COSM14: Case-Based Learning May Improve Medical Education

Anna Messner, MD, started her talk with a confession.

A month before, she had given her residents a lecture on pediatric head and neck oncology.

And it was bad.

“I would look out there and someone here was on their phone, and three people over there were on their computer doing their medical records,” said Dr. Messner, professor of otolaryngology-head and neck surgery and pediatrics at Stanford Medical School in Palo Alto, Calif. “And, frankly, I don’t think anybody was learning much of anything.” She made her remarks during the panel discussion “Technology and Tools for Lifelong Learning.”

Why did her lecture to her students go so poorly? In a word, PowerPoint. She was covering the types and stages of cancer—the topics she was required to teach—in a slide presentation. And it wasn’t exactly gripping.

So the lecture was bad, until the end. That’s when she told the story of a girl named Rachel, who, at age 8, had recurrent rhabdomyosarcoma and needed a laryngectomy, but her parents would not schedule the surgery. “I noticed, at this point in the lecture, that everybody was paying attention,” she said, “because here was a real problem.”

When Rachel’s parents showed up a year later with a daughter who couldn’t breathe and couldn’t eat, and a larynx now overrun with cancer, the laryngectomy was finally performed. The girl did very well at first, but died nine months later from metastatic disease in her lungs.

The lecture, Dr. Messner said, highlights the way in which medical lecturers can fall into a trap of relying on PowerPoint and purely didactic material, relaying the material but not really teaching students anything.

Telling more stories is a great way to improve learning, she said. “This is why case-based learning has become so popular, because people can relate to it and they can remember stories much easier than they can remember the staging system,” she said. More medical lecturers, she suggested, should consider the “flipped classroom,” in which material students need to know—traditionally the “in-class” part—is taught outside the classroom, often online, and the in-class time is used for discussion (see “Flipped v. Traditional Classrooms,” below).

MOC

Randal S. Weber, MD, chair of the Maintenance of Certification (MOC) Committee of the American Board of Otolaryngology (ABOto), talked about the merits of the board’s MOC program, especially during a time in which the public is focusing increasingly on the quality of care they receive and payers want more value in the healthcare they purchase.