The case method is used primarily to develop the skills of self-learning, critical thinking, problem identification, and decision making. When case studies from this casebook are used in the curricula of the health care professions or for independent study by practitioners, the focus of attention should be on learning the process of solving drug therapy problems, rather than simply on 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. Working on subsequent cases with similar problems reinforces information recall. Traditional programs in the health care professions that rely heavily on the lecture format tend to concentrate on scientific content and the rote memorization of facts rather than the development of higher-order thinking skills.
Case studies in the health sciences provide the personal history of an individual patient and information about one or more health problems that must be solved. The learner's 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 the learner's decisions.1 The role of the teacher is to serve as coach and facilitator rather than as the source of “the answer.” In fact, in many cases there is more than one acceptable answer to a given question. Because instructors do not necessarily need to possess the correct answer, they need not be experts in the field being discussed. Rather, the students become teachers and learn from each other through thoughtful discussion of the case.
The patient cases in this casebook should be used as the focal point for independent self-learning by individual students and for in-class problem-solving discussions by student groups and their instructors. If meaningful learning and discussion are to occur, students must come to discussion sessions prepared to discuss the case material rationally, to propose reasonable solutions, and to defend their pharmacotherapeutic plans. This requires a strong commitment to independent self-study prior to the session. The cases in this book were prepared to correspond with the scientific information contained in the eighth edition of Pharmacotherapy: A Pathophysiologic Approach.2 For this reason, thorough understanding of the corresponding textbook chapter is recommended as the principal method of student preparation. The online learning center AccessPharmacy (www.AccessPharmacy.com, subscription required) contains the Pharmacotherapy textbook and many other resources that will be beneficial in answering case questions. The cases in the casebook can also be used with the textbook Pharmacotherapy Principles & Practice, 2nd ed.,3 or other therapeutics texts. Primary literature should also be consulted as necessary to supplement textbook readings.
Most of the cases in the casebook represent common diseases likely to be encountered by generalist practitioners. As a result, not all of the Pharmacotherapy textbook chapters have an associated patient case in the casebook. On the other hand, some of the textbook chapters that discuss multiple disease entities have several corresponding cases in the casebook.
Levels of Case Complexity
Each case is identified at the top of the first page as being one of the three levels of complexity. Instructors may use this classification system to select cases for discussion that correspond to the experience level of the student learners. These levels are defined as follows:
- Level I—An uncomplicated case; only a single textbook chapter is required to complete the case questions. Little prior knowledge of the disease state or clinical experience is needed.
- Level II—An intermediate-level case; several textbook chapters or other reference sources may be required to complete the case. Prior clinical experience may be helpful in resolving all of the issues presented.
- Level III—A complicated case; multiple textbook chapters, additional readings, and substantial clinical experience may be required to solve all of the patient's drug therapy problems.
Using Learning Objectives
Learning objectives are included at the beginning of each case for student reflection. The focus of these outcomes is on achieving competency in the clinical arena, not simply on learning isolated scientific facts. These items reflect some of the knowledge, skills, and abilities that students should possess after reading the textbook chapter, studying the case, preparing a pharmacotherapeutic plan, and defending their recommendations.
The learning objectives provided are meant to serve as a starting point to stimulate student thinking, but they are not intended to be all-inclusive. In fact, students should also generate their own personal ability outcome statements and learning objectives for each case. By so doing, students take greater control of their own learning, which serves to improve personal motivation and the desire to learn.
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 standardized outline format.
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, medical terms and diagnoses are generally not used. The appropriate medical terminology is used after an appropriate evaluation (i.e., medical history, physical examination, laboratory and other testing) leads to a medical diagnosis.
The history of present illness is a more complete description of the patient's symptom(s). Usually included 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., activity, meals)
- Degree of interference with daily activities