We teach our Immunology and Microbiology-Infectious Diseases courses in the sophomore year of a traditional curriculum. Thus, the students have a very busy schedule and it was not possible either to add clinical correlations to an already overloaded schedule, or to use them in a very intense self-learning format. Thus, we planned our Clinical Correlation Exercises (CCE) as self-contained units which the students could complete during assigned class time, freed y eliminating lectures. The CCE were primarily developed by Dr. Jean-Michael Goust and myself, with collaboration by Drs. Roverr B. Galbraith and Dr. Gillian M. Galbraith. Because we had long experience with the use of POPS, we decided to adapt their format and dynamics (with the exception that there are no pre? or post-tests in the CCE), since it would be easier for the students to use the operational skills acquired during previous exposure to POPS packages. All CCE are centered on a case history, distributed to the students 4-7 days before the scheduled meeting; the students are also given a list of reading objectives for each meeting. For the purpose of working on the CCE, the class is split into five groups of 28-32 students each, and each group meets with an instructor. Within each one of those groups, the students arrange themselves into working units of four and receive a written package and instructions. The prescribed order of activities is generally as follows: first, rank in order of priority diagnostic tests out of a printed list and briefly justify the rankings; next the students are given the results of all listed tests and asked to choose additional tests our of a second list and justify their choices. The results to all the tests in the second list are also given and the students are asked to select the three most likely diagnoses on a list of five or six possibilities, ranking them by order of probability, and they are asked to briefly discuss the physiopathology of some of the major signs and symptoms presented by the patient. After the students complete the exercise, they are given a second package containing a brief discussion of the case and a faculty completed version of the case. Four CCE have been developed and tested, corresponding to patients with rheumatoid arthritis, systemic lupus erythematosus, HTLV-I leukemia, and multiple myeloma. The students are generally able to go through a case in a one hour period. Their performance is not directly graded but the students are aware that similar clinical scenarios will be included in their objective evaluation tests.
Our primary objective in devising the exercises was to correlate basic and clinical concepts through clinical case solved in an interactive format. We realized that some of the theoretical and experimental aspects relevant to the clinical situations would probably not be discussed by the students in detail, but on the other hand the students would have to require and interpret laboratory data, rank possible diagnoses, and write discussions of physiopathological aspects relevant to each case. The students are encouraged to work as a group and to bring as many resources as they wish to the sessions and we have observed that the levels of discussion and interaction achieved are quire satisfactory.; One major concern at the onset was that the degree of clinical involvement was excessive for second year students. However, the diversity of backgrounds in the members of a group seems to compensate for individual deficiencies, and simple questions about the nature of the diagnostic tests or about the diseases listed under differential diagnosis are easily handled by the facilitators, which in our course have a medical background. Another concern was that this format would be less effective in delivering information. However, student performance on 15 final exam items related to areas in which formal lectures were replaced by POPS and CCE showed a significant improvement, from 76 + 12% correct answers in 1989, to 80 + 15% in 1990 and 81 + 11% in 1991 (p <0
In the future we plan to develop CCE for Microbiology, incorporating pictorial materials (Gram stains, X-Rays, pictures of the patients, etc.) and we also hope to be able to transpose the CCE to computer format, which would enhance their interactive nature. Although our CCE can also be adapted to a problem-based curriculum, their main strength is the fact that they are self-contained and economical in the use of student’s time, and they are extremely easy to use for large classes. Obviously, they represent one pole of a very wide spectrum of tools available for those wishing to improve their teaching programs within the confines of the traditional curriculum.