Alcochoolism

6. Huntington disease

Organization of clinical case study

Day1: Introductory lecture

Tutor presents the basic facts on body movements, and on movements disorders

Organization of clinical case study

Day 2: Cases allocation

Optimal number is 6 groups with 5 studentsAll teaching materials are at disposal in electronic and all other formsTutor is at disposal all the time, to explain and to steer the group

Supplementary materials

Supplementary materials

Organization of clinical case study

Day 3: Preliminay reports

Each of the groups report its dayly progress

Every studen receive all collected facts and data

Organization of clinical case study

Day 4: Final report

Report content:

1. Summary of clinical case – 1 or 2 paragraphs

2. Answers to all questions

3. Additional information related to the case

Evaluation

• Clinical case summary: 2 points• Five correct answers: 5 points• Sources and references citation: 1 point• Clarity of presentation: 1 point• Grammar, report formatting, tidiness: 1 point

Highest score: 10 points

Achievements and outcomes

At the end of clinical case study, student would:

• Know brain regions responsible for intentional motor movement and their control

• Know specifics of different neurological conditions influencing movement disorders

• Understand the therapeutic options• Understand the consequences of the damage in

different regions of the brain

Pro et contra of clinical cases study (SKS)

Advantages

•Development of thinking capabilities•Knowledge is not served, but conquered in the learning process•Interaction of thinking, discussing, and quest for information•CCS imitate the techniques of problem-solving the reality

Disadvantages

•CCS is not efficient when student need to acquire the large number of facts, data and principles•If applied rarely, too copmplicated both for teachers and for students•Do not offer all necessary information

The tasty dinner is earned, not served one