Original case exhibits · faculty and assessment review
Obesity and Diabetes Care in Women
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: the postpartum visit is not the completed test
The case develops
At eight weeks postpartum, the test order remains open and transport is difficult.
Faculty reasoning and feedback
Connect the correct test to scheduling help, result ownership and the next surveillance decision; do not count an order as completed screening.
Try a different patient
At eight weeks postpartum after gestational diabetes, a woman attended her follow-up but has not had the ordered glucose test. A recent A1C is 5.5%, and she asks whether this makes another test unnecessary. Which assessment plan best closes the gap?
- Obtain fasting plasma glucose now and reserve an OGTT for an abnormal result.
- Use home fasting and postmeal readings for two weeks as the postpartum screen.
- Arrange a fasting 75 g two-hour OGTT now, with a plan to review the result.
- Repeat A1C at three months postpartum, allowing more time for red-cell turnover.
Review the proposed answer and rationale
C. Arrange a fasting 75 g two-hour OGTT now, with a plan to review the result.
The 75 g OGTT is recommended at 4–12 weeks postpartum. A1C can be misleading in this period; fasting glucose alone may miss postchallenge abnormalities. Home readings do not replace the recommended assessment. Address barriers and assign result review. [1]
Assessment map: baseline Q1 → proposed TR1; objective LO1. The current course reference list supports the key; verify the current guideline or label during clinical review.
Case 2
Elena: cardiovascular benefit beyond an A1C target
The case develops
The patient is pleased with glucose control but asks why another treatment discussion is needed after MI.
Faculty reasoning and feedback
Separate glucose and weight outcomes from cardiovascular evidence, then incorporate nutrition, function, safety, cost and preference.
Try a different patient
A 59-year-old woman with obesity, type 2 diabetes and a prior MI has an A1C of 6.6% on metformin and takes her secondary-prevention medicines. She has no HF diagnosis. Which additional conversation best addresses residual cardiovascular risk?
- Review GLP-1 and/or SGLT2 options with demonstrated benefit, alongside current prevention.
- Continue the current regimen and revisit cardioprotective diabetes therapy if heart failure develops.
- Optimize metformin first and defer additional therapy until glycemic control changes.
- Choose the obesity medicine with the largest weight effect as the cardiovascular strategy.
Review the proposed answer and rationale
A. Review GLP-1 and/or SGLT2 options with demonstrated benefit, alongside current prevention.
Established ASCVD supports review of therapies with demonstrated cardiovascular benefit independently of additional glucose lowering. At-goal A1C and absence of HF do not remove that indication for review. Weight-loss magnitude alone does not establish cardiovascular benefit. [5,11]
Assessment map: baseline Q3 → proposed TR2; objective LO2. The current course reference list supports the key; verify the current guideline or label during clinical review.
Case 3
Nora: a reproductive plan changes the care plan
The case develops
The desired conception date moves forward and the patient has borrowed a stopping rule from another medicine.
Faculty reasoning and feedback
Verify the exact product and indication, agree a product-specific timeline and preserve necessary care; do not treat discontinuation as the full handoff.
Try a different patient
A woman taking injectable Wegovy only for weight management now wants to begin trying for pregnancy in ten weeks. She was told that all weekly medicines need the same four-week gap. Which counseling plan correctly uses the product-specific instruction?
- 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.
- 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.
Review the proposed answer and rationale
A. Arrange preconception care and stop Wegovy at least two months before the planned pregnancy.
For this weight-reduction scenario, Wegovy labeling specifies at least two months before planned pregnancy. A monthly cycle or another product’s contraception precaution does not determine this interval. Confirm the exact product and coordinate preconception care. [7]
Assessment map: baseline Q9 → proposed TR3; objective LO4. 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.