Rich-Narrative Case Study for Online PBL in Medical Education

Abstract

Case studies are the basis of a well-known medical education pedagogy called problem-based learning (PBL). Traditional case studies are paper based and contain brief medical facts about a patient's illness. The authors of this article argue for a rich-narrative PBL design, and they report on a pilot project that incorporated such a design. The term "rich narrative" in this article covers two attributes. The first is the development of case studies that are rich in narrative information (often called "thick narrative"). The second component of rich narrative is the presentation of these thick narrative case studies in a media-rich format-that is, video rather than the traditional paper-based cases. Rich-narrative case studies may provide a more robust context for learning than traditional case studies because the rich cases more accurately reflect the complex reality of patient presentation and interaction. They also may help to lay the foundation for the development of a more holistic and patient-centered awareness during the training of health professionals. The use of video as a case presentation tool adds to this robust depiction of the patient as a complete human being rather than a collection of written symptoms. The authors discuss the power of narrative in learning, the significance of rich-narrative in medical education, the steps they took to develop a video-based, rich-narrative case study for online PBL tutorials at Simon Fraser University, and the evaluation of their prototype used in 2008.

Differ in Socio-Cognitive Processes? Some Comparisons Between Paper and Video Triggered PBL

“…Unlike written descriptions of clinical cases, videos presentations of cases provide a richer and more complex ways of learning (Derry, Hmelo-Silver, Nagarajan, Chernobilsky, & Beitzel, 2006), which facilitate students to develop the ability to perceive and represent the dynamic and evolving nature of medical conditions and to develop pattern recognition skills (Bransford, Sherwood, Hasselbring, Kinzer, & Williams, 1990). They may also help to lay the foundation for developing a more holistic and patient-centered approach to training health care professionals (Bizzocchi & Schell, 2009).…”

Twelve tips for improving the effectiveness of web-based multimedia instruction for clinical learners

“…Agency in a WBMI activity may involve a learner performing a role, solving problems, or dealing with the consequences of their decisions or actions. While novice learners may require less (or different forms of) control and agency than more experienced learners (Bizzocchi & Schell 2009), learners should not be unnecessarily constrained in their use of WBMI. WBMI activities can be designed to enhance learner agency and control.…”

From Primary Care to Public Health: Using Problem-Based Learning and the Ecological Model to Teach Public Health to First Year Medical Students

“…Kim et al [20] have proposed a conceptual framework for developing medical school teaching cases, based on the core attributes ''relevant,'' ''realistic,'' ''engaging,'' ''challenging,'' and ''instructional.'' This useful framework guided the development of the case, along with the notion of ''thick narrative,'' or telling a story using description, conversation, and multiple viewpoints [13]. The ''thick narrative'' approach allowed for the inclusion of fictional direct quotes from multiple family and community members, as well as a description of the physician's experience of mixed emotions when confronted with health problems that are less amenable to clinical solutions because they are due to social factors.…”

“…For example, faculty at the SUNY Upstate Medical University developed the Case-Based Series in Population-Oriented Prevention (C-POP), a framework that was successfully implemented at several institutions in the early 2000s [10][11][12]. Problem-Based Learning (PBL) is a more studentdriven version of case-based learning, emphasizing problem solving and critical thinking [13]; the majority of US medical schools use PBL in a limited fashion to teach core clinical content [14]. PBL is based on experiential learning theory, which states that learning is optimized when learners encounter a problem or have experiences that trigger questions for them [15].…”