UTSWMC Dermatology Case Study Template Flow Document
Purpose of this Document
This document is a comprehensive outline of the Dermatology Case Study application
including a detailed description of the content presentation and user interactivity, from
beginning to end, including ALL features and application requirement details.
This document is a working deliverable based upon clearly defined and agreed upon
content structure, application template requirements, and project scope. It‟s the
foundation upon which the application developer can rely upon for the development of
the storyboard and graphics, user interface model, template coding, XML directory
structure, and the case study template itself. It is also a foundation upon which content
developers can be certain that their case study content conforms to the specifications of
the case study template requirements. The final case study flow document cannot be
completed until the first case study test case content has been delivered to the
TeleCampus. Once this document has been approved, no changes can be made without
the risk of affecting the timeline and the final cost of the project.
Case Study Delivery
The case study will be presented as part of an online dermatology course designed to
teach dermatology physician assistants about dermatopathology likely encountered in a
specialty setting, and giving the student varied opportunities to practice sound clinical
The student will log into the Blackboard course delivery system and be presented with a
course menu of case studies to choose from. Quizzes and other assessments associated
with the case study will be contained within the blackboard course delivery system and is
presented and tracked separately from the case study presentation.
When the student selects and launches the case study a new web browser window is
launched and the case study is loaded into the Flash player that is embedded within the
Initial Copyright Screen
When the case study launches the student is initially presented with a copyright
notification screen that informs the student that they must agree to the graphics and
content copyright policy before being allowed access to the case study interface. When
the student clicks an “agree” button the copyright notice screen is dismissed and the
student is presented with the initial case study user interface.
The user interface presents the student with the UTSWMC name and logo, the Coria
Labs logo, a primary navigation menu, a main text content area and a “Patient File”
interface to be described in detail below.
Primary Navigation Menu
The primary navigation menu will contain the following choices: Introduction, Case
History, Physical Examination, Differential Diagnosis, Labs and Procedures, Final
Diagnosis, and Treatment. The Case History section will have the following sub
navigation choices: History of Present Illness, Past Medical History, and Family History.
The typical clinical decision making flow of the case study is anticipated to be reflected
in the order of the navigation menu items, as listed above. However, the student can
move non-linearly through each of the content areas as they evaluate the case and make,
and amend, their clinical choices.
Main Content Screen
The main content screen initially presents the student with the Introduction content. The
Introduction section presents an explanation of the course, a brief case study author bio
and photo, the course purpose and learning objectives. There are no clinical choices in
this section, and this content is not presented in the patient file interface.
The main navigation menu‟s Case History submenu contains the three subsections of the
Case History section (History of Present Illness, Past Medical History, and Family
History). There will be an additional sub navigation menu presenting the student with
three buttons corresponding to these three Case History subsections, for ease of
navigation, that are only visible when the student is navigating within the Case History
When the student selects the Case History menu option the main content text area
initially presents the History of the Present Illness content. This section includes the
patient‟s chief complaint, a brief summary of the patient upon presentation, and a
summary of the review of systems.
When selected the Past Medical History subsection presents a summary of the patient‟s
relevant medical history such as previous conditions and treatments, procedures, and
When selected the Family History subsection presents relevant maternal, paternal, sibling
history, and genetic info, which when there is a genetic component to the case will
present the student with a pedigree chart image, as well as a link to a “patterns of
inheritance” document from the UTSW Med Library.
When selected the Physical Examination screen presents the patient‟s Vital Signs and
general physical exam findings. The exam findings my contain text by itself or text and
accompanying graphics (up to 3 images). Vital Signs content is both specific, such as
Heart Rate, Respirations, and Temperature, as well as general physical behavioral
When a graphic is present, it will be a thumbnail size image which the student can
rollover and click to launch the image within the Image Magnifier tool. The Image
Magnifier Tool is a feature that when an image is clicked, a window screen is launched
that presents a larger version of the selected image. Within this window area there is a
drag enabled magnifier that the student can move over the displayed image to view a
“magnified” zoomed area of the physical exam image. The Image Magnifier Tool
enables the student to examine the image in closer detail in a window that can be
repositioned on the stage, and closed when finished.
The Patient File Interface and Virtual Patient Feature
The Patient File interface is “clipboard” like case summary feature that tracks and
presents a dynamic summary of all of the student‟s clinical choices and results, as the
student progresses through the case. The Patient File will present an accordion style
navigation system that slides to open the selected section. It will contain sections for
differential diagnostic choices, labs and procedures ordered with results and cost analysis,
final diagnosis, and Treatments selected and cost analysis. When a student changes a
previous clinical choice, the Patient File sections dynamically updates to reflect this
change. This feature is designed to emulate a real world patient file which allows the
student to navigate an aggregate of essential patient information and the clinical choices
they make in each clinical section at-a-glance, without having to use the primary
navigation menu. The student can always navigate to any of the case study content
sections with the primary navigation menu, but in addition, the Patient File interface is
always visible and accessible so that the student can review their clinical decision process
at a glance.
The Virtual Patient feature dynamically keeps track of, and adjusts to changes in, the
student‟s clinical choices throughout their progress through the case study, and compares
the appropriateness of their choices to an optimal clinical response key. This feature
evaluates a percentage “score” that is a function of the total number of appropriate
clinical choices the student makes in comparison with the optimal clinical responses
possible. The clinical choices that are tracked include their Differential Diagnostic
choices, the appropriateness of their choices of Labs and Procedures, the resulting Cost
Analysis of the Labs and Procedures, the student‟s choice of Final Diagnosis, and the
appropriateness of the Treatment choices and resulting Cost Analysis of Treatment. The
feature requires that a student score 80% or above in order to be presented with a
password needed to access the corresponding case study quiz/assessment contained
separately from the Case Study within the Blackboard course delivery system. If the
student scores lower than the required 80%, the Clinical Progress Screen presents the
student with feedback on their progress and clinical score, and instructs the student of the
need to reevaluate their clinical choices, in order to receive the quiz password (See
Clinical Progress Screen section below).
When selected the differential diagnosis content screen presents the student with a table
of 10 choices of possible diagnoses for the case under consideration. Each choice
presents the name of the possible diagnosis, 3 images illustrating the condition, and a
brief definition of the etiology and clinical course of the possible diagnosis. Each graphic
will be a thumbnail size image which the student can rollover and click to launch the
image within the Image Magnifier tool. Each diagnostic choice will also provide a link to
a related resource about the diagnosis from the UTSW library. Each diagnostic choice
will have a corresponding checkbox and the student will be required to choose 3
differential diagnoses from the list. Upon submission, the student‟s differential
diagnostic choices will be dynamically tracked and displayed in the Patient File interface,
and scored by the Virtual Patient feature.
Labs and Procedures
When selected the Labs and Procedures content screen presents a list of initial labs and
procedures, with corresponding check boxes, to pick from. The list headings include
Labs, Procedures, and Surgery. A rollover popup approach is applied here to present the
student with additional information, such as definitions/explanations of terms, labs, and
Within this list one or more of the items will be keyed “appropriate” for the case. If the
student does not pick any of the appropriate labs, upon clicking the “submit” button, a
screen presents the lab results and cost analysis of the lab order. If the student orders
one of the appropriate labs/procedures, upon clicking the “submit” button, an additional
list of “unlocked” labs/procedures appears at the bottom of the original list, offering the
opportunity to choose additional labs as well as order more labs from the initial list.
When the student clicks the “submit” button on the labs/procedures screen the lab results
and cost analysis of all of the labs they‟ve ordered are presented to them. Upon
submission, the student‟s lab and procedure choices will be dynamically tracked and
displayed in the Patient File interface, and scored by the Virtual Patient feature.
When selected the Final Diagnosis screen presents the three differential diagnostic
choices previously made by the student. If no previous differential diagnostic choices
have been made, a default message will alert the student that differential diagnostic
choices must be made before making a final diagnosis. If differential diagnostic choices
have been made, these choices are presented exactly as they were initially in the
differential diagnostic screen. Each choice has a check box next to the diagnosis name, 3
images illustrating the condition, and a brief definition of the etiology and clinical course
of the possible diagnosis. Each diagnostic choice will also provide a link to a related
resource about the diagnosis from the UTSW library.
The final diagnosis screen also presents 2 icons: the Supervising Physician and
Dermatology Pathologist icons. These will be links to „advice‟ given by either a
supervising doc or the dermatology pathologist. The student will have the option to click
on these icons to get some additional guidance, suggestions, and information for
consideration of the case. They will likely look at these icons if the correct diagnosis
wasn‟t chosen in the „Differential Diagnosis‟ frame, or if certain labs were not ordered.
Upon submission, the student‟s final diagnostic choice will be dynamically tracked and
displayed in the Patient File interface, and scored by the Virtual Patient feature.
When selected the Treatment screen presents a list of treatments and interventions under
the following headings: Patient Education, Pharmacotherapy (oral, topical, injections),
Phototherapy, Office Procedures, Surgery, Hospital Admission, and Referral. When the
student clicks the “submit” button the treatment cost analysis results are presented. Upon
submission, the student‟s treatment choices and cost analysis will be dynamically tracked
and displayed in the Patient File interface, and scored by the Virtual Patient feature.
Clinical Progress Screen
Contained within the Patient File interface, this screen, when selected, presents the
student with feedback concerning their clinical progress. The student is required to
complete at least one clinical choice in each of the clinical areas before their clinical
score is available. This prevents students from using the dynamic score as feedback for
making clinical choices by looking at the score to see if it increases as they select and
deselect choices. If the student has skipped a clinical choice section they are presented
with feedback instructing them that they need to make at least one choice in each clinical
section of the case study before they can receive a clinical score. If they have completed
each section they are presented with their current clinical “score”. This score is a function
of the total number of appropriate clinical choices the student makes in comparison with
the optimal clinical responses possible. If the student‟s clinical score is 80% or above
they are presented the “password” needed to access the corresponding case study
quiz/assessment contained separately from the Case Study, within the Blackboard course
delivery system. If the student score is lower than the required 80%, the student is
presented with feedback their clinical score, and instructed of the need to reevaluate their
choices, in order to receive the quiz password. If there is no quiz for the case study the
student is presented with their clinical score and final feedback.