A Case Study of Dementia: Self-Learning Module
|9174||May 18, 2012||1|
The Liaison Committee on Medical Education (LCME) standards mandate that medical schools identify clinical conditions that students must experience during required clerkships. If a given clerkship site is unable to provide one or more of the required clinical experiences, it is permissible to provide an alternative clinical experience such as a simulated or case-based alternative that parallels the level of student involvement (for example, observation vs. participation in management decisions) specified for the condition.
Self-learning modules (SLMs) have the potential to improve understanding, facilitate learning, and possibly improve medical students’ test performance. With appropriate design and software, SLMs also provide many of the advantages of educational technology detailed by the Association of American Medical Colleges: safe, controlled environment that eliminates risks to patients; enhanced, realistic visualization; authentic contexts for learning and assessment; documentation of learner outcomes; learner control of the educational experience; uncoupling of instruction from place and time; standardization of instruction and assessment; perpetual resources and new economies of scale.
The multi-institutional development and use of online interactive SLMs utilizing patient simulations to assist in teaching the core curriculum of a clerkship has been successful in Pediatrics (the CLIPP Project). For Psychiatry, the new Clinical Simulation (CSI) in Psychiatry for Medical Students is a collaborative, multi-institutional effort to develop web-based SLMs with a consistent pedagogical approach and peer-review. The eventual goal is to provide a free national database with comprehensive coverage of the Psychopathology and Psychiatric Disorders addressed in the Clinical Learning Objectives Guide for Psychiatry Education of Medical Students endorsed by the Association of Directors of Medical Student Education in Psychiatry (ADMSEP) membership. CSI hopes to publish its series of SLMs on MedEdPORTAL, and its uses could include provision of alternative clinical experiences for third year medical students who do not encounter certain required clinical conditions during their core Psychiatry clerkship. These SLMs are not meant to replace actual clinical experience but, rather, to provide a meaningful learning experience if the ideal of direct exposure to the desired clinical condition is not possible.
In late 2011 CSI plans to submit up to 5 modules to MedEdPORTAL: Dementia with Depression and Delirium Comorbidities; Adolescent Depression; Somatization Disorder; Bipolar I Disorder; and the Psychiatric Interview. The CSI module currently being submitted to MedEdPORTAL is "Dementia with Depression and Delirium Comorbidites". Rather than providing a comprehensive didactic on dementia, this SLM is intended as a clinical application exercise after student completion of the recommended readings, thereby providing e for an “alternative clinical experience” for third year medical students who do not encounter a patient with dementia and comorbidities during their Psychiatry clerkship.
Note: This resource consists of separate pieces of content. You may need to access via website, download resource files and/or request additional information from MedEdPORTAL staff to access the full publication.
Klapheke M. A Case Study of Dementia: Self-Learning Module. MedEdPORTAL Publications; 2012. Available from: https://www.mededportal.org/publication/9174 http://dx.doi.org/10.15766/mep_2374-8265.9174
Contains time-sensitive information that will likely be inaccurate, obsolete, or irrelevant by April 08, 2015
- To describe the evaluation of cognitive dysfunction.
- To formulate a treatment plan for a patient with dementia that includes support of caregivers and monitoring of safety issues.
- Dementia (MeSH), Delirium (MeSH), Major Depressive Disorder (MeSH), Memory, Cognitive Dysfunction, ADMSEP Clinical Simulation
- Geriatric Psychiatry
Knowledge for Practice
Cognition, Human Learning & Problem Solving
- Clinical Skills/Doctoring
- Medical Student
Professional School Post-Graduate Training
Authors & Co-Authors
Martin Klapheke, MD
University of Central Florida College of Medicine
Sponsorship or Funding Source
The work by the author, standardized patient, videographer, photographer, sound technician, and video editing assistant were supported simply as part of their employment by the University of Central Florida College of Medicine.
Effectiveness and Significance
At the 2010 annual conference of ADMSEP (Association of Directors of Medical Student Education in Psychiatry), it became clear from speaking to other members that there was a perceived need for resources to address LCME standards for ensuring medical students’ exposure to required clinical conditions. In response, a group of us developed the Clinical Simulation Initiative (CSI) in Psychiatry for Medical Students in order to create a series of SLMs to provide alternative clinical experiences for third year medical students who do not encounter certain required clinical conditions during their core Psychiatry clerkship. CSI hopes to publish its series of SLMs on MedEdPORTAL and thereby provide a free national database of SLMs for use in medical education in Psychiatry.
Implementation and Effectivenes/Feedback Received on the current submission, Dementia with Depression and Delirium Comorbidities:
- This SLM has been implemented in the University of Central Florida College of Medicine Psychiatry clerkship didactics beginning in July, 2011. Verbal and written feedback regarding the SLM as an independent learning experience has been positive; criticisms and recommendations for revisions are detailed in the submission, section “Please share any lessons learned”.
Along with the other initial CSI pilot modules, this SLM has received peer review as follows:
National educators in Psychiatry at the ADMSEP membership at the 2011 annual conference viewed the first 4 CSI modules (including this SLM) as part of a Poster/Demonstration Project. Extensive feedback, overwhelmingly positive, was received from the attending members, many of whom want to use the resource as soon as possible. Our poster/demonstration won the ADMSEP "2011 Outstanding Innovation in Medical Education Poster Award".
- Following the 2011 annual meeting of ADMSEP, the first 5 CSI pilot modules were also posted on the ADMSEP website and the ADMSEP Executive Council invited all members to review the modules and provide feedback. This feedback has also been used to revise and improve the modules.
As part of a research project (IRB approved), the initial CSI modules are receiving multi-institutional anonymous review by medical students and faculty. The results are being used to revise/improve the modules. To date, I only have a small amount of formal data (6 students and 3 faculty):
All 3 faculty members agreed (agree to strongly agree) with each of the following:
- “This module reached its objectives for the target audience”.
- “I would use this module to teach medical students”.
Two of 3 faculty members agreed (somewhat agree to agree) with the following:
- “It took too long to work through this module”.
All 6 students agreed (from somewhat to strongly agree) which each of the following:
- “This module increased my ability to work through a differential diagnosis of dementia and delirium”.
- “This module enhanced my ability to perform a work-up for dementia and delirium”.
- “This module enhanced my ability to choose treatment options for dementia and delirium”.
Five of 6 students agreed (from agree to strongly agree) which the following:
- "I was able to master this module’s objectives by working through the case”.
Five of 6 students agreed (from agree to strongly agree) which the following:
- “The module was valuable as an educational tool”.
All of the above feedback has been utilized in revisions, leading to the current version of the module now being submitted.
Special Implementation Guidelines or Requirements
METHODS: Articulate software was utilized to develop a self-learning module for third year medical students, utilizing video clips demonstrating the evolution of a clinical case from presentation to follow-up over 5 years. The focus is on differential diagnosis and treatment planning, with intermittent self-assessment quizzes, and references to APA Practice Guidelines and other evidenced-based literature for further study.
- Introduction: Learning Objectives & Recommended Readings
- Video clip #1 and text: Patient presentation with mood symptoms
- Quiz #1: Diagnostic considerations
- Brief text: Initial treatment
- Video clip #2 and text: Clinical evolution of cognitive dysfunction
- Quiz #2: Evaluation of possible dementia
- Brief text description: Patient’s course of cognitive & mood symptoms
- Quiz #3: Differential diagnosis of dementia
- Brief text: Provisional diagnosis and initial treatment
- Quiz #4: Treatment of dementia
- Text description and video clip#3: Monitoring, and development of complication
- Quiz #5: Delirium
- Text: Patient Outcome
POTENTIAL USES IN MEDICAL SCHOOL CURRICULUM:
- Third Year Clerkship Didactics: either as individual independent study, or as a group exercise with faculty present.
- Alternative Clinical Experience for a third year medical student who does not obtain clinical exposure to a patient with dementia/delirium during the clerkship.
- Multidisciplinary (e.g., Psychiatry, Neurology, Internal Medicine) case conference during the third year medical school curriculum could utilize part of this self-learning module for discussion.
The use and reviews of this SLM (see above) by medical students and faculty have provided valuable feedback that led to several revisions (leading to the current submission):
- Some felt the audio narration was too frequent and interfered with reading the text; therefore, the narration was subsequently much abbreviated.
- Similarly, some felt the written text in the SLM was too detailed and the video clips too long; therefore, both of these were subsequently edited and shortened.
- Some felt the quizzes were too difficult; therefore, some questions were revised, and more advanced topics and quiz questions were moved to an optional Appendix. This also helped further shorten the module for those who wish to skip the Appendix.
- Some students complained the quiz questions had content that was not directly answered in the previous slides; however, no changes were made. The students were reminded that rather than providing a comprehensive didactic on dementia, this SLM is intended as a clinical application exercise after the student completes the recommended readings.
- Revisions were made to make the software application properties more user-friendly, e.g., a playbar was added for all video clips, and adjustments were made so that the viewer can more easily navigate forward and backward through the slides as desired.
This information is made available under the Creative Commons license.
This publication has been formally peer reviewed elsewhere
See the section "Effectiveness and Significance".
Publications, Presentations, and/or Citations for this Publication
As noted in "Effectiveness and Significance", national educators in Psychiatry at the ADMSEP membership at the 2011 annual conference viewed this modules as part of a Poster/Demonstration Project.