TABLE 3.
An example of case-based learning
| A 70-year-old man without medical history undergoes colonoscopy as part of a colorectal cancer screening program. The colonoscopy showed a 5-cm LST in the rectosigmoid colon. There are no other polyps. Removal of the lesion is deferred, and the patient is scheduled for repeat colonoscopy with endoscopic resection of the LST. |
| Step 1. Clarification of unknown terms |
| LST: laterally spreading tumor |
| Step 2. Questions raised by the case |
| What is an LST? |
| What are steps in endoscopic diagnosis and treatment of an LST? |
| What is the role of chromoendoscopy in the diagnosis of an LST? |
| What is the endoscopic Kudo classification of an LST? |
| What is the Kudo pit-pattern classification? |
| How do you estimate the risk of submucosal invasion? |
| What is the therapy of choice based on the risk of submucosal invasion? |
| Do you need to take biopsy specimens before resection? |
| What skills do you need to develop to perform endoscopic resection of an LST? |
| What materials and equipment are required for resection of an LST? |
| What are practical steps in endoscopic resection of LSTs? |
| What is the surveillance recommendation in this patient? |
| Step 3. Brainstorm |
| Screening for colorectal cancer: 55–75 years, options: colonoscopy, fecal immunochemical test |
| LSTs are technically difficult to resect endoscopically. |
| LSTs have a high risk of submucosal invasion. |
| Incomplete resection of an LST can lead to post-colonoscopy cancer. |
| Effective endoscopic resection is mandatory. |
| Endoscopic mucosal resection, endoscopic submucosal dissection, and surgery |
| Experienced endoscopist |
| Step 4. Learning goals |
| How to assess the risk of submucosal invasion in the LST. |
| How to ascertain the best therapeutic option. |
| How to perform endoscopic resection of an LST. |
| Step 5. Clustering |
| Two main topics to study: LSTs and endoscopic resection techniques |
| Step 6. Individual research |
| The mentor may give advice regarding literature. |
| Trainees perform an extensive search and read the most relevant references. |
| Step 7. Discussion |
| Second meeting |
| The learning goals are discussed. |
| If some topics need to be highlighted, the mentor can raise these in discussion. |
| A summary of the discussion can be digitally shared. |
| After discussion, a new case is provided. |
LST, Laterally spreading tumor.