Effects of Alternative Outcome Scenarios and Structured Outcome Evaluation on Case-Based Ethics Instruction

Abstract

Case-based instruction has been regarded by many as a viable alternative to traditional lecture-based education and training. However, little is known about how case-based training techniques impact training effectiveness. This study examined the effects of two such techniques: (a) presentation of alternative outcome scenarios to a case, and (b) conducting a structured outcome evaluation. Consistent with the hypotheses, results indicate that presentation of alternative outcome scenarios reduced knowledge acquisition, reduced sensemaking and ethical decision-making strategy use, and reduced decision ethicality. Conducting a structured outcome evaluation had no impact on these outcomes. Results indicate that those who use case-based instruction should take care to use clear, less complex cases with only a singular outcome if they are seeking these types of outcomes.

Appendices

Appendix 1

Case: Big Pharma

Jason is in his second year and Robin is just finishing her first year of postdoctoral training in a cell biology lab where they share a good working relationship. They have generous fellowships thanks mostly to their mentor’s enterprising associations with the pharmaceutical industry. Davis, the mentor, performs drug toxicity screening, and the work requires review and approval by industry scientists before it can be submitted for publication. His university objects to this, and has offered to negotiate with the drug companies for better publication terms, but Davis has so far refused on the grounds that he has no problem with the policy and does not want to compromise his reputation with the industry and the funding it provides for his team of first rate graduate students and post-docs.

The two post docs are using different animal models to test the efficacy of a gene product. It is hoped that this gene product will interfere with cancer cell-signaling and slow or arrest meta-static activity. Jason’s results are extremely encouraging, but Robin’s are not. She confides to her friend that she is disappointed with her failing project and a year’s loss in productivity. She is also frustrated because Davis has hinted that she must be doing something wrong. After all, Robin is working with the same protein as Jason, and it is reasonable to expect that her results would at least show a similar trend. Jason replies candidly about what he learned in his first year—that the industry’s emphasis is on getting results. He points out that if the Davis group does not produce, the project will be turned over to another team that will, and the fellowships will follow the money. What Jason said made sense, but Robin was uncomfortable with the implication she thought was being conveyed. She made a noncommittal remark and changed the subject; however, the new information preyed on her mind. Was she being naively idealistic about science?

Robin continues to feel uncomfortable with the climate of the lab and her interactions with Jason. She contemplates discussing the issue with Davis but fears he will react just like Jason. Ultimately, she decides that the best course of action is to not change her results and to leave the laboratory altogether. When she discusses her resignation with Davis he is surprised and asks for an explanation. She circumvents the real issue, simply telling him that she doesn’t feel like she fits in very well and would like to take her career in a different direction. Robin, admittedly, is conflicted over her decision to withhold information from Davis but thinks that she might create a bigger issue if she shares the entire truth.

Six months later, Robin finds herself in an entry-level position at a small bio-medical company. She is satisfied with her current work and is relieved that she no longer faces the pressures of her previous lab. She is even more relieved that she left her post-doc position when she receives word from a former lab mate that Davis’s laboratory has lost its funding after being investigated by the Office of Research Integrity on data fabrication charges. Source: Devenport (2005)

ACTIVITY INSTRUCTIONS: Presentation of Alternative Outcome Scenarios Condition

Please read the following alternative scenarios pertaining to the case (Big Pharma) you just read and answer the following questions.

Alternative Scenario A

Robin decides to discuss the situation with a trusted faculty member in the department before going to Davis. The faculty member expresses their distrust of Davis and his cozy pharmaceutical relationships and suggests that Robin should take the matter to the Department Chair and College Dean. How should Robin proceed?

Alternative Scenario B

During Robin’s resignation interview, she decides to tell Davis about the real reason she is resigning. She tells him about her suspicions about the lab’s reporting of results and that some results may be less than truthful. How should Robin proceed?

Alternative Scenario C

Robin decides to discuss her concerns with Davis and is surprised when he tells her that she should consider replicating her study and ask Jason for his dataset so that she can examine the data for herself. How should Robin proceed?

Appendix 2

ACTIVITY INSTRUCTIONS: Structured Outcome Evaluation Condition

Now that you have read the case (Big Pharma), please consider the case as you answer the following questions:

Based on the case outcomes, what are the consequences for:

• 1. Robin?

• 2. Davis?

• 3. Jason?

• 4. The department?

• 5. The University?

• 6. Future pharmaceutically funded research?

Appendix 3

Friends Wood City Council

You are an expert building contractor. You have a master’s degree in civil engineering, and after 20 years of working as a licensed contractor, you decided to retire. You and your spouse live in Friendswood, a small community in which you are very active. You often volunteer your services and expertise to local organizations that need your help. For instance, when city structures are being built, you often volunteer your expertise as a contractor free of charge, so that the city can save money. Whenever such opportunities arise, you are pleased to help because no one will place restrictions on you or your “vision”. Most of the time, you enjoy full autonomy to proceed with the projects as you see fit.

You are on the board of the Friendswood city council. There are twelve people that make up the council, including you. Members of the city council are elected by the residents of the city. You feel like the city council elections have become somewhat of a popularity contest, and it seems like the members of the council are the wealthiest members of the community, not necessarily the people who would benefit the community most. You feel like some of the members of the city council have no interest in giving back to the community; they just want to feel important by being a part of this organization.

Recently, two of the members of the council have begun to feud. Bill Knight and John Cosby got into an argument over which of them owns a lake that borders both of their property. The council members have begun to take sides, and the council is dividing into two factions. It is getting to the point where city council meetings are not productive. The meetings always turn into a political forum for Bill and John to voice why each is right in their arguments.

Furthermore, the in-fighting has caused the members not to communicate well. There are subcommittees in the council for various projects, including community fundraising, maintenance of Main Street, and community social events. The subcommittees have turned into cliques that are not communicating their progress to each other, and communication is essential for productive functioning of the city council. You think the whole argument is silly, and you refuse to take sides. You are still able to talk to most of the council members and the community still thinks highly of you. You are worried you won’t be able to prevent these conflicts and are doing what you can to prevent public opinion from turning against you too.

Recently, the city council began looking to fund a renovation project of your local community center. Because you are an expert in construction, you designed the application for constructing companies to bid on this project. Furthermore, because you did not want to work closely with your colleagues on projects, given the in-fighting, you decided to design the application by yourself. You were given full autonomy in designing the application and you applied your expertise to do what would be best for the community.

You are now a part of the committee reviewing and approving the proposals. The city has expressed a desire for the renovations to begin as soon as possible, and you feel like the committee is rushing the process a little. You are concerned that you will miss something important in the review that will result in critical errors that may result in the city hiring a contractor that is less than satisfactory. Nine proposals have passed a first screen by meeting the criteria outlined in the application you designed. You and several others conducted more extensive reviews of the nine proposals. The team of reviewers has identified the winning proposal, which has many outstanding features. As you scan it one more time, however, you notice that it does not meet one of the ten criteria used in the initial screening process; this proposal should never have even made it past the first round of evaluations. No one else has caught this. Now you wonder what you should do.