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Mastering the cognitive knowledge within a field such as family medicine is a formidable task. It is even more difficult to draw on that knowledge, procure, and filter through the clinical and laboratory data, develop a differential diagnosis, and, finally, form a rational treatment plan. To gain these skills, the student often learns best at the bedside, guided and instructed by experienced teachers, and inspired toward self-directed, diligent reading. Clearly, there is no replacement for education at the bedside. Unfortunately, clinical situations usually do not encompass the breadth of the specialty. Perhaps the best alternative is a carefully crafted patient case designed to stimulate the clinical approach and decision-making. In an attempt to achieve that goal, we have constructed a collection of clinical vignettes to teach diagnostic or therapeutic approaches that are relevant to family medicine. Most importantly, the explanations for the cases emphasize the mechanisms and underlying principles, rather than merely rote questions and answers.
This book is organized for versatility to allow the student “in a rush” to go quickly through the scenarios and check the corresponding answers, as well as enable the student who wants thought-provoking explanations to take a slower path. The explanations are arranged from simple to more complex: a summary of the pertinent points, the bare answers, an analysis of the case, an approach to the topic, a comprehension test at the end for reinforcement and emphasis, and a list of resources for further reading. The clinical vignettes are purposely placed in random order to simulate the way that real patients present to the practitioner. Section II includes a listing of cases to aid the student who desires to test his or her knowledge of a certain area or to review a topic, including basic definitions. Finally, we intentionally did not primarily use MCQ format because clues (or distractions) are not available in the real world. Nevertheless, several MCQs are included at the end of each scenario to reinforce concepts or introduce related topics.
Each case is designed to simulate a patient encounter with open-ended questions. At times, the patient’s complaint is different from the most concerning issue, and sometimes extraneous information is given. The answers are organized with four different parts.
1. Summary. The salient aspects of the case are identified, filtering out the extraneous information. Students should formulate their summary from the case before looking at the answers. This is in bullet form now. A comparison to the summation in the answer will help to improve their ability to focus on the important data, while appropriately discarding the irrelevant information—a fundamental skill in clinical problem solving.
2. A Straightforward Answer is given to each open-ended question.
3. The Analysis of the Case, which comprises two parts:
Objectives of the Case: A listing of the two or three main principles that are crucial for a practitioner to manage the patient. Again, the students are challenged to make educated “guesses” about the objectives of the case upon initial review of the case scenario, which helps to sharpen their clinical and analytical skills. We have included the EPA(s) corresponding to the objective for instructors and curriculum overseers (see Table 1).
Considerations: A discussion of the relevant points and a brief approach to the specific patient.
The Approach to the Disease Process, which has two distinct parts:
Definitions or Pathophysiology: Terminology or basic science correlates that are pertinent to the disease process.
Clinical Approach: A discussion of the approach to the clinical problem in general, including tables, figures, and algorithms.
The Comprehension Questions for each case is composed of several multiple-choice questions that either reinforce the material or introduce new and related concepts. Questions about material not found in the text have explanations in the answers.
Clinical Pearls list several clinically important points that summarize the text and allow for easy review of the material, such as before an examination.