2. CASE-BASED LEARNING
CASE-BASED LEARNING:
PARTICIPANT OPINIONS OF ITS VALUE
IN MEDICAL EDUCATION
Timothy Billington
Graduate Medical School
University of Wollongong
Timothy Billington
Ian Wilson
Graduate School of Medicine
University of Wollongong
3. INTRODUCTION
Case-Based Learning [CBL] - leads contemporary higher medical education
- is student-centred
- promotes learning at a deeper level
University of Wollongong:
CBL tutorials for small groups (8-10 members).
We report here:
Results of analysis of a survey questionnaire completed by Phase 1
and Phase 2 students. Phase 1: initial 18 mo. Phase 2: subsequent 12 mo.
AIM
To gather information on opinions of participants regarding CBL
experiences.
To determine whether opinions changed as students progressed
through the medical course.
4. METHODS
SURVEY INSTRUMENT: 21 QUESTIONS
LIKERT
(5-POINT)
12
WRITTEN OTHER
4 5
Bar charts Thematic
Analysis
Demographic
and Statistical
5. Likert Response Scale
Strongly Agree Agree Neutral Disagree Strongly Disagree
Response categories were assigned a numerical label
1 2 3 4 5
Number of responses in each scale point were calculated from a spreadsheet
of all data. In Results, values are expressed as percentages of the total. Bar
charts are used to visualise the data.
6. RESULTS
Likert responses: bar charts
Questions 1 to 6
Phase 1 Phase 2
0 20 40 60 80 100 120
Q6
Q5
Q4
Q3
Q2
Q1
Percent 1
Percent 2
Percent 3
Percent 4
Percent 5
0 20 40 60 80 100 120
Q6
Q5
Q4
Q3
Q2
Q1
Percent 1
Percent 2
Percent 3
Percent 4
Percent 5
Q 1. Adequately prepared by UOW for learning using the CBL process?
Q 2. Now better able to learn using the CBL process than when I started?
Q 3. Sufficient information given to me by UOW on the CBL process itself?
Q 4. Adequate information given to me on my role in the CBL process?
Q 5. Sufficient information given on the Facilitator’s role?
Q 6. Adequate information given on the benefits of CBL learning?
7. We can thus see that:
60% Ph 1/ 67% Ph 2: A they were adequately prepared for learning via CBL.
52% Ph 1/ 61% Ph 2: A they were now better able to learn using CBL.
51% Ph1/ 63% Ph 2: A UOW provided sufficient information on CBL.
51% Ph 1/ 53% Ph 2: A they were given sufficient information on their CBL role.
52% Ph 1/ 38% Ph 2: A they were given adequate information re: Facilitator role.
65% Ph 1/ 55% Ph 2: A they had sufficient information re: benefits of CBL
learning.
A = Agree
8. RESULTS
Likert responses: bar charts
Questions 16 to 21
Phase 1 Phase 2
0 20 40 60 80 100 120
Q21
Q20
Q19
Q18
Q17
Q16
Percent 1
Percent 2
Percent 3
Percent 4
Percent 5
0 20 40 60 80 100 120
Q21
Q20
Q19
Q18
Q17
Q16
Percent 1
Percent 2
Percent 3
Percent 4
Percent 5
Q 16. Individual preparation for each CBL session is important?
Q 17. Helped understanding of the science underpinning CBL cases?
Q 18. More time should be devoted to CBL learning?
Q 19. Benefits derived from interaction between you and the group?
Q 20. CBL-derived knowledge assisted understanding of lectures?
Q 21. CBL-derived knowledge assisted understanding of prac/labs?
9. Previous slide shows that:
78% Ph 1/ 48% Ph 2: SA individual preparation for CBL is important.
46% Ph 1/ 65% Ph 2: A CBL helped understanding of science behind the clinical
case
35% Ph 1/ 27% Ph 2: A more time should be devoted to CBL learning
59% Ph 1 A, 32% SA / 54% Ph 2: A that benefits were derived from group
interaction
62% Ph 1/ 63% Ph2: A CBL knowledge helped understanding of lectures
56% Ph 1/ 50% Ph 2: A CBL knowledge helped understanding of prac/labs
A = Agree
SA = Strongly agree
12. THEMES emerging from analysis of written responses:
Phase 1
Q 7. Provision of more useful information
How should CBL tutorials work? Facilitator’s role? Self-directed learning:
How?
Q 9. Which aspects of CBL do you like?
Group discussion: teamwork, learning from others. Facilitator: is present to
clarify and answer questions. Clinical: Enjoy working through a case which
gives clearer clinical understanding
13. THEMES emerging from analysis of written responses:
Phase 1
Q 10. Which aspects of CBL do you NOT like?
Learning objectives should be set and not developed by students. No
guidance as to how much detail is required. CBL session: not enough
structure. Unequal contributions from members. Timing: Intro session is
far too long and don’t get enough out of the wrap-up
Q 15. Please comment on how you think CBL sessions could be improved
Facilitator’s role: improve teaching and guidance abilities. Learning
objectives should be more directly related to the case. CBL session: there
should be two per fortnight
14. THEMES emerging from analysis of written responses:
Phase 2
Q 7. Provision of more useful information
Facilitator’s role? Group members, each should contribute. Wrap up
sessions.
Q 9. Which aspects of CBL do you like?
Group: collaborative exploration of learning objectives. Facilitator: having
access to his her knowledge is invaluable. CBL wrap-up: this process has
great potential for deeper learning
15. THEMES emerging from analysis of written responses:
Phase 2
Q 10. Which aspects of CBL do you NOT like?
Facilitator: doesn’t give enough guidance. Introductory session: the same
5 or 10 people always dominate. It is too long and a waste of time. Wrap-up
session is unsatisfactory. Wasted my time studying learning objectives
that were not addressed by the lecturer
Q 15. Please comment on how you think CBL sessions could be improved
Facilitator: more input, guidance, feedback and provide more structure to
keep us on track. Learning objectives: Why do we create them when they
appear to be predetermined? Introductory session to a case: these are too
long.
16. SUMMING UP (1): Likert data analysis
This investigation of participants’ opinions of Case-Based Learning has
shown :
Majority agreement re: preparation for CBL, explanation of student and facilitator
roles in CBL, and benefits of CBL learning.
Minor variations with transition from Phase 1 to 2
Majority of strong agreement that individual preparation for CBL was important and
that benefits were derived from CBL learning.
Large agreement in both Phase 1 and 2, that CBL-derived knowledge contributed
to understanding of lecture material. Good agreement between Phase 1 and 2 that
there were benefits to be derived from group interactions. Majority agreement in
both Phase 1 and 2 that CBL helped the understanding of practical and laboratory
sessions
Large increase in transition from Phase 1 to 2 that CBL helped the understanding of
basic sciences underpinning clinical cases.
Minority of students in Phases 1 and 2 agreed that there should be more time
devoted to CBL learning
17. SUMMING UP: (2) Thematic analysis of written responses
Provision of more information: Phase 1 and 2 students highlighted that
they would like to know more about the role of the Facilitator. Phase 1 respondents
were unsure about how CBL tutorials should work and what was meant by self-directed
learning. Phase 2 students emphasised that each member of the CBL
group was expected to contribute to discussions. Phase 2 students also thought that
Wrap-Up sessions were too long.
How to improve CBLs: Both Phases emphasised that they had concerns
about the Facilitators’ roles. Learning objectives were another strong theme that
emerged in both Phases: relevance to the case and method of derivation of
objectives. Phase 1 students thought that there should be two CBL sessions per
fortnight, not one. Phase 2 students emphasised that Introductory CBL sessions
were too long.
18. CBL aspects that were liked: Students from both phases liked group
work and derived great benefits from their Facilitator’s knowledge and
contributions. Phase 1 respondents enjoyed the actual work on a case, gaining
clearer clinical understanding. Phase 2 students thought that the Wrap-Up process
has great potential for deeper learning.
CBL aspects that were NOT liked: A theme common to Phase 1 and
2 was their concern about the Facilitator’s role. Phase 1 responses highlighted
variation in abilities of facilitators and were concerned that facilitators often
dominated CBL sessions. Phase 2 students did not like the fact that facilitators did
not provide enough guidance as to the depth of knowledge required in tackling
learning tasks. Phase 1 students noted that there often was insufficient guidance
and a lack of structure to CBL sessions. A strong theme to emerge was that there
was domination from a few students and insufficient contributions from others.
Both Phases emphasised that Introductory sessions were too long and that the
same 5 to 10 people dominated. A theme common to Phase 1 and 2 was that
Wrap-Up sessions were too long and that insufficient benefit was derived from
them.
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