Rapat Kerja

AIPKEMA (Asosiasi Institusi Pendidikan Kebidanan Muhammadiyah ‘Aisyiyah)

“Mempertahankan Kualitas Pendidikan Bidan di Masa Pandemi Covid-19”
Yogyakarta, 6 April 2021

Case Study dan Case Report

dalam praktik kebidanan

Prof. dr. Mohammad Hakimi, SpOG(K), PhD.

Konsultan Program Studi S2 Kebidanan
Universitas ‘Aisyiah Yogyakarta
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Outline

1. Online Midwifery Education

2. Case Reports and Case Studies
3. Innovative Uses of Technology
– The Virtual Classroom
– The Unfolding Case Study, and
– Online Return Demonstrations of Skills.

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 Online Midwifery Education
• Online education is a contemporary, thriving, and viable
option for health care education in the United States
today, including midwifery education.
• There are currently 4 fully on-line midwifery education
programs in the United States and 17 that are partially
online.
• More than half of the graduates from midwifery
education programs in 2013 were from either a partial
or fully online program.

Arbour MW, Nypaver CF, Wika JC. Innovative Uses of Technology in Online Midwifery Education.
Journal of Midwifery & Women’s Health 60(3):278-282, 2015.

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 Online Midwifery Education
• Online education can help to reduce the shortage of
maternity care providers but must be rigorous and
delivered in a way that is challenging, engaging,
innovative, and convenient to student schedules.
• Class sessions may occur in real time (synchronously)
or be recorded and viewed at a time convenient for
the student (asynchronously) within instructor-
defined time frames.

Arbour MW, Nypaver CF, Wika JC. Innovative Uses of Technology in Online Midwifery Education.
Journal of Midwifery & Women’s Health 60(3):278-282, 2015.

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 Innovative Strategies
• A significant amount of planning and forethought
must occur in online education to ensure that the
major learning needs of all students are met and
that the student’s critical and creative thinking
processes are nurtured.
• Each of the strategies discussed later in this
presentation are designed to increase student
creativity, as well as increase the student’s sense
of connectedness and ensure adequate
preparation.
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 From crisis to opportunity: Stop the
damage, then build back better

• The policies to turn this around can be

grouped in three overlapping phases:
– Coping,
– Managing Continuity, and
– Improving and Accelerating.

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• We want to continue to support students to
successfully complete their programmes on
time.
23 November 2020

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 Case Reports and Case Studies
• The terms "case studies," "case study
designs," and "case reports" are sometimes
used interchangeably, but differences
between them have implications for the
method by which an inquiry is performed, the
way results are reported, and how conclusions
are drawn.

Stegink Jansen CW. Case Reports and Case Studies: A Discussion of Theory and Methodology in Pocket
Format. Journal of Hand Therapy July-September 1999.

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 Case Reports and Case Studies
• Case reports are descriptions of practice
without the application of research
methodology. The objective of a case report is
to describe practice, not to determine cause
and effect of practice.

McEwen I. Writing case reports: a how-to manual for clinicians. Alexandria, Va.: American Physical Therapy
Association, 1996.

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 Case Reports and Case Studies
• Case studies utilize standards of scientific
methods. A case study is an empirical inquiry that
investigates a contemporary phenomenon in its
real-life context, especially when the boundaries
between the phenomenon and the context are not
clearly evident. The case can be a person, a group
of persons, a unit, or a group of multiple units.

Yin RK. Case Study Research: De- signs and Methods. 2nd ed. Applied Social Research Methods Series, vol.
5. London, England: Sage Publishers, 1994.

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 Case study ≠ Case Report
A twofold definition of case study as a research
method:

1. A case study is an empirical method that

– investigate a contemporary phenomenon (“the
case”) in depth and within its real-world context,
especially when
– the boundaries between phenomenon and
context may not be clearly evident.
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 Case study ≠ Case Report
2. A case study
– copes with the technically distinctive situation in which
there will be many more variables of interest than data
points, and as one result
– benefits from the prior development of theoretical
propositions to guide design, data collection, and analysis,
and as another result
– relies on multiple source of evidence, with data needing to
coverage in a triangulating fashion.

Yin RK. Case Study Research and Applications, 6th ed. Los Angeles: SAGE, 2018.

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Yin RK. Enhancing the quality of case studies in health services research. Health
Services Research 34:5 Part II (December 19990.
Yin RK. Case study research. Design and methods, 3rd ed. Thousand Oaks: Sage
Publications, 2003.
 Case Report
• A case report is a detailed narrative that
describes, for medical, scientific, or
educational purposes, a medical problem
experienced by one or several patients.

Gagnier JJ, et al. The CARE guidelines: consensus-based clinical case reporting guideline development
BMJ Case Rep 2013. doi:10.1136/bcr-2013-201554.

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 Case Report
• Case reports present clinical observations
customarily collected in healthcare delivery
settings.
• They have proved helpful in the identification
of adverse and beneficial effects, the
recognition of new diseases, unusual forms of
common diseases and the presentation of rare
diseases.

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 Case Report
• For example, our understanding of the
relationship between thalidomide and
congenital abnormalities and the use of
propranolol for the treatment of infantile
haemangiomas began with case reports.

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 Case Report
• Case reports may generate hypotheses for future
clinical studies, prove useful in the evaluation of
global convergences of systems-oriented
approaches and guide the individualization and
personalization of treatments in clinical practice.
• Furthermore, case reports offer a structure for
case-based learning in healthcare education and
may facilitate the comparison of healthcare
education and delivery across cultures.

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 Case Report in Midwifery Education
• Case reports convey information via
storytelling and patient perspectives.
• As such, they are an excellent vehicle for
sharing the science and art of health care.
• Case reports are also a forum for linking
clinical scenarios to evidence-based
management.
• This format is a well-recognized teaching tool.

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 Online Midwifery Education
• This presentation reviews 3 innovative uses of
technology that online health care education
programs, including those in midwifery, may use
to enhance their educational quality and rigor:
1. the virtual classroom,
2. the unfolding case study, and
3. online return demonstrations of skills.

Arbour MW, Nypaver CF, Wika JC. Innovative Uses of Technology in Online Midwifery Education.
Journal of Midwifery & Women’s Health 60(3):278-282, 2015.

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 The Virtual Classroom
• Students enrolled in online education often have a greater sense
of isolation than students in campus-based programs.
• Shea et al. (2006) found that a strong and active presence of a
faculty member who guides discourse within online education is
associated with a stronger sense of connectedness within the
student and enhances learning.
• Faculty members who have an active visual presence within the
course can build collaborative knowledge and establish a
community of learners who reflect on what they’ve learned and
strengthen current knowledge.

Shea P, Sau Li C, Pickett A. A study of teaching presence and student sense of learning community in fully online and web-
enhanced college courses. Internet and Higher Education. 2006;9:175-190.

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 The Unfolding Case Study
• In unfolding case studies, students are asked
to use clinical forethought to predict what
could happen next.
• By asking questions after each incremental
stage, the instructor provides prompts
students to consider how nursing actions
contribute to the patient's trajectory.

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 The Unfolding Case Study
• Case studies have been a standard component
of advanced practice nursing, midwifery, and
medical education.
• Case studies describe a clinical scenario and
then pose questions for the student to answer.
The concept of the unfolding case study is one
that can be used in a live, simulation-based
environment or in an online format.

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 The Unfolding Case Study
• In an online format, unfolding cases can be presented as
videos, story boards, PowerPoint presentations, or live
streaming during virtual classroom sessions.
• In addition to an improved ability for faculty to assess
critical and creative thinking, documentation skills, and
clinical management, students really enjoy meeting a
virtual woman or family and following them through
many weeks of a pregnancy and birth.
• The same woman can be the topic of the unfolding case
from one semester to the next, antepartum to
intrapartum, postpartum and newborn care.
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 The Unfolding Case Study
• Students state that the unfolding nature of the case mimics what
happens in the office or hospital setting.
• Students also enjoy the variety of scenarios developed by
students from the same root information that each received,
demonstrating their appreciation for creativity in this assignment.
• The assignment helps students realize the depth of discovery
necessary to formulate a differential diagnosis and management
plan.
• Students report a better understanding of management because
they have to provide the necessary background information from
subjective and objective information before arriving at the
diagnosis that they envision.

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Online Return Demonstrations of Skills

• Demonstration
– Shows the learner how to perform a skill by the
teacher.
• Return demonstration
– Carried out by the learner to perform a task with
cues from the teacher.

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Online Return Demonstrations of Skills
• The evaluation of psychomotor clinical skills using
technology has presented both opportunities and
challenges for faculty and students in online programs.
• Clinical skills are most often evaluated during in-
person sessions. There are times, however, when skills
must be evaluated and students are not present on
campus.
• One strategy that enhances the evaluation of student
ability and increases student creativity is the online
return demonstration of clinical skills.

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Online Return Demonstrations of Skills
• In one study, 13 nurse practitioner students
were supplied with handheld video cameras
to record themselves performing a physical
examination on a client.
• These videos were then downloaded to the
Blackboard Learning Management System to
view for self-reflection and clinical mentor
assessment.

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Online Return Demonstrations of Skills
• Examples of skills that are frequently assessed during
an antepartum course include a complete breast
examination; assessment of the pregnant abdomen,
including Leopold’s maneuvers, fundal height and heart
tones; as well as a speculum examination.
• During an intrapartum and newborn course, hand
maneuvers, suturing skills including knot tying,
shoulder dystocia, postpartum hemorrhage, a newborn
assessment, and a breastfeeding assessment should all
be evaluated during a live return demonstration.

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Online Return Demonstrations of Skills
• In preparation for the skills demonstration, the faculty
member provides students with didactic instruction
about a preselected skill.
• This is followed by a demonstration of that skill usually
through a recorded video.
• Next, the students are required to schedule a mutually
agreeable time to meet with faculty online in the virtual
classroom.
• The student should perform the skill in a concise
manner, thereby demonstrating their preparedness and
commitment to the assignment.
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 Conclusion
• The innovative use of technology helps to increase the
success of students by increasing their sense of
connectedness, by improving their creative and critical
thinking skills for clinical management, and through
evaluation of psychomotor skills.
• Innovative uses of technology engage students and
increase the access to highly qualified, clinically
competent maternity care professionals in their own
community.
• It is the responsibility of midwifery educators to create
innovative strategies that enhance access to rigorous
education in order to support students to successfully
complete their programs on time.
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