Published on

Published in: Health & Medicine
  • Be the first to comment

  • Be the first to like this

No Downloads
Total Views
On Slideshare
From Embeds
Number of Embeds
Embeds 0
No embeds

No notes for slide


  1. 1. CASE TEACHING NOTES for "Is It a Lemon or a Lyme? A Case Study on the Decision to Vaccinate or Not" by Kate Rittenhouse-Olson Biotechnical and Clinical Laboratory Sciences University at Buffalo, State University of New York INTRODUCTION This multi-part dilemma case was designed for a junior level immunology course. It could also be used in a microbiology or bacteriology course where the emphasis is on treatment as well as disease. Although the case revolves around a particular microbe that causes Lyme disease, the central question is "Should a person get vaccinated given the associated risks and the benefits?" Objectives At the University at Buffalo, our program is accredited to teach Clinical Laboratory Science by the National Accrediting Agency for Clinical Laboratory Sciences. This accreditation requires that a list of objectives for each lecture in the program be provided for the students. This serves as an aid to the students in understanding which concepts in the material are of primary importance, and is also helpful to the teacher when preparing the tests. These objectives are categorized as in the affective domain (how the student relates to the subject), the cognitive domain (how the student understands the subject), and the psychomotor domain (how the student performs the task). There are many objectives for this case study. In the affective domain, I expect that by working through this case, students will: realize that health care decisions are their own and should be made after obtaining the knowledge needed to make an informed decision; learn that in order to decide whether or not to be vaccinated, an individual should assess their individual risk and determine if the disease pathology is potentially serious, the effectiveness and side effects of therapy for the disease, and the effectiveness and possible side effects of the vaccine; learn to share their ideas and participate in groups since group work is an increasing part of operating in the scientific world, both in industry and academia; gain insight into the need to evaluate the quality of the information that they obtain from different sources.
  2. 2. 2 In the cognitive domain, I expect that after this exercise students should have learned something from each group. They should be able to: judge the relative risk for development of Lyme disease in various regions of the country and the world (with information from the epidemiology group); judge the relative risks at different times of the year and with different activities (from the epidemiology and etiology/pathology groups); discuss the pathologies caused by the bacteria in Lyme disease (from the etiology/pathology group); compare the signs and symptoms of the various stages, or manifestations, of Lyme disease (from the etiology/pathology group); describe the etiology of Lyme disease (again, from the etiology/pathology group); evaluate the appropriate treatment for patients with each stage of the disease, for penicillin allergic individuals, and for pregnant patients as well as be able to describe the potential adverse side effects of these treatments (from the prevention/treatment group); discuss the efficacy of antibiotic treatment of the different stages of the disease (again, from the prevention/treatment group); describe laboratory assays, including PCR, Western blotting, enzyme immunoassays, and immunofluorescent assays, for the Borrelia or for the anti-Borrelia burgdorferi antibody or the Borrelia antigens; for the different laboratory assays, they should be able to describe the specificity and sensitivity of each (from the laboratory diagnosis group). describe the vaccine protocol and be able to describe the risks, costs, and benefits of the Lyme disease vaccine as well as the vaccine's efficacy (from the vaccine group); analyze case studies involving Lyme disease (all groups). In the psychomotor domain, I expect that the students will: gain experience in performing web searches for information. CLASSROOM MANAGEMENT I hand out the case assignment two weeks before I expect to have the in-class presentations in order to give the students time to meet and prepare their presentations together. The students are expected to read the associated chapter in the textbook, Christine Stevens Clinical Immunology and Serology, A Laboratory Perspective (1996). The students are also each expected to read their assigned material (summary sheets) and as a group assign each member certain of the associated links from which to gather information. Members of each group should also be given the take of finding additional sources of information not listed and summarizing the information from these sources. Most students in my immunology lecture class take either a Monday laboratory session or a Wednesday laboratory session. I assign project groups based on the laboratory assignments. In the laboratory class, there is a tendency for friends to sit next to one another, so my group assignments involve splitting each lab into two groups, alternating placement in each of the two groups as I walk by the seated students. The groups contain four to five students each. The fifth group is formed from the students that elected not to take the laboratory component. This case study is the second of two group projects in my classroom, and the groups contain the same individuals for both projects. The advantage of selecting students in the same laboratory session is that there are incubation times during the laboratory procedure in which the students have time to interact and begin work on these assignments and to divide the work appropriately. There is an in-class and an out-of-class component to the projects. Since these projects are
  3. 3. 3 not too labor-intensive, approximately one-third of the work can be completed in the laboratory. The total amount of time that the students should spend on this project is four to five hours. This project is worth one-eighth of their grade. The two projects each have equal weight as the four tests and the final exam has double weight. I give each group a grade based on a total of 10 points, and the individual student grade is determined by the peer evaluation technique suggested by Herreid (see Herreid 2001). The students in the groups of five were given 40 points to distribute, not grading themselves. They could not give 10 points to each other student, and some grading fluctuation had to occur. The students received their peer score times their group score as their final grade. For example, if a student's peer score average was a 9 and their group score a 9, their grade would be 9 x 9 = 81. The presentation phase is run as follows: Each group presents its findings and their recommendation to the class about whether, based on their group's information only, they would recommend use of the vaccine. The order of the presentations is: (1) epidemiology, (2) etiology and pathology, (3) prevention and treatment, (4) laboratory diagnosis, and (5) vaccine. The summary begins with a brief discussion on what, if any, part of the presentations surprised us. Next I have the students write on an index card which group they were in and the personal decision they would make after hearing all the information presented concerning whether or not they would get vaccinated with the Lyme vaccine. I tally this information in front of the students on the blackboard, and this concludes the lesson. Variations for Teaching the Case Using more of a problem-based learning (PBL) format, the students could be placed in groups of five and told to "brainstorm" about what they need to know in order to make a decision about being vaccinated. In this scenario, they would not be told at the outset what factors would be involved in the decision. The class then would have a discussion led by the instructor about what these factors are. Each student in each group could then research and present a different factor. The students would report to each other within their groups, discuss vaccination from this greater knowledge base, and then prepare a written report as a group that is an analysis of the issues and their group's decision about whether or not to be vaccinated. The instructor would lead a group discussion summarizing the thoughts of each group.
  4. 4. 4 REFERENCES CDC Lyme Disease Home Page- CDC Division Vector-Borne Diseases. Available at: Edlow, J.A. 1999. "Lyme Disease and Related Tick-borne Illnesses." Annals of Emergency Medicine 33(6): 680-693. Herreid, C.F. 2001. "When Justice Peeks: Evaluating Students in Case Method Teaching." Journal of College Science Teaching 30(7):430-433. Available at: Modlin, J.F. et al. 1999. "Recommendations for the Use of Lyme Disease Vaccine, Recommendations of the Advisory Committee on Immunization Practices (ACIP)," Morbidity and Mortality Weekly Report, June 4, 48 (RR07): 1-17. Available at: Murray, P. 1996. The Widening Circle: A Lyme Disease Pioneer Tells Her Story. New York: St. Martin's Press. The National Academies Institute of Medicine. 2001. "Immunization Safety Review: Measles- Mumps-Rubella Vaccine and Autism." Available at: Stevens, C. 1996. Clinical Immunology and Serology, A Laboratory Perspective. Philadelphia: F.A. Davis. Acknowledgments: This case was developed with support from The Pew Charitable Trusts as part of the Case Studies in Science Workshop held at the University at Buffalo, State University of New York, on June 12-16, 2000. The author wishes to thank Tucker Crum, Janet MacDonough, and LeLeng To for their contributions to the development of this case. Date Posted: 04/19/02 nas