Original case exhibits · faculty and assessment review
GLP-1 Medicines and Pregnancy Planning
Progressive cases and proposed transfer decisions
These original review exhibits make the grant’s teaching method concrete. The existing learner activity and scored assessment are unchanged. New vignettes are proposed parallel forms, not validated instruments or additional completion requirements. Faculty should revise or reject any item that changes the clinical construct or adds unintended difficulty.
Application narrative bank · Proposed transfer items · CSV · Case design map · CSV
Case 1
Maya P: confirm the medicine before the calendar
The case develops
The conception timeline changes after the first consultation.
Faculty reasoning and feedback
Return to the exact formulation and indication before applying an interval; use teach-back for the revised plan.
Try a different patient
A woman using injectable Wegovy for weight management changes her intended conception date to ten weeks from now. Which plan uses the correct product-specific stopping interval while arranging preconception care?
- Arrange preconception review and stop when she begins trying, with monthly pregnancy testing.
- Use a four-week interval after the last dose, following the contraceptive precaution for tirzepatide.
- Arrange preconception care and stop Wegovy at least two months before the planned pregnancy.
- Arrange a preconception visit and take the last dose one month before trying.
Review the proposed answer and rationale
C. Arrange preconception care and stop Wegovy at least two months before the planned pregnancy.
For this weight-management scenario, the Wegovy instruction is to stop at least two months before planned pregnancy. Another product’s contraception precaution is not a substitute for this interval. [12]
Assessment map: baseline G1 → proposed TR1; objective 1. The current course reference list supports the key; verify the current guideline or label during clinical review.
Case 2
Nora: uncertainty requires careful counseling
The case develops
A patient interprets a nonsignificant observational result as proof of safety.
Faculty reasoning and feedback
Ask what the study can and cannot establish; separate an imprecise relative estimate from an individual absolute probability.
Try a different patient
After an unexpected early exposure, a woman reads that an observational study found no statistically significant association. Its confidence interval includes both no association and a clinically meaningful relative increase. Which explanation accurately communicates that result?
- Use the adjusted point estimate as the causal effect because measured confounders were included.
- The findings retain uncertainty and do not establish intentional use throughout pregnancy as safe.
- Treat the confidence interval crossing the null as sufficient reassurance to continue the medicine.
- Interpret the upper relative-risk limit as the individual patient’s absolute probability of the outcome.
Review the proposed answer and rationale
B. The findings retain uncertainty and do not establish intentional use throughout pregnancy as safe.
The interval includes no association and a potentially meaningful relative increase; absence of statistical significance is not evidence of equivalence. Adjustment cannot remove all residual confounding. A relative risk is not an individual absolute probability. The study does not replace current product guidance. [14]
Assessment map: baseline G4 → proposed TR2; objective 2. The current course reference list supports the key; verify the current guideline or label during clinical review.
Case 3
The transition visit: a referral does not provide interim care
The case develops
A specialist appointment is delayed while home glucose readings rise.
Faculty reasoning and feedback
Make the interim clinical owner, assessment, treatment transition and accepted follow-up explicit; urgency depends on the actual clinical findings.
Try a different patient
A woman with type 2 diabetes has stopped her GLP-1 medicine while preparing for pregnancy. The preconception clinic appointment is six weeks away and her home glucose readings are increasing. Which plan best maintains continuity now?
- Restart the previous GLP-1 regimen for glucose control and revisit discontinuation after a positive pregnancy test.
- Arrange preconception referral and defer treatment changes until the receiving clinician has seen her.
- Stop the medicine, provide nutrition advice and review readings at the next routine visit if she feels well.
- Arrange timely assessment and an individualized glycemic transition with an interim owner and confirmed preconception follow-up.
Review the proposed answer and rationale
D. Arrange timely assessment and an individualized glycemic transition with an interim owner and confirmed preconception follow-up.
The best plan combines active metabolic care with a preconception transition. A referral alone leaves responsibility unclear, and feeling well does not establish adequate glycemic control. The treating clinician assesses readings and symptoms and selects alternative treatment and monitoring before conception. [11]
Assessment map: baseline G6 → proposed TR3; objective 3. The current course reference list supports the key; verify the current guideline or label during clinical review.
Full proposal, objectives and clinical source register
Review the assessment before release
The current baseline and first posttest share three items. Report paired n, absolute percentage-point change, item-level results and uncertainty, with retries separate. The 15-percentage-point gain is a planning target; high baseline scores may create a ceiling. Repeated items measure immediate learning with recall limitations. The proposed transfer form changes the clinical surface while preserving the mapped concept. Before using it for a Moore level 4 claim, independent clinical and assessment reviewers must approve the key, equivalence, difficulty and analysis, then pilot it with representative learners. Use it to replace matched posttest slots only after approval, preserving six final questions and the time target. It is not an additional required test in the present activity. Report unpaired data and nonresponse; do not infer causality, observed clinical performance or patient benefit.
For each case, check clinical realism, fair balance, one defensible best answer, comparable option length, plausible distractors and absence of irrelevant reading burden. Review safety errors separately. Keep a versioned record of reviewer decisions and pilot findings; unresolved ambiguity blocks use of that item.