The oral case presentation—the process of conveying pertinent patient findings to physician colleagues and peers—is an essential skill for nurse practitioners. However, teaching this skill has become increasingly difficult with the advent of online courses. Frequently, instruction is relegated to preceptors in the community, with varying results. To overcome these shortcomings, students in an online family nurse practitioner program were given an opportunity to practice case presentation by recording and uploading an audio file into their discussion forum. This article describes the process and success of this innovative approach.
Students in an online family nurse practitioner program were introduced to the art of case presentation in their first clinical decision-making course. For this assignment, students were instructed to adapt a history and physical that had been written for a patient encounter the previous semester. A grading rubric served as a guide for performance expectations. Outcome standards on the rubric were essentially those of a well-written SOAP note. An additional criterion, the length of time of the presentation, was also included to assess adherence to a time frame of less than 5 to 7 minutes.
Students were instructed to record the presentation as if they were presenting it to a preceptor or to colleagues, save the recording to a MP3 file, and post the recording in the appropriate discussion forum for peer and faculty feedback. The MP3 format was chosen because of its familiarity to students with iPods® and its compatibility with Desire2Learn® (D2L®), the online learning management system used by the university. MP3 files are also compatible with Blackboard™, Moodle®, and other commonly used systems. In addition, creating a separate audio file allowed for a longer recording time than the 1 minute recording time that is available using the “add audio” feature integrated into newer versions of the D2L discussion board.
To create the files, students were provided with links and detailed instructions to free, downloadable software: Audacity® and LAME MP3 encoder. Using Audacity (available at http://audacity.sourceforge.net), students could record and edit their case presentations on their home computers using any inexpensive and commonly available external microphone. Audacity automatically directed first-time users to a link to download the LAME MP3 encoder ( http://audacity.sourceforge.net/help/faq?s=install&i=lame-mp3), which was used to reformat the Audacity audio file from the default Audacity project (*.aup) format to the more universally compatible MP3 format. Students then exported and saved their audio file to their desktop, where they could easily find the completed assignment and upload it to the appropriate discussion forum as a file attachment.
Nineteen students were the first to complete the case presentation assignment. Unexpectedly, students were able to overcome technological glitches with little guidance from faculty. Peer-to-peer troubleshooting solved common problems, such as not saving the files to a compatible file type, large file sizes taking a long time to upload, and poor audio quality.
More importantly, the assignment gave students an opportunity to practice case presentation before starting their clinical practicum experiences, thus boosting their confidence and skill. Students met the standards of the grading rubric for an overall score of no less than 90% across the board. Group learning conveyed the additional benefits of peer support, exposure to multiple role models, and opportunities to hear exemplary presentations. Unsolicited, students posted comments on the assignment itself, saying it was “awesome,” “a great experience,” and helpful in learning “how to condense my thoughts.”
In light of the case presentation assignment’s success, faculty are in the process of developing similar assignments to be used throughout the clinical course sequence. Providing students with an opportunity to practice the art of communicating relevant patient information to colleagues is an essential skill across all levels of nursing education. Recording and uploading a case presentation into an online course overcomes the constraints of a virtual learning environment and is an innovative addition to a nurse educator’s teaching toolbox.
Debbie Ciesielka, DEd, ANP-BC
Clarion University-Pittsburgh Site