Dungeons and Dragons in the Pathology Lab:Increasing Strategic Thinking and Engagement Through Unfolding Cases

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Purpose: In the past decade, the focus of medical education has shifted, leaving behind an outdated cluster of memorized facts for an improved model based on clinical applications. This encouraged medical schools to adapt their curricula to accommodate new requirements for core competencies. Pre-clinical courses have followed suit, focusing more on how the initial basic science concepts translate into clinical practice. This provides the medical students with a clearer perspective of the topics’ relevance in their future careers. Here, we showcase a model with an incomplete scenario that unfolded based on students’ choices and served as a platform to develop strategic thinking and facilitate engagement and learning.

Methods: A class of 135 medical students was separated into two groups that participated at different times in a pathology lab session. During each session, the students received an incomplete clinical case to be discussed as small-groups and asked to propose differential diagnosis. The faculty then led a discussion, debating their reasoning, after which a list of next steps was offered to the students to choose from. The list ranged from simpler options, such as further exploring patient’s history and physical exam, to more complex laboratorial testing, including biopsies, radiological testing and forensic examinations. Each small-group would then choose their preferred next course of action, as long as they debated their reasoning and expected findings with the faculty, who would further discuss how the initial differential diagnosis would evolve based on each new finding. The case would then unfold based on students’ choices. As it progressed, each finding served as a platform of discussion of pathological concepts and specimens. A pathology quiz with 15 questions was given at the beginning and end of the session to assess students’ learning curve.

Results: Although the same concepts were discoursed with both classes, the order in which the case developed was a direct consequence of the student’s choices, determining the fate of the discussion and providing a uniqueness to each session. Students felt in control, more willing to participate and were highly engaged. Realizing the impact of their actions on the fictional patient, the students brainstormed strategies before any decision. The number of students involved with distractors, such as in-class use of social media, drastically reduced during these sessions. A positive impact on quiz performance was seen on percentage of correct responses from pre- to post-quiz (Group1: 75.61% to 97.96%; Group 2: 77.60% to 99.86%). At the end-of-course evaluation, although no specific question targeted this session, students provided a series of positive comments about it in the written qualitative evaluation, such as “increased engagement”, “enhanced productivity”, “facilitation of group activity”, “more helpful” and “entertaining”.

Conclusion: End-of-course evaluation and student feedback suggest that the method was well received by many students, who agreed it made the session more interactive and increased engagement. The sessions’ design encouraged a more accountable decision-making process. The process had a positive impact on post-quiz performance, being interpreted as an effective teaching method. Further studies are necessary to verify superiority of this modality.

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