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INTERACTIVE LEARNING ACTIVITIES IN THE CV COURSE Richard Klabunde MU-COM Active Learning Roundtable May 6, 2015

Types of ILAs • Case discussions (led by clinical and biomed panel) • Computer simulations

• Clinical problems • Clinical journal article discussions

General pedagogical approach to ILAs • Large classroom activity (entire class in each session) • Students asked to huddle together to generate ideas • In some cases, students are asked to present their ideas using the doc camera

(consultants permitted) • Required learning elements prior to ILA (a.k.a., “flipped” classroom) • Reviewing lectures and required readings • Solving problems, answering questions

• Graded ExamSoft quizzes • Pre-ILA quiz (5 min) assess student preparation • Post-ILA quiz (5 min) assess student learning • Both quizzes permit open notes and computer resources

CASE DISCUSSIONS Integration of biomedical knowledge and clinical skills Conducted with a clinician

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Recent Onset Hypertension in 27-yearold Woman

Richard Schuster, DO Richard Klabunde, PhD

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Chief Complaint and History of Present Illness Mindy Portman is a 27-year-old female who complains to her primary care physician that her blood pressure is abnormally high. Mindy is a physically active young woman who recently had her blood pressure taken at the fitness center where she works and exercises. Her blood pressure was found to be 166/112 mmHg. She was concerned because several months earlier her blood pressure was 115/72.

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Outline of Case Discussion • • • • • • • • • • • • •

Chief complaint and history of problem Past medical and surgical history Current medications Family and social history Review of systems Vital signs Physical exam Differential diagnosis (student generated) Diagnostic tests with rationale (student generated) Test results Diagnosis Treatment plan (student generated) Patient education

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Types of questions asked during case discussion: 1. 2.

3. 4. 5. 6. 7.

What is normal blood pressure in a woman of this age? Why is heart rate not depressed by the baroreflex? What are the risks of high blood pressure? What can cause elevated arterial pressure? What information is provided that might narrow your suspicions regarding the cause? What is your differential diagnosis? What diagnostic tests would you order? Provide the rationale for each test.

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8. 9. 10. 11. 12.

Based on the objective findings, what is the diagnosis? What mechanisms contribute to the increase in blood pressure? Why is hypokalemia present? What pharmacologic and non-pharmacologic treatments should be considered for this patient? What should be discussed with this patient prior to treatment and after successful treatment?

COMPUTER SIMULATION

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Computer Simulation Protocol     

 

1. 2. 3. 4. 5.

Discuss drug pharmacology Predict what responses should occur Collect data Compare actual responses with predictions Explain the results

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High Dose Epinephrine Infusion Simulation

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Computer Simulation Protocol  

1. 2. 3. 4. 5.

  

75 7.2 95 14.5 112

 

7.6 59

Discuss drug pharmacology Predict what responses should occur Collect data & add to table Compare actual responses with predictions Results discussed/explained by students

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CLINICAL PROBLEM: VALVE DISEASE • Hemodynamics of valve stenosis • Cardiac pressure and volume changes associated

with valve defects

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Sample question: Assume that a mitral valve with a cross-sectional area of 4 cm2 normally has a peak pressure gradient of 1 mmHg across the valve during diastole when a person is at rest, and that LAP and PCWP are normally 10 mmHg. a.

What will be the peak pressure gradient if the valve cross-sectional area is reduced from 4 cm2 to 1 cm2 and the peak flow across the valve remains the same? How will this affect pulmonary capillary wedge pressure?

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Key Relationships:

P  F  R P  F  1

A2

By the above relationship, if valve area is reduced to ¼ its original area, then the pressure gradient across the valve will increase 16-fold, which will be an increase from 1 to 16 mmHg in this problem.

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Which of the following will occur if the cross-sectional area of the aortic valve is reduced by 50%? (assume stroke volume is unchanged) 1. 2. 3. 4.

Diastolic murmur intensity will increase because of increased turbulence Peak pressure gradient will be doubled Peak pressure gradient will be increased by at least 4-fold Peak velocity of flow will be increased 4-fold

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Data

A

B

C

D

E

110/80

115/75

140/60

100/65

135/90

88

82

75

90

84

110/4

115/30

140/20

100/5

195/25

20

30

20

5

25

PAP

45/25

55/35

45/25

20/8

50/30

RVP (sys/dias)

45/5

55/10

45/6

45/10

50/10

RAP

5

10

6

10

10

LVEDV

90

240

280

100

140

LVESV

50

108

140

40

77

EF

44

55

50

60

45

AP (sys/dias) HR LVP (sys/dias) PCWP

DIAGNOSIS:

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Case A: Based on the data, what is the valve defect? 1. Aortic regurgitation 2. Mitral regurgitation 3. Mitral stenosis 4. Pulmonic regurgitation 5. Tricuspid stenosis

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Case A – Mitral Stenosis Students discuss/explain data

AP (sys/dias) HR LVP (sys/dias) PCWP PAP RVP (sys/dias) RAP LVEDV LVESV EF

110/80 88 110/4 20 45/25 45/5 5 90 50 44

A student is asked to draw PV loop for the valve defect based on the data using the doc camera

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JOURNAL ARTICLE REVIEW An interactive learning activity

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Purpose • This interactive learning activity is designed to: • Acquaint students with clinical research that

investigates the potential benefits of long-term exercise training in heart failure patients • Help students learn how to critically evaluate a

published research study • Reinforce fundamental concepts related to the

pathophysiology of heart failure

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Evaluating a Research Article What is the rationale for conducting this study? What problem(s) is being investigated? 2) What is the hypothesis being evaluated by this study? 3) Describe the study design and be able to discuss the rationale for this design. What other ways might this study have been designed? 4) What inclusion and exclusion criteria are used in this study and what is the rationale for using these criteria? 5) What methods were used in this study? Were they appropriate and reliable? 6) How were the data evaluated statistically? 7) What were the principle findings of this study? 8) Were the results adequately discussed in terms of internal consistency of data, relationship to hypothesis, and relationship to other published studies? 9) Were the conclusions supported by the data? 10) What were some of the limitations of this study and how might these limitations affect a more general application of the conclusions? 11) What is the significance of this study in terms of treating heart failure? 1)

Value of interactive learning activities • Promote critical thinking skills by challenging student

understanding of important concepts • Graded in class quizzes incentivize preparation prior to ILA • Provide an opportunity to apply basic science knowledge in a clinical context