Goals and Objectives• Determine if a patient is a candidate for surgery for lung cancer – Evaluate stage and determine if surgery is the best option for the patient’s stage – Evaluate anatomic resectability – Evaluate pulmonary function tests (PFTs) – Decide if additional testing is required – Interpret additional testing if needed
Design Framework Task Class 2 – healthy patientTask Class 1 – straightforward with staging or anatomic healthy patient reason not to operateTask Class 3 – Severely limited Task Class 4 – the borderline pulmonary function, won’t patient requiring additional tolerate operation testing Partial Task Practice Ready for Clinic – calculating PFTs
Task Class 1 Supportive informationTask Class 1 – straightforward healthy patient Modeling example – worked example showing all steps and cognitive considerations in patient evaluation Just in Time informationChart showing staging for lung cancerPFT cutoffs for surgery Detterbeck (2009)
Example Learning TaskHealthy 50 year 1 cm nodule in right PET positive only in old man upper lobe nodule PFT’s FEV1 85% pred DLCO 78% pred
Task Class 2 Supportive information Task Class 2 – healthy patient with staging or anatomic reason not to operateTwo worked examplesshowing patients for whomsurgery is not the correcttreatment Just in Time information Stereotactic Body Radiation Therapy Stage Stage IA IB SurgeryChart showing recommendedtreatment by stage Stage Stage IIA Stage IIB IIIAPFT cutoffs for surgery Stage Stage IIIB IV Chemotherapy +/- Radiation
Example Learning TaskHealthy 50 year 5 cm mass in left PET positive in mass old man upper lobe and entire pleura PFT’s FEV1 85% pred DLCO 78% pred
Task Class 3 Supportive information Worked examples of Just in Time information calculation of predicted postoperative PFTs Equations for calculating predicted postoperative PFTs 18 - # of segments to be resected ppoFEV1 = FEV1 xTask Class 3 – Severely limited 18 pulmonary function, won’t tolerate operation Partial Task Practice – calculating PFTs
Partial Task Practice Preoperative lung function COPD or pulmonary Amount fibrosisof lung to Cutoff:be taken ppoFEV1>40% ppoDLCO>40% Tumor obstruction Still smoking?
Task Class 4 Supportive information Guidelines for use of supportive testing - Cardiopulmonary exercise test (CPET) - Ventilation-perfusion scan (VQ) Task Class 4 – the borderline patient requiring additional Just in Time information testingCutoff for VO2 max on CPETHow to adjust ppoFEV1 for VQ
Final Exam – The Clinic78 year old womanShortness of breathat two blocksStill smoking ½ PPD PFTs FEV1 48% predicted DLCO 47% predicted
References• Detterbeck, F.C., Boffa, D.J., Tanoue, L.T. (2009). The new lung cancer staging system. Chest, 136, 260-271• van Merriënboer, J. J. G. (1997). Training Complex Cognitive Skills: A Four-Component Instructional Design Model for Technical Training. Englewood Cliffs, New Jersey: Educational Technology Publications.• van Merriënboer, J. J. G., Clark, R. E., de Croock, M. B. M. (2002) Blueprints for complex learning: The 4C/ID-model. Educational Technology, Research and Development, 50 (2);39-64.