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Upstate Medical university Case Study

Overview of the MLC



What do these courses consist of?

The essence of the courses are the reading of a series of cases from the medical literature. The cases for the year are available on the SUNY Health Sciences Library website. The cases are to be read with the overall objective “to understand and be able to explain what happens and what is discussed.” To this end students will find it necessary to consult reference texts and other resources to fill in gaps in their knowledge.  In some instances, supplemental readings will be assigned to highlight or deepen understanding of aspects of basic science suggested by the case. The task is potentially daunting and students will find it useful to form study groups with their peers outside of class time to discuss issues raised by the cases and to share information and insights. The level of student understanding will be assessed by quizzes and by analysis of written assignments including a “pathophysiologic hypothesis” required of each student on each case. Class time will largely consist of student questions to faculty members about issues that they were not able to satisfactorily resolve independently.

What are the tasks for students?

Students are assigned to read the cases in their entirety with the overall objective “to understand and be able to explain the underlying mechanisms of what happens to the patients and the rationale for what is done or discussed by the authors.” Students work independently or with peers to fill in the background necessary to achieve this understanding via reference texts and other information resources. Students are instructed to direct themselves toward a number of guiding objectives while studying the cases.

The student’s overall objective is “to understand and be able to explain what happens and what is discussed” in the case reports. The student will not be expected to “solve” the cases (i.e., make a diagnosis or determine appropriate management). Since the student will have the entire published report on each case, it is merely a matter of reading the report of how experts do these things and filling in the background information that allows one to follow along.  To this end, the student should pursue the following specific objectives:

  • Define all terms used in the case presentation and discussion.
  • Make notes on the facts of the case in standard format for case write-up.
  • Make a problem list. Attempt to group findings into pathophysiologic syndromes.
  • Generate a differential diagnosis for each of the patient’s major problems at each stage of the clinical presentation and relate the clinical data and further workup to sorting among the diagnostic possibilities.
  • Determine the basis for interpretation of any special studies used in the work-up of the case or in furthering the study of the disease in question.
  • Determine the mechanism of action and rationale for each drug or other therapeutic intervention used in the case.
  • Summarize the prototypical features of each disease in the differential diagnosis suggested by the discussant in the case report.
  • Outline the author’s reasoning in discussing the diagnostic hypotheses or the results of the study.
  • Construct a “pathophysiologic hypothesis” to account for the clinical findings based on the patient’s underlying diseases.  

Medical school program objectives related to the courses


Relationship of course objectives to medical program objectives and assessment


How are students evaluated?

Student evaluation is primarily through the use of multiple quizzes related to each case and associated readings. In addition to the quizzes, students will have various assignments including a “pathophysiologic hypothesis” for each case.


Students are given to understand that most class sessions will begin with a quiz prior to any discussion of the case. The quizzes in this course are mostly multiple-choice question format, a format most suitable for testing recall of information (open-ended short answer formats are also to be expected). Aware of this, we have designed the quizzes with features that emphasize participation in the process rather than assessment of general content knowledge.  Our assumption is that participation in itself will likely assure achievement of the course goals. The features to insure participation include first, the use of “open notes” quizzes. The “open notes” format changes the student’s task from memorizing facts to recording an adequate path of study in their attempt to understand the case.  Students’ handwritten notes are records of what has been investigated and using this testing method to encourage students to take notes as they study is a means of forcing elaboration of ideas. A second feature of the quiz design is that the quiz questions themselves have a certain format that emphasizes focus on the particular case. A general rule we have used in making questions is that the stem of each item should include the phrase “in this patient.” Even a knowledgeable physician should not be able to answer the questions without having read the case because the question is not simply about a general piece of information; it is about information or concepts as applied to the specific case. Examples of quiz questions can be found on the course web site.

The quizzes related to each case cover the specific objectives listed previously. All class discussion on general or case-specific objectives will come after the quiz related to them. Students are told not to go to instructors for individual help. One fundamental idea of this course is to learn how to gather, structure and evaluate information independently.

“Pathophysiologic Hypothesis"

An important component of the course is having students construct written hypotheses that specify the mechanisms of disease explaining clinical phenomena in the cases. Each student must submit a “pathophysiologic hypothesis” for each case, which consists of a diagram and explanatory text showing the causal relationships between the underlying disease and the clinical manifestations in the patient. The emphasis is on mechanisms at the level of organ system dysfunction (pathophysiology).

The objective is to force exploration of relationships and identification of gaps in understanding that require further study. The assignment of creating the “pathophysiologic hypothesis” leads students to elaboration of ideas both because of the nature of the assignment itself and because it encourages peer collaboration (although individual students are ultimately responsible for their own understanding of the cases).

Instructions and examples are found on the course website under "Sample Case Experience."

What happens in the class sessions?

Class sessions are large group format (i.e., involve the entire class of approximately 150 students in an auditorium with one faculty discussion leader).  A typical case has three class sessions devoted to it with a range in recent years of two to eight sessions. Each case features an initial session with a physician, ideally a specialist in the area of main focus, to give a clinical perspective. Additional sessions are designed to focus on the pathophysiologic mechanisms operative in the case and to explore the state-of-the-art of selected basic science issues raised by the case (see "Sample Case Experience" for an example of assignments and activities in class sessions related to a case).  These sessions are led by faculty members from the relevant basic science or clinical departments.  The basic science sessions often feature additional reading assignments from the current medical literature around which the sessions are organized. Faculty are encouraged to give a brief account of their perceptions about the case or reading assignment. The remaining time in class is ideally a discussion driven by student questions about issues they could not resolve on their own, or if necessary, by faculty posing questions to the students to make certain that there is general understanding. Lecturing from prepared slides is actively discouraged.