4C-ID Model Applied to Teaching about Lung Cancer
Shari Meyerson
van Merriënboer (2002), figure 2
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 1 – straightforward healthy patient
Task Class 2 – healthy patient with staging or anatomic
reason not to operate
Task Class 3 – Severely limited pulmonary function, won’t
tolerate operation
Partial Task Practice – calculating PFTs
Task Class 4 – the borderline patient requiring additional
testing
Ready for Clinic
Task Class 1
Task Class 1 – straightforward healthy patient
Supportive information
Modeling example – worked example showing all steps and cognitive considerations in patient evaluation
Just in Time information
Chart showing staging for lung cancer
PFT cutoffs for surgery
Detterbeck (2009)
Example Learning Task
Healthy 50 year old man
1 cm nodule in right upper lobe
PET positive only in nodule
PFT’sFEV1 85% predDLCO 78% pred
Task Class 2
Task Class 2 – healthy patient with staging or anatomic
reason not to operate
Supportive information
Two worked examples showing patients for whom surgery is not the correct treatment
Just in Time information
Chart showing recommended treatment by stage
PFT cutoffs for surgery
Stereotactic Body Radiation Therapy
Surgery
Chemotherapy +/- Radiation
Stage IA
Stage IB
Stage IIA
Stage IIB Stage
IIIAStage
IIIBStage
IV
Example Learning Task
Healthy 50 year old man
5 cm mass in left upper lobe
PET positive in mass and entire pleura
PFT’sFEV1 85% predDLCO 78% pred
Task Class 3
Task Class 3 – Severely limited pulmonary function, won’t
tolerate operation
Partial Task Practice – calculating PFTs
Supportive information
Worked examples of calculation of predicted postoperative PFTs
Just in Time information
Equations for calculating predicted postoperative PFTs
ppoFEV1 = FEV1 x 18 - # of segments to be resected
18
Partial Task Practice
Amount of lung to be taken
Still smoking?
Tumor obstruction
COPD or pulmonary
fibrosis
Preoperative lung function
Cutoff:ppoFEV1>40%ppoDLCO>40%
Task Class 4
Task Class 4 – the borderline patient requiring additional
testing
Supportive information
Guidelines for use of supportive testing- Cardiopulmonary exercise test (CPET)- Ventilation-perfusion scan (VQ)
Just in Time information
Cutoff for VO2 max on CPETHow to adjust ppoFEV1 for VQ
Final Exam – The Clinic
PFTsFEV1 48% predictedDLCO 47% predicted
78 year old womanShortness of breath at two blocksStill smoking ½ PPD
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.
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