Added value using video in case-based learning (CBL) in pain treatment education

[Abstract] 

Keywords: Experimentation in education, limits of medicine, philosophical approach, using video to reflect together with students, both on communication and challenges in educating and transforming how and what doctors should talk to patients about, online teaching and learning, using video dramatization and re-enactment in the clinic. CBL, case-based learning, dispersing updated knowledge,  

[Introduction] 

In medical training the use of cases in a problem-based learning context is a common and well-known way of teaching. However, when transforming this type of teaching into an online setting, what do you do?  

Over the last 2 years, “45” videos have been produced as a part of an extensive project focusing teaching on Pain treatment. The goal is to reach a diverse multidisciplinary audience through online courses, both students, patients, general practicioners/doctors and other health care practitioners. Since the real-life experience in the clinic is the basis for treatment on the subject, these experiences also make up the raw material for the case-videos. Using real-life scenarios and re-enacting them using video, there is also a possibility to take a closer look at ambiguous situations occurring in the clinic together with a group of students. 

In this paper we will look at 3 different videos produced and how they were used in an e-learning course. 

The national center for “…complex illness” the St Olavs hospital in Trondheim, Norway, has been in the forefront of both teaching and education on pain treatment for many years. As a part of the practice as an integrated university hospital, teaching and research is an important part of the activity at the center, with teaching of clinical methods for treatment of different conditions of pain, also “untreatable pain” or chronic pain as main focus. 

When teaching different pain condition to a variety of audiences, the topic of pain treatment has to be presented in many different ways. Both to regular students and doctors working. An important argument for creating online courses, and using new technology, is reaching a larger audience and getting cost-efficient education and avoiding time-consuming weekend courses for doctors working. 

The core challenge in pain treatment therapy is to introduce non-medical treatment techniques, varying from communication skills to use of physiotherapy and psychological techniques such as ACT (acceptance and commitment therapy). The major use of opioids in the US har resulted in an epidemic-like crisis, were the medicines made to help different conditions of pain creates bigger problems like drug-addiction.  

Patients with chronic pain conditions usually have toured different clinics and various types of treatment, where the pain clinic is the last stop. No more treatment is given, in terms of surgery or use of medicines. These patients have reached the limits of traditional medicine, where doctors don’t know how to help them. Communicating this to a patient-group or even to students in medical training can be challenging and raise many questions and reflections.  

What is CBL? 

CBL is a teaching tool used in a variety of medical fields using human cases to impart relevance and aid in connecting theory to practice.  

Other human health-related fields have also recognized the value of illustrating teaching points with actual cases or simulated cases. Using clinical cases to aid teaching has been termed as case-based learning (CBL). (McLean, 2018) 

[Pedagogical design] 

Using case-based learning the possibility for a dialogue between teachers and the students on open ended questions where there is necessarily not an easy answer. Both in an online context and an auditorium setting, videos will be a very effective and productive starting point stirring up emotions that can trigger discussions. “Video is superior at creating engagement and setting the stage for learning, even though the video itself may not contain the new information people are supposed to learn.” (Schwartz, Hartman 2007)  

In a test phase the videos produced were used in the classroom, were an educator presented the case-videos as a part of multidisciplinary teaching. Afterwards the students were to discuss and reflect upon the patient/therapist-dialogue and give feedback using an online tool which was presented on a screen in the classroom (Mentimeter, menti.com). For the educators the group of students proved a useful test group when converting this to an online setting, where the range of feedback could be tested. What the educators discovered was that the reception of the videos functions as effective triggers for a subsequent discussion (Schwartz, Hartman 2007, s. 11) The intensity of the subsequent disscussion could be labeled as engagement.  

Engagement may be characterized as the pull that brings people to a situation or topic and keeps them involved. Engagement creates the mental context that prepares people to learn. (Schwartz, Hartman 2007)  

Thus, videos creating engagement can be used in addition to other learning material, using different modalities, to benefit from the pull that is described in the quote above.  

“If the lecture videos do not play to the strengths of the media of moving images, otherwise a different medium, such as books or presentation slides, may be more suitable to transfer the knowledge presented.” (Reuteman, 2018) We see that if case-videos are produced in a proper and engaging way, and play on the strengths of moving images, they can be used effectively in a socio-cultural learning context. Avoing the more common use of lecture videoes solely for transfering knowledge. [ref. læringsteori] 

[Examples of videos produced] 

In a test-phase, students in regular classes… [Astrid fyller inn] 

So, even though the videos could present dialogues where the doctor gave the patient an inadequate or wrong approach, this was corrected by the audience in the auditorium. This example could point to how prior knowledge in the subject is important when assessing a video-case.  

«The explicit discussion of misconceptions seems to be an effective learning strategy whether the students actually hold the misconceptions or not» (Muller et al, 2008) 

Use of video in online education 

Video is very often an integrated part of online education, as a result video production is often the first stop when teachers want to create online learning. As a recommendation this is maybe not the best way to go about it, since this often results in a lack of planning of the course material. But, in this case, using video as a mean to discuss open-ended topics with students before creating the online content, could also be a way of involving student feedback in the production process, and opening up for discussion about topics relevant for the online learning. And contributing to a more informed production of engaging content when converting ordinary teaching to an online setting.  

Using video in case-based online learning may contribute to using video in combination with text and illustrations and putting weight to the affordances of the different mediums [ref]. 

Where video is, as we argue above, very effective in creating engagement and preparing students for learning. Also facilitating for social interaction on an online platform through discussion on real-life situations in the clinic.  

Doing this requires a great deal of consciousness on how the message is perceived and putting it into context. The limitations of medicine could also be a productive message for students to be aware of, as health is more than just treating illness, it is about quality of life.  

[Discussion] 

[Conclusion] 

Added value using video in case-based learning (CBL) in pain treatment education  

[Abstract] 

Keywords: Experimentation in education, limits of medicine, philosophical approach, using video to reflect together with students, both on communication and challenges in educating and transforming how and what doctors should talk to patients about, online teaching and learning, using video dramatization and re-enactment in the clinic. CBL, case-based learning, dispersing updated knowledge,  

[Introduction] 

In medical training the use of cases in a problem-based learning context is a common and well-known way of teaching. However, when transforming this type of teaching into an online setting, what do you do?  

Over the last 2 years, “45” videos have been produced as a part of an extensive project focusing teaching on Pain treatment. The goal is to reach a diverse multidisciplinary audience through online courses, both students, patients, general practicioners/doctors and other health care practitioners. Since the real-life experience in the clinic is the basis for treatment on the subject, these experiences also make up the raw material for the case-videos. Using real-life scenarios and re-enacting them using video, there is also a possibility to take a closer look at ambiguous situations occurring in the clinic together with a group of students. 

In this paper we will look at 3 different videos produced and how they were used in an e-learning course. 

The national center for “…complex illness” the St Olavs hospital in Trondheim, Norway, has been in the forefront of both teaching and education on pain treatment for many years. As a part of the practice as an integrated university hospital, teaching and research is an important part of the activity at the center, with teaching of clinical methods for treatment of different conditions of pain, also “untreatable pain” or chronic pain as main focus. 

When teaching different pain condition to a variety of audiences, the topic of pain treatment has to be presented in many different ways. Both to regular students and doctors working. An important argument for creating online courses, and using new technology, is reaching a larger audience and getting cost-efficient education and avoiding time-consuming weekend courses for doctors working. 

The core challenge in pain treatment therapy is to introduce non-medical treatment techniques, varying from communication skills to use of physiotherapy and psychological techniques such as ACT (acceptance and commitment therapy). The major use of opioids in the US har resulted in an epidemic-like crisis, were the medicines made to help different conditions of pain creates bigger problems like drug-addiction.  

Patients with chronic pain conditions usually have toured different clinics and various types of treatment, where the pain clinic is the last stop. No more treatment is given, in terms of surgery or use of medicines. These patients have reached the limits of traditional medicine, where doctors don’t know how to help them. Communicating this to a patient-group or even to students in medical training can be challenging and raise many questions and reflections.  

What is CBL? 

CBL is a teaching tool used in a variety of medical fields using human cases to impart relevance and aid in connecting theory to practice.  

Other human health-related fields have also recognized the value of illustrating teaching points with actual cases or simulated cases. Using clinical cases to aid teaching has been termed as case-based learning (CBL). (McLean, 2018) 

[Pedagogical design] 

Using case-based learning the possibility for a dialogue between teachers and the students on open ended questions where there is necessarily not an easy answer. Both in an online context and an auditorium setting, videos will be a very effective and productive starting point stirring up emotions that can trigger discussions. “Video is superior at creating engagement and setting the stage for learning, even though the video itself may not contain the new information people are supposed to learn.” (Schwartz, Hartman 2007)  

In a test phase the videos produced were used in the classroom, were an educator presented the case-videos as a part of multidisciplinary teaching. Afterwards the students were to discuss and reflect upon the patient/therapist-dialogue and give feedback using an online tool which was presented on a screen in the classroom (Mentimeter, menti.com). For the educators the group of students proved a useful test group when converting this to an online setting, where the range of feedback could be tested. What the educators discovered was that the reception of the videos functions as effective triggers for a subsequent discussion (Schwartz, Hartman 2007, s. 11) The intensity of the subsequent disscussion could be labeled as engagement.  

Engagement may be characterized as the pull that brings people to a situation or topic and keeps them involved. Engagement creates the mental context that prepares people to learn. (Schwartz, Hartman 2007)  

Thus, videos creating engagement can be used in addition to other learning material, using different modalities, to benefit from the pull that is described in the quote above.  

“If the lecture videos do not play to the strengths of the media of moving images, otherwise a different medium, such as books or presentation slides, may be more suitable to transfer the knowledge presented.” (Reuteman, 2018) We see that if case-videos are produced in a proper and engaging way, and play on the strengths of moving images, they can be used effectively in a socio-cultural learning context. Avoing the more common use of lecture videoes solely for transfering knowledge. [ref. læringsteori] 

[Examples of videos produced] 

In a test-phase, students in regular classes… [Astrid fyller inn] 

So, even though the videos could present dialogues where the doctor gave the patient an inadequate or wrong approach, this was corrected by the audience in the auditorium. This example could point to how prior knowledge in the subject is important when assessing a video-case.  

«The explicit discussion of misconceptions seems to be an effective learning strategy whether the students actually hold the misconceptions or not» (Muller et al, 2008) 

Use of video in online education 

Video is very often an integrated part of online education, as a result video production is often the first stop when teachers want to create online learning. As a recommendation this is maybe not the best way to go about it, since this often results in a lack of planning of the course material. But, in this case, using video as a mean to discuss open-ended topics with students before creating the online content, could also be a way of involving student feedback in the production process, and opening up for discussion about topics relevant for the online learning. And contributing to a more informed production of engaging content when converting ordinary teaching to an online setting.  

Using video in case-based online learning may contribute to using video in combination with text and illustrations and putting weight to the affordances of the different mediums [ref]. 

Where video is, as we argue above, very effective in creating engagement and preparing students for learning. Also facilitating for social interaction on an online platform through discussion on real-life situations in the clinic.  

Doing this requires a great deal of consciousness on how the message is perceived and putting it into context. The limitations of medicine could also be a productive message for students to be aware of, as health is more than just treating illness, it is about quality of life.  

[Discussion] 

[Conclusion] 

Trying to define .. 

Trying to define ..