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.