Case Methods in Teaching How case methods work Models for case teaching PBL or CBL? Planning your case teaching What students think about CM References and resources

Continuing the elements to be taken into consideration when planning to use case methods in your teaching, on this page we look at:

4. Space and time
5. Learning resources
6. Assessment

4. Space and Time Class size, teaching space and time available are your greatest limiting factors to using case method at the University.

Class size

Case method teaching has been used effectively with classes of 6–100 students, but large numbers will need to be divided into smaller work groups. When class size is too small there will be too few opinions to challenge discussion. When class size is too large individuals get little opportunity to contribute so may skip required preparation.

Experience with case-based learning in Australian medical schools shows optimal group size of 10–20 students. (We have listed some ways of dealing with big classes.)

Teaching space

Lecture halls with fixed seating should preferable only be used for case introductions, round-up sessions, or occasional lectures (which may be given as a learning resource). However, even this teaching space can be managed for limited small group discussion (‘Dealing with big classes’ may help).

Resource or workshop sessions are opportunities for groups to meet, share ideas and research specialised resources provided by the facilitator, possibly in a laboratory setting. There needs to be space to move around in small groups, with the facility of teaching from one end of the room (with whiteboard etc.) so students and facilitator can pose questions of the class and groups can make individual presentation of their conclusions.

Time available

Planning and preparing good case method teaching can take longer than preparing traditional theory-based lecture notes as there will be no standard textbook to follow the content.

It may first look as though the teaching/learning takes longer too (quote: ‘It takes all week to study one case and treatment options – I used to teach a whole body system in that time!’). But by using case methods your students are learning background theory and application, analytical processes, treatment options and systematic links at the same time. (Their learning is holistic and contextual.)

Remember that case-based methods have been introduced into health science curricula in some universities to make learning more efficient and facilitate a concomitant reduction in years of study to complete a qualification.

If you intend to base your teaching around the use of cases you will need to reorganise your use of time and the way learning outcomes are expected to build on each other.

5. Learning resources

For students to be self-directed in their search for content and answers to learning activities, they must have access to necessary resources (the type will vary according to subject):

• textbooks/CDROMs/readings, for core theory;
• on-line computers and a list of some useful websites to initiate a search for most current information;
• library and journals;
• practical equipment in lab situations if applicable;
• even a ‘real patient’ (or actor) to question;
• timetabled tutorial sessions to brainstorm, discuss and consolidate information;
• set lectures/seminars, which are still the best way to succinctly cover some of the theory, special techniques etc., but should not take over from the case methodology.

Where cases are the principal guide to a week’s learning, it is common to have a set timetabled structure. Theory lectures have a regular timeslot, and workshop sessions where lab equipment and other resources can be provided under the supervision of a tutor/facilitator.

6. Assessment

As with the assessment you design for any student learning, there are three basic questions that need to be addressed:

• Why is assessment necessary?
• What is to be assessed?
• How are you going to assess it?

Why assess?

There are two main purposes for implementing assessment in a course and it is good teaching practice to include a balanced mix:

• summative assessment - to judge if learning objectives and/or competency has been achieved and provide a measure of this achievement;
• formative assessment - to diagnose progress, provide formative feedback and motivate performance.

In practice, many assessment exercises perform both functions: assignments throughout a course contribute to the final mark, but are returned to the student with constructive criticism from the tutor to guide improvement. However, students should if possible be offered the opportunity of undertaking assessment which does not carry marks - an assessment task which gives them penalty-free feedback on the progress of their learning.

What to assess?

Curricula based on well constructed learning objectives/ outcomes are at a sound advantage here - appropriately designed assessment will show to what extent these have been achieved. When teaching has employed case method techniques there is an emphasis on the aquisition of process skills as well as content knowledge and applications, so it is important to include assessment of problem-solving, reasoning and communication skills.

When client relations are being considered there are aspects of empathy (including listening skills) and ethics (legally and morally responsible behaviour) which are essential to the practicing professional - these provide challenges to objective assessment and make it particularly important to use appropriate assessment methods.

How to assess?

Conventional or traditional approaches to assessment include examinations, tests, problem sheets and essays, together with the demonstration of professional skills and abilities. There tends to be an emphasis on memory recall, and this assessment mix may not give exposure to the analytical and attitudinal aspects fostered by case method study.

There are clear benefits in using more 'authentic' assessment tasks that mirror and integrate the learning objectives/outcomes in a realistic way. This can include variations on conventional tasks, for example: instead of writing a compare and contrast essay on some aspect of primary health care, students would be asked to produce a briefing paper for the regional health services division, or prepare a discussion for an allied health group.

Authentic assessment formats require students to carry out tasks and procedures which would be required of them in the workplace. This might include:

One particular assessment method is increasingly used across medicine and the allied health services: the 'OSCE' (Objective Structured Clinical Examination). Students rotate around a series of short structured clinical encounters (set up in the classroom or ward etc.) which each test an element of clinical competence. This can be complex to set up and has high supervisory demands, but offers great flexibility.

What's special about assessment for case method learning?

It is always important too make sure there is a match between learning objectives, teaching methods and assessment practice - what you tell the students they are going to be able to do at the end of a learning segment should be what you test them for, and the way you facilitate their learning enables them to achieve the required outcomes. In traditional classroom learning this is relatively straight-forward: "You will learn these facts; practice these facts and learn them; now write them down so I can check that you have learnt them" (obviously a simplified rendition!)

But it is more challenging to achive that match when you are requiring deeper "internalised" learning that mirrors professional practice.

If you would like to read more about alternative Assessment Practices, the University Teaching and Learning web site contains an interesting and comprehensive on-line guide.

Have you looked at the different Models for case teaching illustrated on this web site?

Have a look at the References and Resources on case methods in teaching Health Science.

See evaluation findings on what students think about studying by case method.