Case-based Learning (CBL): Improving Student Engagement … · of week Group identification of 8-10...

Case-basedLearning(CBL):ImprovingStudentEngagementthrough

ConnectingEarlyLearningwithGraduateContexts

DrSharonDarlington & DrLouiseGreen(ClinicalScienceEducatorsTeam)

FacultyofMedicine,TheUniversityofQueensland

ITaLI’s TeachingMasterclassSeries

Overview of Session

• WhatisCBL?WhyuseCBL?

• PracticalImplementationofCBL

• ChallengesandPotentialSolutions

What is Case-based Learning (CBL)?

‘CBLisalearningandteachingapproachthataimstopreparestudentsforclinicalpractice,throughtheuseofauthenticclinicalcases.Thesecaseslinktheorytopractice,throughtheapplicationofknowledgetothecases,andencouragetheuseofinquiry-basedlearningmethods.’Theeffectivenessofcase-basedlearninginhealthprofessionaleducation, Thistlethwaite Jetal.MedicalTeacher,2012;34(6)e421-e444. www.bemecollaboration.org

?DoesCBL=Group-basedlearning

Why use Case-based Learning (CBL)?

• Placesearlylearninginaclinical(graduate)context• Facilitatesintegrationofexistingknowledgewithnew

knowledge• Facilitatesintegrationofknowledgefrommultipledisciplines• Developclinical(critical)reasoningskills• Developskillsforworkingeffectivelyinhealth-careteams• Preparationforclinicalpractice• Themajorityofhealthprofessionalstudentsandteachersreport

thattheyenjoylearningviaCBL

Why use Case-based Learning (CBL) in the Medicine Program?

CBL in the Medicine Program

• Graduateentry,4-year,DoctorofMedicine(MD)Program• CBListhecornerstoneofthecurriculuminyears1&2• 500studentsperyear->50CBLgroups• Groupsmeettwiceaweekfor2-2.5hourseachtutorial• Facilitatedbyanindustry-qualifiedtutor

Tutorial1

Commenceclinical‘case’relevanttoKLIs

ofweek

Groupidentificationof8-10‘FQ’s

Learningresources

Tutorial2

PresentationofFQs

Finalcasetriggersfordiscussionand

closure

CBL

PBL

Tutorial1

‘Main’clinical caserelevanttoKLIsof

week

RAPsessionwithidentificationof2-3

‘GIFT’s

Learningresources

Tutorial2

PresentationofGIFTs

2‘Additional’,related,pre-

preparedcases

Learningresources

CBL Cycle

RAP: Reflection&PlanningGIFTs:GroupIdentifiedFocusTasksFQs: FocusQuestions

Trigger 1• YouaretheinternondutyintheEmergencyDepartmentata

metropolitanhospitalwhenamaninhisearly30sisbroughttoyou.Helooksdistressedandisbendingoverwithbotharmswrappedaroundhisabdomen.HeapparentlyspeaksnoEnglish,butisaccompaniedbyamalefamilymemberwhopointstothepatient'sabdomenandsays“bellyache!"

General ProcessCUES HYPOTHESES MECHANISMS NEEDTOKNOW GIFTS

MaleApprox.30yrsAbdopain

NoEnglishAccompaniedbyfamilymember

Systems/OrgansStomach;Smallintestine;Largeintestine;Liver;Gallbladder;Pancreas;Heart/Aorta;Kidneys;Reproductive

PathologicalprocessesVascular– ischaemiccolitisInfective- gastroenteritisInflammatory– Crohn’sNeoplastic– bowelcancer

Etc.

Location,nature,timing,severityAssociated- diarrhoea?- vomiting?- fever?- bleeding?PastmedicalhxMeds/allergies?Social&culturalbackgroundInterpreter?

Etc.

Neoplasticgrowth

Obstructedbowellumen

Build-upofgas/fluidproximally

Stimulationofstretchreceptors

Pain

Discussion Starters• Whatsystems/organsmayberesponsibleforthispatient’spain?• Howdoesvisceralpaindifferfromsomaticpain?• Whatshouldweaskwhentakingahistorytohelpusworkout

whattheproblemis?• Whatconstraintsareplacedonthehistory-takingprocessbythe

factthatthepatientisunabletospeakEnglish?• WhatadditionaldifficultiesfacepatientsofCALD(culturallyand

linguisticallydiverse)backgroundswhopresentformedicaltreatment?

What our students say about CBL

What our students say about CBL• “CBLsgetyouthinkingandapplyingprincipleslearnedinlecturesand

inlearningmaterials.Ilikethatmental/cognitiveexercise.”• “TheCBLcaselearninglinkedtothetopicsoftheweekallowed

practicalapplicationoftheweek’scontent.”• “CBLtutorialswerefantastic;agreatlearningopportunityandan

excellentwaytodevelopclinicalreasoning.”• “TheCBLsetupisbrilliant.Suchagoodenvironmentforlearning.”• “TheCBLsessionswereveryhelpfulfordeepeningmyunderstanding

ofthecoursematerial…”• “IreallyenjoyedtheCBLasIfeltithelpeddrawtogetherallthatwe

werelearningintotheclinicalenvironment.”

What our students say about CBL

• “(CBL)seemedtoputintopracticewhatwelearnedinourlectureswhichisverydifferenttomostundergraduatecourses,asitmadeuscollateallthematerialinourmindswhichnotonlyhelpedthelearningbutalsostartedmakingusfeellike‘realdoctors’andasenseofwhatwe’reworkingtoward.”

What our students say about CBL

• Removesthe‘tunnelvision’effectofPBL

• Moreopportunitiesfordevelopmentofclinicalreasoningskills

• Moreefficientutilisationoftime

• Enhancedstudentengagementandenjoyment“CBListhebestthingever!” Studentpreference

(n=225)

Alternate CBL settings?

• Individualstudentformat?Online?

Alternate CBL settings?

• Individualstudentformat?Online?• Team-basedLearningmodel?(TBL)

Team-based Learning

6

66

6 6 6

6 6 6

66

• Inlecture• Studentsine.g.10x

teamsof6• Triggerspresented

fromthefront• 2-3“roving”

facilitators

Practical Implementation of CBL

1. Decide your setting• Learningenvironment

ØTutorial,lecture,online….

• GroupsizeØIndividual,pairs,smallvs.largegroup….

• FrequencyØ‘1plus2’model,weekly,endofcourse‘module’….

• FacilitationØLecturer,tutors,peer-led,written….

• Timeallocation

2. Identify your objectives … and therefore your case

• “Startwiththeendinmind”• ConsiderLearningOutcomes• Considerpriorknowledge– pre-requisites,earlierlearninginthe

samecourse,whatpreparationwillbeset• Consideropportunityforintegration– withinowncourse,with

othercourses/disciplines• Considercommonandimportantgraduatescenarios

For consideration …• Willyoumandateparticipation?• Willyouassess?

3. Writing Your Scenario - Triggers • Keeptimeallocationinmindfromthestart

– MDprogramusuallyaround4triggersperhourinsmallgrouptutorialsetting

• Haveanoverallideaofthescenario:thinkobjectives&relevance– startwiththeskeleton,thenfleshitoutwiththedetails

• Keepinitialtriggerbroad;dripfeedwithsubsequenttriggers• Don’toverloadthetriggerswithinformationbutensureenough

isprovidedforstudentstoaddressobjectives(andisrealistic)• Providesomeformofscenarioclosure

– Expected/unexpectedoutcome?Scenariotobepickedupagainatalaterdate?

• Review andreviewagain!– Contentexperts,typosandgrammaticalerrors….

4. Writing Your Scenario – Discussion Process / Discussion Questions• GeneralProcess– whatdo“hypotheses”and“mechanisms”

meaninyourdiscipline?• ConsiderthepurposeofDiscussionQuestions• RememberBloom’sTaxonomy• Posequestionsthatpromotedeeplearning

Finish Well – Reflection and Planning (RAP)Attheendofeachsession:

• reflectongroupprocessanddynamics– anyareastoimprove?

• identify“gaps”inlearningandhowthesewillbeaddressed

Challenges? Questions?

Some Challenges and Potential SolutionsChallenges PotentialSolutions

Largecohort,resourcelimitations StudentfacilitatedCBL,Team-basedCBLor“debrief”format

Tutordiversity Tutortraining;facilitationratherthan”contentexpert”approach

Integrationwithothermodulesandcourses

Effectiveacademicteamwork

StudentParticipation Considerparticipationassessmentoptions

Difficultgroupdynamics Studenttrainingin teamwork; havetutors facilitateCBLs;tutortraining

10 TIPS

• Ourowntop tipsfromourownCBLimplementationexperienceforyoutotakeaway!

• Pleasecontactuswithanyqueries:l.green4@uq.edu.au or sharon.darlington@uq.edu.au

References and ResourcesDavidA.Cohen,LoriR.Newman&LaurieN.Fishman(2017)Twelvetipsonwritingadiscussioncasethatfacilitatesteachingandengageslearners,MedicalTeacher,39:2,147-152,DOI: 10.1080/0142159X.2017.1266315http://dx.doi.org/10.1080/0142159X.2017.1266315

JillE.Thistlethwaite,DavidDavies,Samilia Ekeocha,JaneM.Kidd,ColinMacDougall,PaulMatthews,JudithPurkis &DianeClay(2012)Theeffectivenessofcase-basedlearninginhealthprofessionaleducation.ABEMEsystematicreview:BEMEGuideNo.23,MedicalTeacher,34:6,e421-e444,DOI:10.3109/0142159X.2012.680939http://dx.doi.org/10.3109/0142159X.2012.680939

LouiseGreen:l.green4@uq.edu.auSharonDarlington:sharon.darlington@uq.edu.au