DC for Clients and Facilitators

Diagnostic Challenge Case Characteristics

A Diagnostic Challenge case:

  1. Requires and stimulates students to learn independently.
    Students should not be overly dependent on the advice and expertise of college faculty to work through their case.  These specialists / experts will not be so accessible when the students are no longer in the university environment. We must also be careful not to impose new burdens on these very busy people.
  2. Has good Differential Diagnoses.
    A good DfDx list requires students to learn about other conditions in order to rule them out.  It also forces them to prioritize as they develop a diagnostic plan.  Even if the final diagnosis is fairly uncommon, we would like for the initial presentation to represent a more common problem so that students must consider the possible DfDx's  (e.g. vomiting in a cat).
  3. Must be multi-step.
    A diagnosis is not possible after a single submission and ideally should require three submissions.
  4. Should NOT represent a disease or condition that has ALREADY been covered well in lecture or laboratory.
  5. Requires students to apply basic concepts and information learned previously to a new case.
    A DC case should require students to INTEGRATE. e.g. interpretation of a CBC, proper collection of a culture sample, biopsy
  6. Does NOT have to represent a case one of us actually worked on.
    DC cases can be built as composites from the literature, taken from case reports, and developed using records from the diagnostic lab or teaching hospital.
  7. Is often built around one or more basic concepts.
    (e.g. DIC, pathogenesis and Dx of deep mycotic diseases, etc)
  8. Is not overly dependent on physical findings.
    "Paper" cases in which students are not able to actually see the animal do not simulate these aspects of the case well.
  9. Requires the use of multiple diagnostic tests and/or procedures.
    Exposure to new tests such as radiography & ultrasound, interpretation of test results such as antibody titers, and "quandaries" about which test or procedure is most likely to be rewarding are good. Whenever possible, it is best to be able to give students results in the form they will receive them in practice and, at least initially, not to provide interpretation (e.g. give them the radiograph). Interpretations can be provided later in the form of arranged consultations (e.g. meeting with a radiologist) or written reports (e.g. a written cytology report).
  10. Is not dependent on a single finding, especially if that finding might be discovered fortuitously.
  11. Has built in "dilemmas" that simulate real life practice issues.
    Examples include but are not limited to:
    • a conservative (e.g. response to Rx) vs. aggressive / invasive approach
    • unexpected complications (sudden change or turn for the worst)
    • problems that might arise from Rx (i.e. treatment can be the problem)
    • strong competing DfDx's
    • potential impact on a population of animals
    • the importance of getting a definitive Dx versus treating the animal's problems
  12. Contains relevant client, ethical or referral issues.
    Examples include {a} deciding when euthanasia should be recommended and how the client should be informed, {b} potential zoonotic diseases, {c} the threat of litigation, {d} breeding of animals with heritable diseases, {e} cost effectiveness of treatment, {f} economic and/or emotional value of animal to client, {h} conflict with another veterinarian, etc., etc.  These are the so called "provocative undercurrents".
  13. Allows students to work together as a team and to build group problem-solving skills that will be necessary in a multi-veterinarian practice.
Washington State University