Case-Based Learning
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Introduction
Case-based learning is a powerful, popular method of engaging learners.
Problem-based learning (PBL) focuses on the self-directed seeking out of information by learners. Facilitators need not be subject experts, and as a result, the PBL process is profoundly affected by resource preparation and group function (Dolmans et al, 2005). Contrasted with this, case-based learning has a subject expert as facilitator, and learners normally have the required knowledge either previously learned or available (Tarnvik, 2007).
Interestingly, a shift from PBL to CBL in two Californian medical schools showed an overwhelming preference of students and faculty for CBL, primarily because of "fewer unfocused tangents, less busy-work, and more opportunities for clinical skills application" (Srinivasan et al, 2007).
The Sharing In Health Model
The SiH model uses three distinct but related types of case-based learning:
- self-learning, using a computer interface
- small-group, paper learning
- simulations (a separate SiH topic)
Supporting these, we provide, up-front, relevant background content, rather than asking students to search out basic factual answers. It is important that this background content be in place for the cases to unfold properly. Content is designed to be universally relevant, while cases are customized for local culture, geography, epidemiology, and health care infrastructure.
Within cases, we embed a number of question prompts designed especially for application of knowledge, skills, and attitudes. Brief answers are provided, with further explanations linked to the background content.
On the other side of the learning experience, we provide assessment tools targeted to the foundations of what the students are expected to learn - the 'competencies' of their professional practice.
Writing the Case
In preparing the case, consider the following:
- who is the target audience?
- what topics will the case involve?
- what knowledge, skills, and attitudes do you want to assist the learners in consolidating?
Technical considerations
Feel free to write the case in a Word document or a Powerpoint; we'll take the content and embed it within our website, taking care of the formatting details.
Please review our Open-Access license to be sure you agree with our terms, and feel free to ask any questions you'd like before moving forward!
General advice
Ideally, cases strengthen core understanding of the topics. Unusual presentations or diagnoses are certainly valuable to cover, but if the case covers a topic that is extremely rare, it may not be the most relevant for learning.
Some distractors or superfluous information can be helpful to add complexity and ambiguity (which is certainly, but too much can cause frustration and confusion. Consider leaving out unnecessary details.
Avoid giving hints through the title, leading questions, etc.
While we certainly embrace flexibilty, there is a template that most cases follow:
Introduction
Begin with a short description of the case's objectives, primarily to engage the learner. However, if there is an unexpected diagnosis embedded, it is a good idea not to include this. Instead, focus on diagnosis and management of the initial clinical presentation.
Introduce the case with a clinical presentation, with initial background information. Some distractions can be added as appropriate. Begin simply, and don't provide too much information.
Ideally a picture is included; this need not be the actual patient, but rather simply an image that engages the reader.
End with 1-3 open-ended questions, such as:
- what further questions would you ask?
- what would you look for on physical exam?
- what is your differential diagnosis at this point?
- what initial management might you want to begin (if situation is acute)
Provide answers of 1-3 sentences. We will provide a link to relevant in-depth background content as appropriate.
Progression, Part I
Introduce further information from history, physical exam, tests, or simply the passage of time.
Again, a picture is helpful to brighten the case.
Provide further questions, such as:
- what is your differential diagnosis at this point?
- what management do you institute?
- interpret these results (labs, ECG, chest X ray, etc)
As above, provide short answers, expecting a link to background information.
Progression, Part II
Continue the case as the story dictates. At this point, information gathering should be largely complete, though further investigation may be warranted as conditions change.
This last set of questions should focus on more complex intepretation of findings or results, as well as ongoing management.
Conclusion
Finish with a short description of how the case concluded. The ending should be realistic.
Provide a more complete summary of the competencies you hope the learner has grown in, broken down into:
- knowledge
- clinical reasoning
- skills
- attitudes
Links to relevant background materials will also be provided here.
Completion of the case should ideally lead to independent assessment tools linked to the above competencies.
After writing the case, find a reviewer or two to ensure the level of difficulty is sufficient, and that there are no content or style errors.
Presenting the Case
As a presenter or facilitator, it is critical to be very comfortable with the content beforehand.
Ensure you have carefully reviewed the material and understand the flow.
Do not race ahead too quickly. Do not give hints.
When concluding, provide a brief review with a few key points, but limit the didactic sharing of further information beyond what was covered in the case.
Further information can readily be provided for learners to reference.
An excellent article further describing this was written by Dhaliwal and Sharpe (2007).
Resources and References
Dolmans DH, De Grave W, Wolfhagen IH, van der Vleuten CP. 2005. Problem-based learning: future challenges for educational practice and research. Med Educ. 39(7):732-41.
University of Saskatechewan - small group learning resources
Dhaliwal G, Sharpe B. 2009. Twelve tips for presenting a clinical problem solving exercise. Medical Teacher. 31(12):1056-1059.
Srinivasan M, Wilkes M, Stevenson F, Nguyen T, Slavin S. 2007. Comparing problem-based learning with case-based learning: effects of a major curricular shift at two institutions. Acad Med. 82(1):74-82.
Tärnvik A. 2007. Revival of the case method: a way to retain student-centred learning in a post-PBL era. Med Teach. 29(1):e32-6.
Medical Education wiki, University of Saskatchewan
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