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UNIVERSITY OF TORONTO MEDICAL JOURNAL
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 outline how to create these types of high quality online learning resources.
HANDBOOK PRODUCTION: The PedsCases editors and 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 clinical
cases, MCQs, and podcasts. 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.
HANDBOOK DESCRIPTION: 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 scenarios. The section on podcasts explains characteristics
that make a podcast unique from lecture and discussing the advantages and
disadvantages of podcasts as a learning venue. In addition, we review important
considerations to take into account while creating medical education content specifically
for undergraduate medical students.
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CONCLUSIONS: This handbook highlights how students can effectively transform
textbook knowledge into an online resource that complements day-to-day medical
education. Placing 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 a consensus among educators that active
inquisition and discovery are more effective learning methods than passive absorption.
This signals a shift toward student-centered learning, which puts the onus on the
student to identify useful educational tools.
Currently, there is a deficiency of pediatric medical education in the 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 resulted in 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 (MCQs), and podcasts, directed towards
educational deficiencies and the content is peer-reviewed by pediatricians to ensure
validity, accuracy, and relevance.
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Figure 1: Student and faculty partnership and collaboration - 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 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 the 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, MCQs, and podcasts. The objective of the handbook is to
provide a thorough overview of the creative and technical processes involved in the
creation of high-quality learning tools. The overall aim is to create a comprehensive
handbook that will empower students to take initiative in creating online learning
resources for the benefit of themselves and their peers.
HANDBOOK PRODUCTION & DESCRIPTION
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 clinical cases, MCQs, and podcasts. 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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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.
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. Explanations after each stage of the case
should be thorough and comprehensive since this part as the most value to your reader.
Multiple Choice Questions
There are certain fundamental ways to make multiple-choice questions successful
indicators of knowledge. Wording, format, and question style noticeably differentiate
great questions from ineffective ones. The MCQ section provides a brief overview of
how to construct effective multiple-choice questions including question mechanics and
how to test reasoning and application.
Like in all circumstances, with multiple-choice questions we always aim to assess a
student’s comprehension of concepts, not memorization of facts. Testing broader
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concepts will ensure that the material will remain with the student well after the question
is completed. In addition, testing concepts allows for greater applicability of the
information compared to a detailed fact-based MCQ. Questions that promote analysis
and application better examine for understanding, versus straightforward questions that
require identification of recalled specifics 1-4.
Podcasts
As a learning venue, podcasts provide learners with the ability to access content
‘anytime, anywhere’. 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, which covers all the important content that students must know.
Podcast scripts are usually the same length as a clinical case and cover elements such
as history, physical exam, differential diagnosis, and major take-home points. After
talking to multiple students we have discovered that podcasts that are brief, concise,
and relevant are more helpful in the long run in regards to retaining the core material.
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 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 pediatric medical education.
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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 always expanding, 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 relevance and applicability 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 such as nursing, physiotherapy, psychologists etc. Widespread use
of our handbook will ensure the continued success of student-centered and
independent learning.
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 since PedsCases is a student driven initiative. As well, there are multiple
learning modalities present on the website, which are accessible to students across
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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
undergraduate 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
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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 test 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; 2002 [cited 2010
Nov 24]. Available from: http://www.nbme.org
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