Case
studies have long been used in business, law, medicine, and other
discipline to teach students about their prospective field.
Traditionally, pharmacy programs have reeled heavily on the lecture
formal, which concentrates on scientific content and the rote
memorization of facts rather than the development of higher-order
thinking skills. The main goals of the case method are to develop the
skills of self-learning, critical thinking, and decision making. When
case studies are used in the pharmacy curriculum, the focus of
attention should be on learning the process of solving drug-related
problems, rather than simply finding the scientific answers to the
problems themselves. Students do learn scientific facts during the
resolution of case study problems, but they usually learn more of
them from their own independent study and from discussions with their
peers than they do from the instructor. Information recalls is
reinforced by working on subsequent cases with similar problems.
Case
studies provide the personal history of an individual patient and
information about one or more health problems that must be solved.
The students' job is to work through the facts of the case, analyze
the available data, gather more information, develop hypotheses,
consider possible solutions, arrive at the optimal solution, and
consider the consequences of their decisions.
The
Patient Presentation
The
format and organization of cases reflect those usually seen in actual
clinical settings. The patient's medical history and physical
examination findings are provided in the following standard outline
format.
CC: The Chief Complaint is a brief statement of the
reason why the patient consulted the physician, stated in the
patient's own words. In order to convey the patient's
symptoms accurately, no medical terms of diagnosis are used.
HPI:
The History of Present Illness is a more complete description of the
patient's symptom(s). General features includes in the HPI are:
- Date of onset
- Precise location
- Nature of onset, severity, and duration
- Presence of exacerbations and remissions
- Effect of any treatment given
- Relationship to other symptoms, bodily functions, or activities (e.g., daily acitivity, meals)
- Degree of interference with daily activities
PMH:
The Past Medical History includes serious illnesses, surgical
procedures, and injuries the patient has experienced previously.
Minor complaints (e.g., influenza, colds) are generally omitted.
FH:
The Family History includes the age and health of parents, siblings,
and children. For deceased relatives, the age and cause of death are
recorded. In particular, heritable diseases and those with a
hereditary tendency are noted (e.g., diabetes mellitus, CVD,
malignancy, RA, obesity).
SH:
The Social History includes not only the social characteristics of
the patient, but also the environmental factors and behaviors that
may contribute to the development of disease. Items usually included
are the patient's marital status, number of children, educational
background, occupation, physical activity, hobbies, dietary habits
and use of tobacco alcohol or other drugs.
Meds:
The Medication History should include an accurate record of the
patient's current prescription and non-prescription medication use.
The pharmacist should perform a complete medication history interview
rather than relying on the information obtained by other health
professionals.
All:
Allergies to drugs, food, pets and environmental factors (e.g.,
grass, dust, pollen) are recorded. An accurate description of the
reaction that occurred should also be included. Care should be taken
to distinguish adverse drug effects (e.g., “upset stomach”) from
true allergy (e.g., “hives”).
ROS:
In the Review of Systems, the examiner questions the patient about
the presence of symptoms that are pertinent to each body system. In
many cases, only the pertinent positive and negative finding are
recorded. In a complete listing, body systems are generally listed
starting from the head and working toward the feet and may include
the skin, head, eyes, ears, nose, mouth and throat, neck,
cardiovascular, respiratory systems. The purpose of the ROS is to
evaluate the status of each body system and to prevent the omission
of pertinent information. Information that was included in the HPI is
not repeated in the ROS.
PE:
The actual procedures during the Physical Examination vary depending
upon the chief complaint and the patient's medical history. The
general sections for the PE are outlines as follows:
- Gen (general appearance)
- VS (vital signs – BP, pulse, RR, Temp, weight and height)
- Skin (integumentary)
- HEENT (head, eyes, ears, nose, throat)
- Lungs / Thorax (pulmonary)
- Cor or CV (cardiovascular)
- Genit / Rect (genitalia / rectal)
- MS / Ext (musculoskeletal and extremeties)
- Neuro (neurologic)
Labs: Laboratory tests includes electrolytes (Na, K, Cl, CO2,
Ca, Ma, phosphate) expressed as mEq/L; BUN, serum creatinine,
glucose; also CBC, cardiac enzymes, LFT, urinalysis, fecalysis.
Other
tests: Radiologic and other diagnostic tests.
