Problem Case Analyses (PCAs)

 

This is when you and your trainer discuss a case in which you yourself have identified a problem (hence problem case). For instance, you might have had a difficult consultation with a lady with migraines who has tried a few things but still not getting relief. Bringing this to the attention of your trainer might result in a tutorial on migraines, or the diagnosis of headaches, or the use of prophylactic medications in migraine.

 

 

 

 

Random Case Analyses (RCAs)

 

Random Case Analyses are different to PCAs. This is where you and your trainer sit together and look at a morning or afternoon surgery. Your trainer then randomly picks a case and you brief him/her about it and any difficulties you had. Throughout the discussion, you may become aware of issues you previously hadn't considered or didn't realise. Random Cases explore these previously unidentified issues which would have remained undiscovered if only a Problem Case Analysis approach was used.

 

 

To help you understand this further, let's look at something called JoHari's Window.

 

 

 

The JoHari Window

 

Named after two guys called Joe and Harry (Jo-Hari). This is what it looks like. Don't be frightened of it. Actually, it's quite easy to understand and will help you to understand why we use certain teaching methodologies and help you "hook" into them.

 

Okay, so what does all this mean?

 

The SELF axis is you; the GROUP axis is (let's say) your trainer. What this window says is that there are

 

1. things that BOTH YOU AND YOUR TRAINER KNOW about you (=ARENA) eg right at the start of your post, you might have explicitly said that you're not very good with dealing with mental health problems.

 

2. things which YOU DON'T KNOW but which your TRAINER DOES know about you (=BLINDSPOT) eg you might think you're good at dealing with female related problems but your trainer knows you're not (either from a third person like another doctor with an interest in women's health problems who has seen some of your patients or even the trainer himself)

 

3. things YOU KNOW which your TRAINER DOESN'T KNOW about you (=FACADE) eg "I'm not very good at headaches but I can get by; but my trainer doesnt know that"

 

4. finally, things which BOTH OF YOU DON'T KNOW (as yet) about you (=UNKNOWN) eg you might think you're pretty good at dishing out the oral contraceptive pill, and your trainer thus far hasn't seen any concerns relating to this; but the truth of the matter is that you might not be doing a full enough assessment or you might be doing something based on old guidelines

 

So, if we look at the window again, we need a method which expands box 1 (the arena) where both of you know what your learning needs are and one which reduces the size of box 4 (the unknown).

 

Through discussion and self disclosure, random case analyses are a great way of giving insight into issues that were not previously concieved. For instance, there may be a case where you might say "Oh, this particular case was okay. It was just she had a bit of a cough and it was easily sorted out."

 

A further discussion might then reveal that you had given antibiotics for a tonsillitis (which you thought was okay) but the trainer then focuses on the evidence as to whether they make a difference. This is something you might not have considered.

 

You both look up the evidence on the internet and find that antibiotics in tonsillitis make a difference of only half a day compared to those in whom it was not given.

 

This now alters your behaviour (you decide only to give antibiotics in tonsillitis if the patient looks ill rather than giving them willy nilly) and is now one less learning need: hence reducing the size of the "UNKNOWN" and increasing the size of the "ARENA" (or put another way random case analyses bring previously UNKNOWN issues into the ARENA).

 

The diagram below illustrates this.

 

We hope you can see the value of random case analyses and that you'll engage with them.