Variations on an Historical Case Study.

Byline: Patrick Field

Images courtesy of Providence Holy Cross Medical Center

The National Inquiry Standard for Science Education Preparation requires science teachers to introduce students to scientific inquiry to solve problems by various methods, including active learning in a collaborative environment (NSTA 2003). When given an inquiry-based problem, students in structured groups learn to use critical-thinking skills to analyze the components of the problem, ask questions about the problem, hypothesize methods by which they might secure an answer or solution to the problem, communicate and justify their ideas about the problem to others, and finally, after all the data are collected, develop concepts about the nature of the problem (NSTA 2003).

In order for science teachers to comply with this inquiry standard, activities must be designed for students to practice these skills, either in open-ended problems or assignments that have specific solutions. The case of Isidro Mejia, a construction worker who had six nails accidentally shot into his head from a nail gun, is the basis for a series of activities that range from the open-ended, Problem-Based Learning (PBL) type suitable for an introductory undergraduate biology course, to an advanced analytical case study appropriate for graduate-level neuroscience students. (For an overview of case teaching techniques and strategies, see Herreid 1994.)

Background of the case study

On April 19, 2004, Isidro Mejia was working construction on the roof of a house when he lost his footing on the scaffolding and fell on top of another worker, who was using an automatic, high-powered nail gun. As the man holding the nail gun tried to regain his balance to prevent himself from falling off the second floor, he grabbed Mejia, tumbled on to him, and discharged the pressure-sensitive nail gun into his head and body. This particular nail gun is extremely powerful, as it has to drive nails into two-inch by four-inch wooden planks, enough power to penetrate through bone (Wan 2004). Upon impact, the nail gun drove six 3 1/2 inch nails into Mejia's head, face, and neck within seconds.

Barely breathing, Mejia was rushed to Providence Holy Cross Medical Center in the Mission Hills region of Los Angeles, California. As paramedics escorted Mejia into the emergency room, he stopped breathing. He was quickly resuscitated, but remained in a comatose state after resuscitation (Wan 2004). "At first, the extent of damage could not be determined because the nails were driven beyond the initial wound," commented staff radiologist Dr. Stephen Greenberg, but after receiving the x-ray images, he later reported, "the initial x-rays display the six nail placements and that the jaw bones were intact" (Thompson 2004). Neurosurgeon Dr. Raphael Quinonez had little hope for Mejia after his preliminary examination, but with no options available, he had Mejia prepared for surgery to remove the nails (Wan 2004).

Activities For introductory undergraduate biology courses with students with a minimal background in central nervous system (CNS) anatomy

Begin by dividing the class into groups of four to five students. Next, distribute to each student a handout containing the brief explanation of the accident provided above in "Background of the Case Study," along with copies of the x-rays showing the frontal and lateral…