A Case‐Based Learning Module On Acute Ischemic Stroke Using Donated Medical Records

Pathological findings during anatomy dissection labs are common, yet medical records are rarely donated to give insight into how pathologies affected donors during their lives. Case‐based learning from medical records can enhance students’ learning experience by integrating clinical and basic science knowledge in a realistic scenario, and are valuable education resources to supplement traditional learning. An informal survey of MedEd Portal revealed a lack of active learning modules on acute ischemic stroke, which is the fourth leading cause of death in the United States. A case‐based learning module was created for students in health sciences programs to integrate knowledge from classes like neuroanatomy, gross anatomy, and clinical instruction using medical records from a donor with acute ischemic stroke and an 18mm basilar artery aneurysm. The donor family and the State Anatomical Board of Colorado approved the release of these records for use in the learning module. The interactive module was created in Articulate Storyline, which allows users to create a web of slides that students can easily navigate, and runs in web browsers for compatibility on Mac and Windows machines. 3D models of the brain were rendered using photogrammetry in Agisoft Photoscan Pro and animated in Blender. Photogrammetry is a process that generates a dense point cloud and texture model using principle components of 2D images taken around a 3D structure. Our module contains 84 slides that are separated into 12 scenes, and takes approximately 65 minutes for learners to navigate. 26 multiple choice and discussion questions are distributed throughout the module, allowing for formative self‐assessment by the learner. Students may use the module individually, but small groups (3–4 people) are recommended to facilitate discussion. Throughout the interactive learning module, students must choose which tests are appropriate for an acute ischemic stroke patient based on clinical presentation and a realistic timeline. The clinical recommendations are based on current guidelines from the American Heart Association and American Stroke Association. As students progress through the case, they view the test results taken from the patient's medical records, and use those results to formulate a care plan. At the end of the module, students observe images and a 3D model of the donor's brain to visualize the morphological changes that the brain aneurysm caused. Students use the models and their knowledge of the underlying neuroanatomy and gross anatomy to answer questions about the structures that were injured as a result of the stroke. Meta‐analysis studies of curricula utilizing case‐based learning show that these active learning strategies significantly increase students’ program evaluation ratings and clinical performance. Our case‐based learning module, developed using a real patient's medical records as well as donor post‐mortem brain images and interactive 3D models, provides an authentic clinical learning experience to supplement basic science training in neuroanatomy and gross anatomy. Small student groups involved in pilot tests reported overall enjoyment of our module, and especially cited the 3D models as positively affecting their experience. The module will soon be used in a graduate level anatomy course, where its overall efficacy, including improvements to immediate recall and long‐term retention, as well as the students’ attitudes toward the experience, will be formally evaluated. 1Learning module user interface.23D brain model showing an 18 mm basilar artery aneurysm.3Multiple choice question using 3D brain model and illustrated trigeminal nerve nuclei