By: Karey Waters | Aquifer Communications & Insights Manager

Katherine C. Chretien, MD | Associate Dean for Student Affairs, Professor of Medicine | George Washington University School of Medicine and Health Sciences

Jennifer Bierman, MD | Clerkship Director, ECMH (Education Centered Medical Home), Associate Professor of Medicine | Northwestern University Feinberg School of Medicine

Students provide consistently high rankings for Aquifer at the end of each case as reported in our five-star rating feedback data, but how and when cases are integrated into the curriculum can have a significant impact on their learning. When we ask students to share what they think are the most effective ways their programs have used Aquifer cases, some clear themes emerge.

Link Cases to Other Learning

Faculty have long reported that the “magic happens” when Aquifer cases are used as a springboard for discussion or the basis for active learning activities. Assigning a block of cases as homework has value, but students appreciate when cases are paired with activities that extend the content and bring the cases to life. Aquifer cases lend themselves to a wide variety of learning activities and discussions to meet your learning objectives—in the clinic or the classroom.

“I like the synergy of correlating required Aquifer cases to the didactic schedule. This helps reinforce concepts already learned in the classroom or clinic. Seeing the content again in a different setting makes me more likely to remember the information and use it appropriately.” 

—Third-year Medical Student

Practical Tips

1. Link Cases Directly to Clinical Experiences.
   Aquifer cases naturally support in-person clinical learning. Encourage students to use the Patient Library to find specific cases to prep for a patient they will see, or learn more about on a condition that they encountered in clinic.
2. Replace Talking Head Didactics with Active Learning Sessions.
   Using Aquifer cases as a framework, create a case-based learning session to meet your needs–or take advantage of Aquifer’s ready-to-use teaching tools. These tools can also be a great framework for M4’s or residents to teach junior students and share their experiences. This method works well via Zoom or your video conferencing tool of choice. 
3. Build Clinical Skills
   Think of Aquifer cases as standardized patients and ask students to prepare oral case presentations, write a SOAP note related to the patient, or review the summary statements they write as part of their work inside the case. This method helps develop important clinical skills and provides a structure for faculty feedback. 
4. Use Cases as a Starting Point for Discussion.
   After students complete a case, discuss it as a group, or ask them to bring their questions to clinic. Extend the learning by asking “what if” questions to put a different twist on the case scenario (ie. “what if the patient had this symptom instead?” or “what if test results showed x?”). Build on the learning in the case through discussion, share faculty expertise, and additional articles and learning resources. 

Build Confidence in Clinic: Assign Cases Early

When students are hungry for clinical learning–in the pre-clinical years, while prepping for rotations, or early in their clerkships–they see big value in completing Aquifer cases.

Pre-clinical and clinical students alike note that the step-by-step process of a complete patient encounter delivered in the Aquifer cases is extremely helpful in learning what to expect, developing clinical reasoning skills, and practicing in a safe space before they go on the wards or start in the clinic. Assigning cases earlier in their learning can help build a foundation to scaffold future clinical learning and skills.

“I would honestly like my school to take more advantage of Aquifer earlier in the year, prior to rotations, and make it much more of a fundamental in the curriculum.”

—Fourth-year Medical Student

“Incorporating more cases earlier into the curriculum would help me feel more prepared (even as an M1) to see patients in clinic and present to my attendings.”

—Third-year Medical Student

Practical Tips

1. Bring Clinical Context to Basic Science Learning
   Integrate an Aquifer case into basic science or pre-clinical skills teaching sessions as a framework for case-based learning and help bring the basic sciences to life. Consider setting ‘cut points’, working through the case just until diagnosis, for example, to keep the content at a manageable level for early learners.  
2. Front-load Bread-and-Butter Cases
   Early assignment of select cases on the core conditions students are likely to see (or as pre-work) on a clerkship or clinical course builds confidence and helps students feel prepared. Assign additional cases–or let students select cases on their own–later in the course.

Space Assignments to Avoid Overload

Aquifer’s signature cases provide a detailed, in-depth patient scenario–with optional deep dives and references. Cases typically take 45 minutes to an hour for students to complete.

Students who are assigned a large number of cases at once (ie. complete all 40 Aquifer Family Medicine cases by the end of your clerkship) have reported some fatigue and information overload. Spacing your assignments, and giving rolling due dates, can help your students manage their “case load” and help them fully digest the information.

“There are some rotations that are giving 2-3 select cases a week, and I think that has been working well. Others have been assigning an ‘overwhelming amount’ which is hard to pay attention to after doing a few in a row.”

—Third-year Medical Student

Practical Tips

1. Allow Space for Self-Directed Learning
   Assign a core set of required cases, and then allow students to select cases on their own in the Patient Library to fill gaps in their learning or focus on a special interest.
2. Weekly Clinical Case Assignments
   Clinical students note a preference being assigned a few cases (2-3) per week to allow time to focus and digest the information during clinical rotations.
3. Adjust Pacing for Pre-clinical Students
   For a pre-clinical student, 1 case per week has been found to work well to allow early learners time for self-study.
4. Consider Rolling Due Dates
   If you’re assigning large blocks of cases during your course or clerkship, students prefer a few checkpoints along the way instead of a large block of cases due at the end of the course.

Share Your Perspectives

What has worked well for your students? Let us know—and share with your peers—by submitting a pearl.