This innovation addresses two major difficulties related to case-based small-group learning: (1) the faculty-intensive nature of small-group learning, and (2) the inconsistencies in experiences between groups. This paper describes a method used at the DeBusk College of Osteopathic Medicine (DCOM) to run 15 small groups simultaneously using PowerPoint and the TurningPoint audience response system.1 Technology Enhanced Scripted Scenario (TESS) cases rely on an extensive script developed by a team of faculty. Student groups take a patient history, simulate a physical exam, make a differential diagnosis, order tests and labs, make a final diagnosis and develop a treatment plan. At each step, students within a group come to a decision, and then there is a discussion between the groups until the class as a whole comes to a consensus. Using the audience response system, the student groups can be graded on each of these tasks. A unique aspect of TESS cases is that the script and PowerPoint presentation for each case has multiple pathways. The actual path followed depends on the diagnosis and treatment plan decided upon by the class. Running clinical cases using the TESS format has several benefits. A small number of faculty can facilitate multiple student groups simultaneously, making cases less faculty intensive. Since a small team of facilitators runs all the groups, the experience is the same for all students. This format also prevents facilitators from using small groups as additional lecture time. TESS cases help students develop good history-taking habits before beginning rotations. Students also get practice making a differential diagnosis, ordering appropriate labs & tests, making a diagnosis, and developing a treatment plan. Cases are more realistic, with plot-lines that follow the student decisions, and results that arrive at the appropriate point in the case. Feedback comes to the students from the case itself, not from a faculty facilitator. Analysis of student responses allows assessment of the student decision-making process, which is not easily assessed in lecture exams. Student performance can provide indications of holes in the curriculum and can guide curricular development. TESS cases can also be used to deliver cases to third and fourth year students at their rotation sites.
We have run four TESS cases for first and second year osteopathic medical students at DCOM. Student feedback was very positive, and faculty commented that the students were much more engaged than in small groups led by individual facilitators. In running these cases, it became obvious that students needed much more experience in obtaining a patient history. It was also interesting that students had no problem diagnosing a case with striking findings (e.g. aspiration pneumonia) but found it much more difficult to diagnose a more routine, less striking case (e.g. exacerbation of COPD). Results from the TESS cases are being used by systems coordinators to modify their curricula.
1The facilitator’s room is connected to the small group rooms via a Tandberg 6000 MXP codec. Each small group room contains a Tandberg 550 MXP codec connected to a 42 inch monitor. Similar audio and video connectivity could be achieved via the internet using web conferencing software such as Adobe Acrobat Connect Pro.