Case-Based Learning

In my final blog post, I am reflecting on the exposure that I have had to case-based learning (CBL) during my selective.  Throughout my clinics and the lunch-time rounds, I have had the opportunity to listen in and participate in the discussion as residents prepare for their Royal College examination by going through practice cases.  The scenarios have ranged from topics within the various Internal Medicine subspecialties and the practice questions always include asking the trainee to summarize the case in one to two sentences.  The next step is to create a differential diagnosis (with their leading differential stated upfront) and develop a preliminary management plan.  Follow-up questions from preceptors may surround counseling or altering the scenario to see how management plans may differ under other circumstances.  After the trainee has completed the case, we talk as a group about how the scenario went.

We use this framework in CBL frequently and it stimulates fruitful discussion as it allows group members to contribute and bounce ideas off of each other as to how they would manage certain patient cases.  It is particularly useful as you put yourself in that situation and think about what you would really do if you saw that presentation in the emergency department or an outpatient setting.

CBL has been defined by Thistlewaite et al. in 2012: “The goal of CBL is to prepare students for clinical practice, through the use of authentic clinical cases.  It links theory to practice, through the application of knowledge to the cases, using inquiry-based learning methods.”  (Thistlewaite et al., 2012) CBL allows for the application of lecture material to practical scenarios.  (Brown et al., 2012) In CBL, there may be some advanced preparation and discovery is encouraged in such a way that both students and facilitators share responsibility for coming to closure on key clinical pearls.  (Srinivasan et al., 2007)

CBL is contrasted with problem-based learning (PBL) which operates slightly differently and is more open-ended and self-directed in which students must identify what they need to know.  In PBL, facilitators play a minimal role and allow students to explore different avenues.  (Srinivasan et al., 2007) When students work together for PBL, the group will still be presented with a clinical case, but students are allowed to define and struggle with the problem.  (Srinivasan et al., 2007) PBL focuses on discovery by learners to stimulate problem solving and critical thinking as well as both independent learning and team learning.  (Srinivasan et al., 2007)

The study in 2007 by Srinivasan et al. at the University of California, Los Angeles (UCLA) and the University of California, Davis (UCD) looked at the response of medical students and faculty after a switch was made from PBL towards CBL.  CBL was preferred by both students and faculty, however those that did prefer PBL felt it encouraged self-directed learning.  (Srinivasan et al., 2007).  In PBL though, it can be difficult to cover large amounts of ground given the exploration component.  (McLean, 2016) Whereas, CBL allows more focusing on learning objectives and there is more emphasis on achieving a set outcome by the end of the session.  (McLean, 2016) Both are advantageous to medical education and have unique aspects to offer.

Thanks for reading my posts!

SH

Resources:

1. Srinivasan, M. et al.  (2007).  Comparing Problem-Based Learning with Case-Based Learning: Effects of a Major Curricular Shift at Two Institutions.  Academic Medicine, 82(1): 74 – 82.

2. Thistlewaite, J. E. et al. (2012). The effective of case based learning in health professional education.  A BEME systematic review.  BEME guide number 23. Med Teach, 34: E421 – E444.

3. Mclean. Case-Based learning and its Application in Medical and Health-Care Field: A Review of Worldwide Literature. Journal of Medical Education and Curricular Development 2016:3 39–49 doi:10.4137/JMecd.S20377.

4. Brown, K. et al. (2012). Case Based Learning Teaching Methodology in Undergraduate Health Sciences.  International Journal of Health Sciences, 2(2): 48 – 66.