Evidence Based Module

Using Web Cases in Courses

Philosophy

Overall, the CAM Web Cases focus on problem solving. Each case is designed to both introduce the student to the integration of alternative therapies into clinical practice, and to set the student a problem that must be solved by immersion into the medical literature. The cases do not stand alone. They are meant to be integrated into courses with a mixture of self-directed study and small group discussion. The cases follow a model for web case design* that is illustrated in the diagram below.

This model provides five divisions of the content and activities. The five divisions are: knowledge, application, synthesis, scaffolding, and communication. The three main categories (The three boxes in the middle) are used to organize the content presentation and learning activities. The top division, scaffolding, deals with the level of support and direction we give to the students as they work with the content. The bottom division represents the interaction that takes place between the students and the instructor and is made up of the several possible web-based communications modes. This fifth division falls in the affective domain and includes motivational, as well as, interactive components. Each division is discussed in detail below.

The knowledge division is where the majority of the content is presented. This is the area where information is presented to the learner and the learner is expected to recall the facts of the information. Thus, this part of a case will usually consist of either textual information or links to textual information. It could also include links to audio or video presentations. Assignments in this division are of the recall nature, such as a matching exercise between words and their definitions.

The application division is where students explore relationships between the facts that were presented in the knowledge division. This area usually takes the form of assignments where the students explore the relationships between facts and describe causal links.

The synthesis division consists of problem-solving activities that emphasize the selection of information to be applied to a particular situation, and the formulation of a solution.

The top division, scaffolding, relates to the balance between instructor driven and student driven learning. We want students to be independent learners, but while they are in school they need guidance in the “how to learn” process. In the old teaching tradition faculty relied on telling the students how to solve a problem. After explaining how to do it, we expected students to be able to do it themselves. The notion of problem-based learning often goes to the other extreme. Here, students are given problems and told to “go find solutions.” Either extreme leaves the students floundering. The instructor needs to find a balance between “providing guidance” and “setting them free.” This is where the concept of scaffolding comes into play. Scaffolding is the structure of support the instructor erects to assist the students in efficiently locating resources and tools to solve problems. Thus, a well designed case can present students with a problem, and as they work through the problem, provide gentle and appropriate guidance so the students have a successful learning experience and are still responsible for developing their own solution.

The bottom division, communication allows the consideration of how the students and instructor will interact throughout the learning activity. Generally, case communication takes the form of either web-based or face-to-face interactions. Web-based communication is done via email, discussion forums, or real-time chat rooms. Face-to-face communication is done in small or large classroom settings.

* Based on an article that places web site design in the overall context of the role of technology in higher education. Marion, R. The Influence of Technological Change on Teaching/Learning in the Academy. Journal of Physical Therapy Education, Winter 2002, Volume 16, Number 3, 23-30.

Example - Using the Low Back Pain Case

The Low Back Pain case has been used several times with medical and allied health students. The web portion of the case is meant to be used as a resource prior to a discussion component. The case itself has two elements from the model discussed above: knowledge and synthesis. Most of the pages of the case present knowledge and the last two pages (Interlude to Think and Follow-Up) are a synthesis assignment. Presented below are two variations on student assignments for this case.

Using the Case with a Large Class

The case has been used a number of times with large groups. Once with second year medical students in a course called Practice of Medicine II and again annually in the UTMB School of Allied Health Sciences in a course named Team IDEAL. Team IDEAL is an interdisciplinary course that includes all the allied health disciplines. The case was incorporated into the course as an activity titled, Integrative Therapies in Outpatient Rehabilitation. The previous link illustrates the instructions that the students received prior to participating in the activity.

The Interlude to Think page in the case sets out the remainder of the instructions to the student. This page can be edited by the instructor via a web-based editing component. Thus, the instructor can customize this page to guide the students along in their process. The Interlude to Think page as it was used with the allied health students is presented in this link.

Using the Case as an Individual Assignment

The case is also used as an individual assignment in the Team IDEAL course. The Interlude to Think instructions were left the same, and the Pre-Case instructions outlined the steps to follow for self-directed work.