Speaker 1: In some regard we've actually been teaching with cases in the classroom but at a very basic level. So most of us have probably used some form of traditional case study where we're presenting information to the student having them think about what data is presented to them and we're leading them down a path to what we call the right answer. You know giving them feedback along the way based on some of the information that they've decided was important and the decisions that they've come up with and we're like yea you've come to the right answer or maybe you didn't quite get to the answer we wanted you to get to and here's some feedback on how to get you there. So what we need to do going forward is to expand on that so not just do a traditional linear case study where we're trying to force you along a trajectory to get to the outcome but where we're building on your decision making skills and we're also changing the case as we move along so that the student is now having to adjust on the fly and look at new data to come up with new ideas and new plans of care for the patient. So we can use an unfolding case study which in some regards might be a little bit linear as well but we are giving additional information along the way to test their thinking to see if they notice these changes these subtle cues and when we're looking at next generation NCLEX some of the new question formats are really looking at unfolding cases they will start with the chart based scenario and have to come up with some answers to whatever questions are being addressed and then when they get to that next question which will be the same chart with a different information or additional information now they're going to have to process that additional information to make a decision. So an unfolding case in that regard is really going to help students in terms of their next-gen NCLEX preparation but also in terms of practice when they're going out there and they're looking at patients trying to learn how to recognize subtle cues so they can take that information and match them with some of the other cases that we're going to start with. cues and changes in condition so they can change their plan of care and address these issues on the fly. There are some more complex type of case studies, so if you think back to when you read those books where you're trying to make a decision and it tells you if you make decision A you're going to go to page 30 and if you make decision B go to page 60, that kind of case study is actually maybe a little more indicative of real life. It's a lot harder to develop such a case study, but if you're giving students the option of making a decision and then you're having the case follow the path of that decision, then they're going to see the consequences of those actions as well in real time or in case time within the classroom. And that might be a good outcome, depending on the issue, the choice they've chosen, or it might be a detrimental or negative outcome and then if they're choosing the path that gets them on the negative outcome, then we also need to look at how do we address so that happens in the real world when we have a negative outcome, when we make an error. And then there's a lot of debriefing that's going to occur. Not just to address what was wrong with your thinking that put you down the wrong path, but if that really happened in real life, what are the steps now that you have to do to address that problem? Was it a medical error where now you have to do incident reporting and you have to report, you have to address that with the patient and the family or other providers? And that's a whole other set of skills that we oftentimes don't teach in the classroom setting with our students. So when we look at all these different types of cases, we can really build on not just the critical thinking and critical judgment in terms of the nursing. In terms of the nursing process, in terms of the disease process, the pathophysiologic process, designing our plan of care, but also building on the affective domain and our students' values and their cultural competence and their ability to address the harder issues of nursing when it comes to working with colleagues and dealing with bullying and incivility or other issues that I often tell my students are 70% of your job. You know? One is the actual nursing care that you're providing the patient to get to an outcome. The other 70% is having to deal with all these other aspects of healthcare in the 21st century that we need to give you the tools to be able to address so that 30% of the time you're with the patient, you are, with that minimal time, making the right decisions, using your critical thinking and your clinical judgment to make sure we have the best possible patient outcome.