December 1, 2013 Volume 77, Number 12
Call for PBLDs David L. Hepner, M.D., Chair
Committee on Problem-Based Learning Discussions

The Committee on Problem-Based Learning Discussions (PBLD) invites submissions for the ANESTHESIOLOGY™ 2014 annual meeting PBLD program planned for New Orleans. In San Francisco this past October, 85 cases were scheduled for two presentations, and nearly all sessions sold out. Each case was presented twice to maximize the opportunity for attendees to participate. There was lively debate and discussion at the tables. For 2014, the committee will again continue the open-call process. Submissions in each of the meeting tracks are being solicited, including ambulatory anesthesia, cardiac anesthesia, critical care medicine, fundamentals of anesthesia, neuroanesthesia, obstetric anesthesia, pain medicine, pediatric anesthesia, regional anesthesia and professional issues. Submitted cases should only have one moderator who must be at the faculty or attending level. Last year, for the first time, fellows were allowed to submit cases together with an attending. We will again provide this opportunity for fellows. At the time of the presentation, both attendings need to be present to moderate the PBLD.


PBLD authors often ask why a particular case was not selected and how to improve his or her presentation. In order to increase the transparency and improve the success in getting cases accepted, members of the PBLD committee have presented a workshop on preparing, submitting and moderating a PBLD at the last two ASA meetings. In addition, for the past couple of years, there have been PBLD offerings on how to write and moderate a PBLD.


An ideal PBLD case presents an interesting hypothetical patient, has a teaching point and includes controversies or a conflict in management. The case should be relevant to current clinical practice and require that dilemmas be solved and decisions made. The case asks open-ended questions and, as in clinical practice, it unfolds gradually with new information. The questions should be interspersed and not be asked at the end of the case. A common approach is to have multiple iterations of one or two descriptive sentences of the case followed by a few questions. It is best to avoid questions where answers could be given without reading the case. The discussion section should not be in the form of an outline; it should reveal some scholarship and not answer question by question. It is better for participants to have to go over the entire discussion and extract the information. You can think of the discussion as a short review article, with the references numbered in the text and entered at the end. Prior years’ PBLDs of very high quality have also been submitted to the MedEdPORTAL program of the Association of American Medical Colleges for publication review. This past year, the PBLD committee noticed that many excellent PBLDs included figures, tables and diagrams that were copyrighted. It is imperative that discussions do not contain copyrighted material. The committee prefers the use of graphics designed by the authors. If original figures, tables or diagrams are utilized, permission needs to be obtained from the publisher and not from the authors.


A good way to start choosing a topic is to identify current debates in your particular field. Find a topic that is interesting, relevant and presents a clinical dilemma. The case should evaluate and treat a patient in a challenging situation. Good cases allow for many different techniques to be discussed. Important rules to follow when writing a PBLD are to avoid following your own recipe, as it may not be the best or the only way, and to avoid writing something that may not be perceived as safe or best practice. It is imperative that authors provide current information (e.g., ACC/AHA guidelines, ACLS guidelines) and provide generic drugs with accepted doses.


Although it is fine to start with your own experiences, the case should be hypothetical. A PBLD is not about how you took care of an interesting patient. A fictitious amalgam of several cases with more than one possible solution presents an ideal case. A medically challenging case describes an uncommon disease or a complicated patient and how you managed it. Extremely rare or unusual cases, with limited management options, are more ideally suited to the Medically Challenging Cases section of the meeting. Unique cases should also be considered for publication review.


All cases undergo review by multiple committee members and are selected for their relevance, content, scholarship and adherence to the guidelines and instructions posted on the ASA website and included here. It is important not to choose a common dilemma, as cases are divided by subspecialty to ensure quality and breadth of cases. Each of the tracks requires enough cases, and they can’t all be the same topic. Common reasons for rejection include unique cases and those with limited management options. Other common reasons for rejection include the presence of typos, grammatical errors and factual errors, or HIPAA violations such as patient initials or health center. Unlike a publication for review, the reviewers do not have the opportunity to write comments back and forth with the authors. Hence, PBLDs that require more than minor edits are likely to be rejected. Authors are strongly encouraged to check for typos and grammar and to have a colleague review the case.


The best cases for submission are provocative or controversial and offer more than one plausible approach or strategy. Multiple decision points or controversies should be a prominent feature. At the PBLD sessions, which include groups of about 10 discussants, emphasis is placed on an interactive team-based discussion rather than a lecture by the moderator. The moderator starts the session by presenting the case with clear objectives and creates an atmosphere for participants to work together to find solutions. In addition, the moderator provides feedback to the group and guides participants through discussion and decision-making as the case unfolds. Moderators should be prepared to facilitate discussion among attendees, and no audiovisual equipment is required or allowed. All cases must be submitted online in the annual meeting section of the ASA website The link to the site opens on December 10, 2013 and closes on February 10, 2014.

 David L. Hepner, M.D. is an attendinganesthesiologist, Department of Anesthesiology, Perioperative and Pain Medicine, Associate Director, Weiner Center for Preoperative Evaluation, Brigham and Women’s Hospital and Associate Professor of Anaesthesia, Harvard Medical School, Boston.