Editor’s Notes: Aquifer cases can form the basis for a huge variety of classroom sessions that can be easily adapted for virtual learning via Zoom, Webex, Microsoft Teams, or any other collaboration platform. Here are some suggestions to help spark your creativity if you are designing your own activity. Remember to allow students enough time to complete the cases in advance–most cases take 45 minutes to an hour. 

The Aquifer Educators Consortium has also developed a variety of ready-to-use teaching tools, included with your subscription, to support active learning sessions. 

By: Petra J. Lewis, MD | Professor of Radiology | Geisel School of Medicine at Dartmouth College

Suggested Strategies

Flipping the classroom can be done in a variety of ways.

• Prepare for clinic: Assign specific cases for students to review before a clinic that is likely to have one or more patients with these disorders (e.g., asthma, COPD). Using appropriate patients as the focus points, see how the student can integrate the key learning points from the case into patient assessment and management. Ask about differences and similarities between the actual cases and the Aquifer cases.
• Replace didactic material: Assign students cases containing topics you would normally cover during that didactic session and use the classroom time to go deeper into the topic–to discuss different but related cases or to discuss one or more of the assigned cases in more detail.
• Question pairs: Have one student ask another student a question based on something they learned from the case.
  • Questions should be developed during the pre-work. Students may need encouragement to make sure questions are not too simple.
  • Consider asking students to submit written questions, which you then randomly assign.
  • Can they write a question based on another case they know on this topic?
• Poll-repoll: Have students respond to a multiple-choice question individually, then allow 2 minutes for discussion of the answer with a partner, then ask them to resubmit their answer. This works especially well with a large group.
• Structured controversy: Recent changes in preventative health management, imaging, and screening. Debate both sides of the question.
• Jeopardy: This is a good exercise to consider for the end of the clerkship after students have reviewed a number of cases. Categories may be based on particular cases or topics.
• Polling type questions: Use questions in the cases that have more than one right answer. Ask students to defend their answers or critique the alternatives. Can be used with groups, pairs, or individuals.
• Compare and contrast 1: Ask students to compare/contrast certain disease presentations and treatments suggested by the cases
• Compare and contrast 2: Ask students to compare/contrast the “real world” with the virtual patient and evidence-based medicine. (i.e., Can you think of a time in this rotation/prior rotations  that a patient presented/was treated differently than this virtual patient?)
• Have students write a mini case on a given topic in the case-this extends their learning beyond what is presented to them.  
• “What if?” applications for the local system: Ask students to work out local systems for common problems (e.g., antibiotic sensitivities, social services, finding medication doses, etc.)