1. 4C-ID Model Applied to Teaching
about Lung Cancer
Shari Meyerson

2. van Merriënboer (2002), figure 2

3. 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

4. Design Framework
Task Class 2 – healthy patient
Task Class 1 – straightforward
with staging or anatomic
healthy patient
reason not to operate
Task Class 3 – Severely limited Task Class 4 – the borderline
pulmonary function, won’t patient requiring additional
tolerate operation testing
Partial Task Practice Ready for Clinic
– calculating PFTs

5. Task Class 1
Supportive information
Task Class 1 – straightforward
healthy patient
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)

6. Example Learning Task
Healthy 50 year 1 cm nodule in right PET positive only in
old man upper lobe nodule
PFT’s
FEV1 85% pred
DLCO 78% pred

7. Task Class 2
Supportive information Task Class 2 – healthy patient
with staging or anatomic
reason not to operate
Two worked examples
showing patients for whom
surgery is not the correct
treatment
Just in Time information Stereotactic Body Radiation Therapy
Stage
Stage
IA
IB
Surgery
Chart showing recommended
treatment by stage Stage
Stage
IIA Stage
IIB
IIIA
PFT cutoffs for surgery Stage Stage
IIIB IV
Chemotherapy +/- Radiation

8. Example Learning Task
Healthy 50 year 5 cm mass in left PET positive in mass
old man upper lobe and entire pleura
PFT’s
FEV1 85% pred
DLCO 78% pred

9. Task Class 3
Supportive information
Worked examples of Just in Time information
calculation of predicted
postoperative PFTs Equations for calculating
predicted postoperative PFTs
18 - # of segments to be resected
ppoFEV1 = FEV1 x
Task Class 3 – Severely limited 18
pulmonary function, won’t
tolerate operation
Partial Task Practice
– calculating PFTs

10. Partial Task Practice
Preoperative
lung function
COPD or
pulmonary
Amount fibrosis
of lung to Cutoff:
be taken ppoFEV1>40%
ppoDLCO>40%
Tumor
obstruction
Still
smoking?

11. Task Class 4
Supportive information
Guidelines for use of supportive testing
- Cardiopulmonary exercise test (CPET)
- Ventilation-perfusion scan (VQ)
Task Class 4 – the borderline
patient requiring additional
Just in Time information testing
Cutoff for VO2 max on CPET
How to adjust ppoFEV1 for VQ

12. Final Exam – The Clinic
78 year old woman
Shortness of breath
at two blocks
Still smoking ½ PPD
PFTs
FEV1 48% predicted
DLCO 47% predicted

13. 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.