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Students may find case-based and problem-based learning quite a challenge when they meet it for the first time. Instead of being provided with a clearly structured list of study notes to learn and a lecture program to sit through they find a short account of a patient who has entered the consulting room, a worried customer at the pharmacy counter, or a blood sample accompanied by a hastily scribbled test request.
Just like they will encounter 'out there' in the real world of work!
There's a library full of books they can research, some suggested web sites to look up and a tutorial scheduled the following day, at which they must be prepared to engage in well-informed discussion.
Of course, it is the lecturer's job now to act as responsible facilitator - to guide the students through the study resources, help them identify the core issues and potential stumbling blocks and pose questions to get the ball rolling at discussion time. Facilitation includes the choice of methods used to present the case material (see 'Alternative presentations of a case' in the section on How Case Methods work). Note that the use of real patients or actors to illustrate or present a medical, nursing or pharmaceutical case is not automatically 'better' than a paper-based case. It is more important to match the objectives of a case with a suitable teaching strategy.
However, as with all teaching techniques students like a variety. Carefully crafted paper-based cases all presented according to the same formula may be of a consistent and proven quality, but can, quite simply, be cumulatively boring (see Farmer 2001 in the References).
Some universities present cases to their 1st year students in the same way as the 5th years, requiring the students to set their own learning tasks from the outset. Others believe in breaking them in more gently, providing more background information in the early years and allowing cases to become more cryptic as students gain experience and confidence.
The method to be used to deliver the new curriculum from School of Medicine at the University of Tasmania is to use CBL to focus the curriculum rather than drive it in the early years.
CBL Evaluation in the FHS
Medical students in years 5 and 6 at the Launceston Clinical School were asked to evaluate their overall experience of case teaching sessions. They completed questionnaires to indicates their level of satisfaction in a number of parameters: the case material (content) and its presentation (context and learning tasks); and the presenter (facilitation and communication).
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The level of student satisfaction was about 85% in all parameters (i.e. 85% of students 'agreed' or 'strongly agreed' the evaluation criteria had been achieved). |
Here are some additional findings:
- Allied health professionals were sometimes invited as co-presenters of the case-based sessions. The resulting discussion and incorporation of alternative perspectives of a case was well received by the students.
- The use of real patients to present their own cases to the class and respond to questioning was much appreciated by the students when it was used as an alternative to paper-based presentations.
- Timing: sometimes enthusiastic specialists have run their case-based sessions for 2½ hours without a break. They may believe the discussion and interaction is similarly invigorating. Students, however, found this 'awful' - the concentration required is very tiring and the classroom may not be optimal. Case sessions may be planned like practical sessions to take a whole afternoon, but there should be breaks to rest the brain and stretch the legs.
(These course evaluation findings by Robin Ikin from the Medical Education Unithave not yet been separately published.)
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