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Case study methodology in tertiary education owes much of its recent origins to the Harvard Business School. Detailed scenarios would be presented of activities in a business organisation (e.g. a human resources problem which would have generalisations across other organisations) and a rigorous process of analysis would then be followed according to set procedures. This resulted in identification of the root cause(s) of the problem, related back to theory, and predicted options for its solution. Note that the ‘case’ that was presented would have been a fully reported story of events entitled, for example, ‘X Ltd’s staffing difficulties’; it would not have been ‘Staffing difficulties and how to resolve them’ – this would have been the theory that would have been referred to in order to solve the specific case being analysed.
A corollary in the health sciences world might be ‘Mr X’s incontinence problem’, with lots of information on hand (patient history) to help diagnose Mr X’s problem; which could then go on to be managed appropriately. Of course, an issue here is that the actual process of obtaining that history may be critical to the objective of studying this case, as well as determining what kind of further investigations should be carried out.
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In making cases the central learning activity – especially in later years of a course – it is therefore common to present to the students only a very brief scenario, akin to the typical situation when a patient first fronts up at the surgery.
However, because of the options this then presents (leading eventually to a differential diagnosis), in classroom practice this often leads to the actual person (Mr X) disappearing, and the ‘case’ becomes, in this instance, ‘Urinary tract problems in men’, thereby losing the significant aspect of contextual learning.
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This happens with some ‘paper’ cases in use in the Faculty of Health Science. A case may be as brief as a four-line scenario, or as comprehensive as a four-page history with accompanying test results. It may be that the four-line scenario is hiding a wealth of very idiosyncratic and significant application of theory, but unless the revelation of this information is carefully staged (further handouts given to the students as discussion progresses, for instance) the actual case (the person in the surgery) may be lost. In the concluding session of a case study, the presenting patient should be the subject of the final remarks. After all, this will be the situation the students will face when they are in practice.
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