Using Case Studies in EMS Courses

[Part II]

Daryl Boucher, MS, RN, EMT-P; EMS Coordinator, Northern Maine Technical College

Published in the Winter, 2004 edition of the Maine EMS I/C News

What makes a good case study?

EMTs respond to a nursing home for a patient with dementia complaining of chest pain. As the paramedic heads to the patient’s room with a CNA, the EMT stops at the nurses station to pick up the required transfer paperwork. The paramedic begins to provide care. She assesses airway, applies oxygen, and attaches the cardiac monitor. As she turns to the door, she notices that the Basic EMT is wearing a gown, mask and gloves. — Oh No! The patient has MRSA!!

Using stories to teach is always a challenge. Using good stories requires forethought, organization, and samples from real life situations. Have you ever considered scene safety in a nursing home? Imagine all of the teaching opportunities form the above scenario. An instructor could develop a discussion on the types of infectious diseases that require gowning. Certainly, this scenario allows a broad discussion about scene safety. How about identifying the roles of the paramedic and EMT? This is also a good entry into subjective history gathering.

In short, stories really allow the transfer of information in a fun, informative way for the students. Instructors continually balance the line between telling inappropriate “war stories” with using a story to illustrate an important point. This article, the second of a three part series, will highlight what makes a good case study.

The most effective case studies create empathy with the main characters. This allows students to become more engaged. It brings realism and credibility to the case study, and keeps the student’s interest. A good case study also tells an interesting story. Though short, the above scenario allows students to place themselves in the nursing home. The instructor can develop the prose to include vivid verbs and adjectives, or leave it general. Either way, the more interesting the story, the greater the learning possibilities. Remember too that the conclusion to a good story may not exist yet. Just like a good book, a good case study at the beginning of class makes students look forward to the “development of the story.”

Good case studies have to be current, or at least be in the current media. During the ‘Reagan years” I used the videotaped shooting of the former President and his aids as a great introduction into care of the head injured patient. This worked well for a few years, but my 18 year old students now do not even know who Reagan was, and, they argue, security and the Secret Service are much better now. So, I try to develop my case studies on current happenings, either locally or globally.

The most effective case studies are well thought out ahead of time to provoke conflict and promote decision making. If there is no controversy inherent in the case, the instructor should introduce one by using Socratic questions. For example, in the case above, I may introduce controversy by saying that it is the policy of this particular service that both EMTs enter the room simultaneously. “How would this policy impact scene safety?” In addition, good cases force students to make difficult decisions (even if they are wrong ones.) Remember that learning is enhanced by targeting all of the senses, and forcing students to speak enhances this idea. Be sure the case study accomplishes what you desired from the start. What are the objectives? How will you measure whether these objectives have been met?

Good case studies are short. Students get bogged down with too much data, and it is easy to lose the main point and objective when too many solutions exist. Instead of developing a long case study, develop a short one and build on it. It is also easier to hold someone’s attention for a short time than for a long time. Good case studies also contain effective questioning. This allows the instructor to focus on or clarify the topic. (See Table 1, below.)

Table 1: Socratic Questioning Examples:

Clarification questions:

§ What is your main point? Could you state that another way?

§ How does ___ relate to ___?

§ What does this case assume?

§ Do we all agree that ___?

Assuming questions:

§ What are you assuming as you provide care ?

§ Is this always the case when you encounter a ___?

§ What could we assume instead?

§ Why might you assume that this patient is ___?

Reasoning questions:

§ How do you know?

§ Why?

§ What difference would this make…?

§ What if I changed the scenario to ___?

§ Do you see any problems with what ___ said?

§ How would you do this differently?

§ What other conditions might cause these symptoms?

Source and consequence questions:

§ Where did you get this idea?

§ What is an alternative?

§ What would happen if ___?

§ What might you expect if you saw or did ___?

§ How would a patient respond if ___?

§ What is your next step?

Finally, I like to role play when doing case studies. This allows students to be active, makes the learning realistic, and really allows for evaluation of student learning. Imagine the following scenario:

During an EMS class, a student runs in and says, “The is the paramedic class, right?’ Naturally, the instructor answers yes. The panicked student goes on to explain that another student is acting strangely in the lounge after having fallen down the steps. She requests help right away.

The instructor tells students A and B, who are basic EMTs, to go assess the patient while he gets his keys and jump kit, and calls for help. He asks that the other students remain in the class to work on a group project. The EMTs (students) begin their assessment, and the instructor observes from a distance. After their initial assessment, the instructor arrives on scene and alerts the EMTs that this was a role play, and asks them to remain quiet in the classroom for a few minutes as the others discuss the case.

Again, imagine the teaching opportunities. How did the students who were told to remain in the classroom feel? Is this typical of EMTs as a group? What possible injuries might this person have? What kind of assessment was done or should have been done? This list is endless. I have used role plays like the one above at a point in the course when students are becoming bored, and seem to be disinterested. It enhances the discussion, and allows the students to apply what they have learned. Overusing such a technique may become counterproductive, but as a “statement” this type of class is extremely effective.

Though using and developing case studies is time-consuming for instructors, the quality of the learning that takes place is superior to lecture in many instances. In Part III of “Using Case Studies in EMS Courses,” I will discuss using case studies not only as a learning tool but also in the evaluation of students. I will also include a short overview and critique of resources that may be used by EMS instructors.