Definition

Learning issues are focused questions generated by the medical student about the diagnosis, pathogenesis, treatment, prognosis, or prevention of a patient's health problem. Students are expected to select and research learning issues regularly. Students are required to electronically submit a total of two (2) formal reports on learning issues to the campus administrator in Fargo, Barb Swann, at: bswann@medicine.nodak.edu.

Rationale

We anticipate that the process of selecting, researching, and reporting learning issues will aid in the development of the student's self-directed, lifelong learning skills in addition to building general medical knowledge.

Selecting a Learning Issue

• For each item on a patient's problem list, ask yourself:
  • What is the differential diagnosis? How are the possible diagnoses discriminated from each other?
  • What is the pathogenesis?
  • What are the treatment options? What are the potential benefits and risks of the various options relative to other options?
  • What is the prognosis?
• Questions you can't answer are potential learning issues.
• Select a question for formal study if it is of great importance to the patient, and/or if it is related to a high priority learning objective for the course.

Researching a Learning Issue

• Format your issue as a question about your patient .
• Select and find appropriate references.
  • Textbooks are best for very general questions.
  • Original literature sources are best for specific, focused questions.
  • Read with your question(s) in mind.

Format for Learning Issues

• Patient Summary (1 point)
• Necessary as the evaluator doesn’t receive the H&P. 
• Summarize, don’t regurgitate.  Briefly identify the patient issues prompting the question.
• Question (2 points)
• 1 point is given for the question’s presence.
• 1 point is awarded for question clarity.  Multiple issues reduce clarity.  Attempt to focus the question on what you want to know about your patient.
• Discussion (2 points)  Be brief and focused on the question and issues specific for your patient.
• Patient Reconnection (2 points)  Connect what you learned to the patient.  Based on what you learned, what is the patient’s prognosis?  Should an MRI have been obtained?  Should treatment x have been used rather than treatment y?
• Reference (1 point) If you used a summary source (e.g., Up-to-Date, Dyna Med) that is your reference, not the reference list from that source.
• Foreground Question (1 point)  A foreground question uses specific data from a journal article (usually) to address an issue, summary articles (i.e., a review) are not generally accepted as support for a foreground question.  (Generally, above expectation for third-year IM clerks.)
• Critical Review of Literature (1 point) This addresses the quality of the supporting literature, e.g., the patient population selection, study design, selection of outcome variables, data analysis, and study interpretation.  (Generally, above expectation for third-year IM clerks.)

Evaluation of Learning Issues

• Each student is required to submit a total of two (2) learning issues before the end of Week 8.
• An evaluation of these reports by Dr. William Newman will be included as a component of the evaluation of the student's portfolio.