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PedsCases Content Production Handbook: A
Glimpse into the Future of Medical Education
Debraj Das1, Michelle Bischoff1, Peter MacPherson1, Chris Gerdung1 Lauren Kitney2,
Peter J Gill1, Melanie Lewis1
1
University of Alberta Faculty of Medicine & Dentistry, Department of Pediatrics, 8213
Aberhart Centre 1, Edmonton, Alberta.
2 University of Toronto, Department of Paediatrics. 555 University Avenue, Toronto,
Ontario.
Corresponding Author:
Debraj Das
780-907-6769
Email: debrajd@gmail.com
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ABSTRACT
INTRODUCTION: PedsCases (http://www.pedscases.com) is a pediatric educational
website for undergraduate medical students developed through student-faculty
collaboration. PedsCases consists of pediatric specific clinical multiple-choice questions
(MCQs), podcasts on key learning objectives, and interactive cases that teach students
clinical decision-making skills. Our objective was to create a handbook for medical
students that outlined how to create high quality online learning resources.
METHODS: The PedsCases contributors worked together on this project and drew
upon prior experiences and medical education theory to develop a handbook that
carefully summarizes the core elements of writing MCQs, podcasts, and clinical cases.
Individual members drafted a version of the handbook, which was then peer reviewed
and verified by members of the PedsCases team, including the director of pediatric
undergraduate education.
DESCRIPTION OF HANDBOOK: Each section consists of: 1) specific writing
mechanics; 2) how to test knowledge application; and 3) tips specific for PedsCases
content. The clinical case section explores how to develop and organize a clinical case
scenario while ensuring that the content is applicable to medical students. The MCQ
portion discusses how to properly write a question stem, challenging distracters, and
how to integrate MCQs into clinical situations. The section on podcasts explains
characteristics that make a podcast different from a spoken lecture, giving an outline for
podcasts to follow, and discussing the advantages and disadvantages of podcasts as a
learning venue. In addition, we review important considerations to take into account
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while creating medical education content specifically for undergraduate medical
education.
CONCLUSIONS: This handbook highlights how students can effectively transform
textbook knowledge into an online resource that complements day-to-day medical
education. Putting students in a virtual setting where they are able to make decisions,
follow their curiosity, and arrive at the right conclusions, helps to develop well-rounded
medical students and future medical educators.
Keywords: Medical education, pediatrics, peer teaching, undergraduate, e-learning
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INTRODUCTION
Canadian medical schools are replacing traditional didactic lectures with interactive
problem-based learning. This shift reflects consensus among educators that active
inquisition and discovery is a more effective learning method than passive absorption.
This signals a shift toward student-centered-learning, which puts the onus on the
student to identify useful educational tools.
There is a deficiency of pediatric medical education in the general undergraduate
curriculum. Pediatrics is often taught longitudinally, with lectures sparsely distributed
throughout the preclinical and clinical curriculum. The resources available often
overwhelm students and this has compelled the creation of a comprehensive
educational tool to focus on the core objectives of undergraduate pediatric education
tailored to medical students.
PedsCases (www.pedscases.com) is a collaborative resource created for and by
medical students, which provides an opportunity for active self-directed learning. The
site engages students by inviting participation, either as authors or by contributing to the
discussion surrounding content. The premise of the website is that students create the
interactive cases, multiple choice questions, and podcasts, directed towards educational
deficiencies and the content is peer-reviewed by pediatricians to ensure validity,
accuracy and usefulness.
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Figure 1: Student and faculty partnership - PedsCases
PedsCases has been integrated into the third year undergraduate pediatric medical
education curriculum at the University of Alberta in Edmonton, Alberta, Canada. It is one
of the main sources recommended to students to cover the core objectives of the
clinical pediatric rotation and to assist in preparing for the final examinations. Since the
focus of medical education has shifted towards independent learning, PedsCases has
become an essential tool. Currently, PedsCases has 11 publications on the Association
of American Medical Colleges (AAMC) peer-reviewed publication service
MedEdPORTAL (www.aamc.org/mededportal) and 42,509 downloads of 22 podcast
episodes. The usage of PedsCases around the world signifies the widespread and
increasing use of online learning tools in undergraduate medical population.
Recently, the PedsCases team at the University of Alberta developed a handbook that
outlines the steps behind the creation of the core elements of the PedsCases:
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interactive clinical cases, multiple-choice questions, and podcasts. The objective of the
handbook is to provide a thorough overview of the creative and technical process
involved in order to create high-quality learning tools. The overall aim is to create a
comprehensive and practical handbook that will empower students to take initiative in
creating online learning resources for the benefit of themselves and their peers.
METHODS
The PedsCases contributors worked together on this project and drew upon prior
experiences and medical education theory to develop a handbook that carefully
summarizes the core elements of writing MCQs, podcasts, and clinical cases. Individual
members drafted a version of the handbook, which was then peer reviewed and verified
by members of the PedsCases Team, including the pediatric undergraduate education
director.
Figure 2: Collaborative student teaching and mentorship - PedsCases
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DESCRIPTION OF HANDBOOK
Clinical Cases
The purpose of a case is broader than simply testing facts and concepts. You need to
feel like you are in the situation itself – making decisions, following your curiosity, and
arriving at the right conclusions. A well-written case will be able to integrate that
practical experience with all of the important knowledge that a student should know for
the topic being presented.
1. Start Basic! Complete Your Research

Cases require background reading of textbooks, journals, and review
articles.
2. Organize Your Case

Organize your case to cover points such as patient history, physical exam,
and diagnosis. Each case is composed of 7-10 steps that cover initial visit
to discharge.
3. Write Your Case Objectives

Objectives cover exactly what the reader should be able to understand,
answer, or explain at the end of the case. Make sure objectives are clear
and concise.
4. Develop a Scenario

Think of a ‘real-life’ situation where your case may exist (e.g. family clinic,
pediatrician’s office etc.). Scenarios allow you to actively engage the
reader so they feel like they are making clinical decisions.
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5. Avoid Excess

One of your tasks is to filter the research and content you have to read
from your background research. Overloading the student with facts,
figures, and details will be overwhelming and counterproductive.
Each step of a case presents relevant information that will shed more light on the
patient you are working with. The steps should be presented in a logical order similar to
how you would deal with a patient in an actual clinic setting. A logical flow will allow the
case to unfold in an appropriate manner and therefore, ensure that the reader comes to
a conclusion that makes clinical sense.
Scattered throughout the case there should multiple-choice questions that challenge the
reader’s understanding of core concepts. Creating a successful multiple-choice question
demands many important considerations from the writer. Not only does the question
need to test the application of a concept but the distracters need to be effectively written
so that the reader is challenged with every option. A well-written multiple-choice
question resounds with the reader well after the case and guarantees that they fully
appreciate the idea being tested. (Refer to MCQ section of handbook)
In conjunction with the multiple-choice questions there needs to be thorough
explanations of not only the correct answer, but why the distracters were incorrect. Feel
free to be detailed, and spend time explaining concepts and ideas to their fullest. This
portion of the case is of the most value to your reader – it needs to be thorough and
comprehensive.
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Multiple Choice Questions
There are certain fundamental ways to make multiple-choice questions successful
indicators of knowledge. Wording, format, and question style noticeably differentiate
good questions from ineffectual ones. This section provides a brief overview of how to
construct effective multiple-choice questions including question mechanics and how to
test reasoning and application.

Keep Details in the Question
o The question stem should provide all necessary information. This allows
for the question to be read easily by the student1, 2, 3.

Utilize Consistency in Language
o Question stem, answer and distracters should have consistent tense,
units, pleurisy, subject-verb agreement, and length1, 2, 3.

Write Effective Distracters
o Distracters should be,

Plausible but incorrect

Correct but irrelevant to the question stated

Incorrect but relevant to the question stated3
Like in all circumstances, with multiple-choice questions we always aim to assess a
student’s comprehension of concepts, not rote memorization of facts. Testing broader
concepts will ensure that the material and content will remain with the student well after
the question is completed. In addition, testing concept allows for greater applicability of
the information compared to a detailed fact-based multiple-choice question. Questions
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that promote analysis and application better examine for understanding, versus
straightforward questions that require identification of recalled specifics.
Also, in similar fashion to clinical cases, incorporating the question into a clinical
vignette is a helpful method of testing application of knowledge. For instance, instead of
asking a precise question about disease X, provide a description of clinical
manifestations and ask the student to identify the most likely diagnosis.
An example of a knowledge-based question is as follows:
Which of the following drugs is the first line treatment for a school-aged child in
status epilepticus?
In contrast, here is a question that tests knowledge application via a clinical scenario:
You are working in the Emergency Department when EMS brings in a 9-year-old
boy presenting with a generalized tonic-clonic seizure that began 20 minutes
ago. He is receiving oxygen via mask and an IV was initiated in the ambulance
en route. Which of the following medications should be administered first?
Podcasts
As a learning venue, podcasts provide learners with the ability to access content
‘anytime, any-where’. This is their principal advantage as a learning tool. They are also
shorter and more focused than traditional lectures and provide another way to learn to
match individual learners’ preferences. In the end, the goal of a podcast is to provide a
concise overview of a topic.
1. Selecting a Topic
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
The first step is to choose an appropriate topic and consider your target
audience. Currently, PedsCases has created podcasts that reflect the
undergraduate pediatric curriculum.
2. Background Reading

Consult several different textbooks, journal articles, and lectures.
Pediatrics In Review and American Family Physician have comprehensive
review articles that provide an approach to various clinical presentations.
3. Writing a Script

The core elements of your script should include the following:
 Introduction
 History
 Physical Examination
 Specific Diagnoses
 Take-home points
4. Review

If you are a junior learner, you will need a staff physician to review your
script to ensure its validity, accuracy and usefulness as well as its
appropriateness for the target audience. You should find a physician to
help you before you do the research and write the script.
CONSIDERATIONS
There are several important considerations to keep in mind when creating medical
education content for medical students:
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1. AUDIENCE: Always keep your audience in mind when writing your case. PedsCases
is a tool for every medical student both pre-clinical and those in clerkship. Questions
should focus on key teaching principles at the medical student level, and not, for
instance, trivial details in the footnotes of a pediatric subspecialty textbook.
2. CLINICAL APPLICABILITY: Formulate each case based on diseases that are
relevant to the average medical student. Focusing your case on common
circumstances, presentations, and illnesses will ensure broad applicability. Using
teaching points can also be helpful since they focus on concepts that are important
during clerkship years. Write your case always keeping clinical relevance in mind.
Although integrating unique facts is fun, remember that you are writing the case to
challenge your reader’s clinical understanding of a problem.
3. EXPLANATIONS: What distinguishes an excellent question from a good question on
PedsCases, in large part, is the presence of a thorough explanation of why answers are
correct or incorrect. Construct a comprehensive description, as the true learning lies in
the rationalization. The more detailed your explanations are, the more knowledge can
be obtained by students using your cases, questions, and podcasts.
CONCLUSIONS & FUTURE DIRECTIONS
PedsCases is continually growing and expanding to address the needs identified by
medical students. Currently, wide ranges of podcasts are being recorded to
comprehensively address the key identified learning outcomes in undergraduate
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pediatric medical education. Furthermore, videos are being filmed to outline the core
procedural skills for medical students, including lumbar puncture, otoscopy, etc. In
addition, the volume of cases and questions is continually growing, as is the large
number of pediatricians participating in the site, both at the University of Alberta and
other institutions.
In regards to the handbook, we aim to verify its usefulness in the near future by
distributing the resource to past students and faculty contributors and surveying its
usefulness to these individuals. We also hope to open the content and information of
the handbook to other faculties that may benefit from high-quality online learning
resources. Since medicine is an inter-disciplinary profession producing relevant
interactive educational tools for nurses, physiotherapists, psychologists etc. will be
highly valuable in the overall evolution of teaching styles.
Current drawbacks to PedsCases include the large time commitment required to create
online learning resources. Conducting the background research, formulating objectives,
contacting physician editors etc. can be a long and difficult process. In addition, finding
adequate funding to support the continued growth of PedsCases can at times be
challenging.
On the other hand, one of the major strengths of PedsCases is that we are able to
tackle and address issues that are specific to the undergraduate medical student
population because PedsCases is a student driven initiative. As well, there are multiple
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learning modalities present on the website, which is open and accessible to students
across Canada and the globe. Lastly, as an online project the website is in a constant
state of growth, development and improvement meaning that the future of PedsCases
and pediatric medical education is bright.
Figure 3: Layout of PedsCases Website (www.pedscases.com)
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ACKNOWLEDGMENTS
The authors would like to acknowledge Dr. Dan Kozan for his technical support in
creating and supporting PedsCases. We would also like to thank the Office of
Undergraduate Medical Education and the Department of Pediatrics at the University of
Alberta for their continued personal and financial support in all of the endeavors
undertaken by the PedsCases team.
CONFLICTS OF INTEREST
There are no conflicts of interest to report.
SUPPORTING INFORMATION
The additional document provided with the manuscript is our most updated and
complete version of the PedsCases Content Production Handbook. The handbook
covers all of the topics discussed in the manuscript.
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REFERENCES
1.
Boland, RJ, Lester, NA, Williams, E. Writing multiple-choice questions. Acad
Psychiatry. 2010 Jul-Aug;34:4.
2.
Braddom, CL. A brief guide to writing better rest questions. Am J Phys Med
Rehabil. 1997 Nov-Dec;76:514-516.
3.
Collins J. Writing multiple choice questions for continuing medical education
activities and self-assessment modules. RadioGraphics 2006 Mar;26:543-551.
4.
NBME: Constructing written test questions for the basic and clinical sciences
[Internet]. Philadelphia: National Board of Medical Examiners; c2002 [cited 2010
Nov 24]. Available from: http://www.nbme.org
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