title: Using National Health Care Databases and Problem-Based Practice Analysis to Inform Integrated Curriculum Development.
abstract: One challenge when implementing case-based learning, and other approaches to contextualized learning, is determining which clinical problems to include. This article illustrates how health care utilization data, readily available from the National Center for Health Statistics (NCHS), can be incorporated into an educational needs assessment to identify medical problems physicians are likely to encounter in clinical practice. The NCHS survey data summarize patient demographics, diagnoses, and interventions for tens of thousands of patients seen in various settings, including emergency departments (EDs), clinics, and hospitals.Selected data from the National Hospital Ambulatory Medical Care Survey: Emergency Department illustrate how instructional materials can be derived from the results of such public-use health care data. Using fever as the reason for visit to the ED, the patient management path is depicted in the form of a case drill-down by exploring the most common diagnoses, blood tests, diagnostic studies, procedures, and medications associated with fever.Although these types of data are quite useful, they should not serve as the sole basis for determining which instructional cases to include. Additional sources of information should be considered to ensure the inclusion of cases that represent infrequent but high-impact problems and those that illustrate fundamental principles that generalize to other cases.
authors.affiliation: A.J. Baker is senior test construction analyst, Test Development Services, National Board of Medical Examiners, Philadelphia, Pennsylvania.M.R. Raymond is research director and principal assessment scientist, Research and Discovery, National Board of Medical Examiners, Philadelphia, Pennsylvania.S.A. Haist is vice president, Test Development Services, National Board of Medical Examiners, Philadelphia, Pennsylvania.J.R. Boulet is associate vice president, Research and Data Resources, Foundation for the Advancement of International Medical Education and Research, Philadelphia, Pennsylvania.
authors.forename: Amy J
authors.initials: AJ
authors.lastname: Baker
authors.forename: Mark R
authors.initials: MR
authors.lastname: Raymond
authors.forename: Steven A
authors.initials: SA
authors.lastname: Haist
authors.forename: John R
authors.initials: JR
authors.lastname: Boulet
mesh_terms: D000554:Ambulatory Care Facilities; D003479:Curriculum; D016208:Databases, Factual; D004501:Education, Medical / Q000379:methods*; D004636:Emergency Service, Hospital; D019538:Health Care Surveys; D006296:Health Services / Q000706:statistics & numerical data*; D006760:Hospitalization; D006801:Humans; D009309:National Center for Health Statistics, U.S.; D020380:Needs Assessment; D010342:Patient Acceptance of Health Care; D018794:Problem-Based Learning / Q000379:methods*; D014481:United States