Case teaching method in clinical medicine, refers to the use of carefully selected cases, through the active guidance of teachers and the students ‘ learning, making system for students to understand theory of medical knowledge, clinical skills and logical thinking of a teaching tool. In the process of case teaching in clinical medicine, case selection and problem of design is the key, organization is key.
Case method is means education who spirit theory and actual organic combination of purposes, under teaching purpose, to case for basic teaching footage, will students introduced a specific of real situation in the, through teachers and students Zhijian, and life Zhijian of multi-directional interactive, actively participation, equal dialog and discussion, focus training students of clinical logical thinking, and reasoning judgment ability, to reached high-level cognitive learning target of teaching method . It originated in United States, Harvard University, and is widely used in medicine, economics, management science, law practice, applying strong disciplines such as [2, 3]. With the traditional “teachers teach, students learn” teaching mode of one-way information transfer, case method not only advocating students ‘ “learning” (discussion), and more emphasis on teacher “guidance” (boot), is part of the study on the modes of learning, is an extension of students ‘ thinking, capacity training emphasized. Practice of clinical medicine is a subject of very strong, especially suitable for the application of case teaching method.
1 features and function of case teaching method
1.1 help stimulate students ‘ initiative
One notable feature of the case method, is to make students feel things and their own observations, analysis, reflection, so that their own sensible, law of development and changes of ownership of things. It both focus on theory teaching links, more note practice teaching links, to clinical case plot for clues, makes students consciously to entered asked disease, and examination, and set secondary check and treatment programme of work “site”, application past by learn knowledge, combination classroom theory teaching of enlightenment, active to will collection to of case information be analysis, and reasoning, and judgment, clear disease diagnosis of possibilities, prompted they diligent thinking, and at decision. Students passive lecture for positive thinking, the process of active participation in the process, each student’s subjective initiative effectively, fully mobilize the enthusiasm of the students ‘ learning. 1.2 in favour of improving student’s comprehensive quality
Clinical case teaching method by analysis of the actual case, students will ever learn Anatomy, pathological physiology, Symptomatology, diagnostic and other vertical and horizontal linkages related knowledge initiative, mastery, mutual penetration, flexible application. Consolidate knowledge and improving student’s comprehensive ability and capacity to address issues such as clinical diagnosis. Students through real-world case-discussions, experienced clinical analysis, process of thinking, reasoning and judgment, fully realized active participation, development, Exchange and cooperation, optimism, inquiry learning method brings the fun and help. Case method provides each student with a relative opportunities for personalized, multi-channel access to knowledge, in close connection with reality in the theory of learning to improve the comprehensive quality of students, laying a foundation for students lifelong development.
1.3 to promote the professional development of teachers
Clinical case, encourage teachers to widely collected a variety of complex and difficult cases in clinical practice, scientific arrangement and to collect the data, different case selection applies to teaching needs; pursuance continuous updates of medical theory and technique of diagnosis and treatment of development and change, make the necessary amendments, updates in a timely manner, so as to keep teachers teaching, scientific research level are constantly increasing. And teachers guide students analyze the clinical cases, the process of solving practical problems, is the process of teacher learning, could further improve the teachers ‘ own business quality.
2 case study organizations implement process
2.1 selection of typical clinical cases
Selection and preparation of clinical medical case is the basis and prerequisite for implementing case teaching, case level directly impacts on the quality of teaching is good or bad, so case choice should be based on the following principles:
Is a clear objective, the prominent theme. A good case, must show a clear set of objectives and a distinct topic, at least through discussions should enable students to deepen the understanding of some of the key points and difficulties in the course and to benefit from lessons learned theoretical knowledge for horizontal linkages, intertwining. Cases for deaths caused by acute cholecystitis, cholecystolithiasis extensive anterior myocardial infarction cases, it is stressed by the differential diagnosis of abdominal pain, in a process of discussion highlights in acute abdomen and abdominal disease identification of important, students from local to the overall expansion of clinical thinking, improve students ‘ ability to analyze and solve problems.
Second, objective truth, lively and typical. So-called real-world, typical that the case should be derived from clinical practice, and has a certain general, able to reflect more fully the proposed contents of theoretical system, and to inspire students ‘ thinking. In the actual activities of teachers from the phantasmagoria, complicated medical, to choose, by category and sort out a representative instance of clinical, students can play a role by analogy, reason by analogy. Select case must be lively and attractive, so as to arouse students ‘ interest, to in-depth discussion.
Third, moderate difficulty and amount of information. Teaching cases to have a certain degree of difficulty, not too simple. Complex should consciously choose some critically ill, easily lead to misdiagnosis cases stimulate students ‘ interest in learning, and active enthusiasm for study reasons, data access, in-depth analysis. In addition, to reflect the key issue in the case, teachers should provide clear information to facilitate cases of the use and implementation of case teaching. Hansen, who referred to the case when writing once said, “from the perspective of case author, I am willing to put the case into a description of real events, the information contained therein, to be enough to attract interest in thinking and debate, is rich and instructive. “
2.2 design issues
Question design is key to the smooth implementation of case teaching. Issues of design, which is the common sense, of a single, such as which organs are included on the upper right abdomen? ; Can also be a logical, integrated, such as with symptoms, signs and auxiliary examination information inferring what is the most likely diagnosis? Or: why the patients follow the treatment of cholecystitis well? And so on. Generally, arrangements should be in the order as to the problem of curriculum theory as the guidance going forward, from the outside to the inside, and easy-to-digest. When you select the real cases, final diagnosis hidden to pay particular attention to the case, especially the pathological results of the autopsy must be hidden, thinking space left to the students is broad enough, and participation in class discussion space.
2.3 case layout and group discussion
Layout case study is designed to give students have full understanding and analysis on the case, so that students can better active participation in the teaching process. Due to limited classroom time, students take the time to understand the case is unlikely in the classroom, the arrangement of case should be completed before the lesson. When the layout via a local area network (such as a personal home page or other specific home page) published are also available through the issuance of paper materials. General layout of a week or so before the lecture as well.
A panel discussion before class, students develop self-confidence, and master the textbook is an extremely effective way. Establishment of the learning group is for students to change past “go it alone” roles in each other voluntarily formed on the basis of “learning communities”, it should not be too large, General 4-6, not more than 10 people. Panel discussion provided for each student in the form of a participation in the Exchange, opportunities to express their views and ideas, cultivate a spirit of teamwork, enhance case studies of the effect.
2.4 class analysis and summary
Analysis of classroom discussion-analysis methods should be adopted as far as possible, the students take, encouraging students to fully speak, teachers only as a facilitator, cleverly guiding discussions, timely introductory briefing or discussed. If the teacher to do your basics before the discussions (as a concept or content system) explanation, it should not be too long a time. If the teacher before the discussion is not for explaining basics, you can require students to speak basics of fusion in the discussions in the discussion. Student discussion, teachers should pay special attention to Flach point appeared in a discussion of the issues and thought, to promptly adjust teaching focus, make teaching more targeted. At the time of conclusion, students in teachers ‘ comments on the subject during the discussions (such as ideas and argumentation methods, problems, etc), attention should also be made according to the logic of teaching content of the main line a complete analysis and conclusions of, especially on cases involving key clinical manifestations of the value of the differential diagnosis should also be extended to explain, to improve case teaching practical effects.
2.5 after school jobs
May this discussion in the form of jobs require students to compose a written analysis reports, in 1500-3000 words. Mainly help students to digest this discussion, to consolidate the school you want to feel more deeply, future clinical medical personnel can also exercise type Foundation.
3 paying attention to some problems in the case teaching of clinical medicine
3.1 a good grasp of application timing
Case teaching requirements students must first acquire a certain amount of theoretical knowledge, only theoretical knowledge thorough understanding of the premise to fully carry out analysis and discussion of case, achieve teaching objectives. On teaching, Diagnostics, surgery, clinical medicine, etiology, mechanism of disease, symptoms, signs and laboratory examination construe of such basic knowledge is essential to the advantage only of case teaching method and traditional teaching complement can be on full display.
3.2 adequate preparation
The saying goes, don’t fight no preparation for battle, case teaching as well. Adequacy of preparation before class is the important guarantee for the smooth implementation of case teaching. First of all, teachers must master the whole case material, clearly involves the teaching of basic theories of; followed by forecasting potential ideas and perspectives of students, and determine their own intervention timing of discussions, create an elaborate case discussion guide plan; three is gathering case-related symptoms, signs, and auxiliary images such as checks, image data, making the multimedia courseware. Using text, graphics, images, sound and other multimedia teaching method of combination of elements, or visit the clinic so that it seems to better attract the attention of students.
3.3 control of teaching rhythm
Emphasis on teaching time, control of the content and form. Because of the limited classroom time in hours and, in the implementation of case teaching in the process, not only with teachers teaching schedule as a whole is in order, also requires teachers of the overall ability to master. Class analysis, case discussion of teachers to seriously listen to the students to speak, raised key issues in a timely manner, prompted students to do a more in-depth consideration, or adjust the direction of thinking; timely summarized the recommendations or opinions of students, help students to clear thinking, built on a solid theoretical basis point. Also when there is silence or too intense in classroom discussions, timely intervention, creating a relaxed and harmonious atmosphere; according to the priorities assigned to discuss the problem of time, using a variety of different ways of effective control of the process of classroom discussion, discussion of seeking to achieve the desired effect.
Case teaching method is the outcome of the quality education reforms , to make it in clinical medicine teaching in universities full play to the role, need combined with the current situation on health reform, appropriate adjustments to training objectives and training program in clinical medicine, and create a system, a wealth of case teaching resource library. At the same time, teachers in such areas as education and teaching methods and teaching means also to make the appropriate changes. Only in this way, to develop basic skills and the ability to work in a down-to-earth manner of practical, innovative clinical medical personnel.
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