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Case-basedLearning(CBL):ImprovingStudentEngagementthrough
ConnectingEarlyLearningwithGraduateContexts
DrSharonDarlington & DrLouiseGreen(ClinicalScienceEducatorsTeam)
FacultyofMedicine,TheUniversityofQueensland
ITaLI’s TeachingMasterclassSeries
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Overview of Session
• WhatisCBL?WhyuseCBL?
• PracticalImplementationofCBL
• ChallengesandPotentialSolutions
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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
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Why use Case-based Learning (CBL)?
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• Placesearlylearninginaclinical(graduate)context• Facilitatesintegrationofexistingknowledgewithnew
knowledge• Facilitatesintegrationofknowledgefrommultipledisciplines• Developclinical(critical)reasoningskills• Developskillsforworkingeffectivelyinhealth-careteams• Preparationforclinicalpractice• Themajorityofhealthprofessionalstudentsandteachersreport
thattheyenjoylearningviaCBL
Why use Case-based Learning (CBL) in the Medicine Program?
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CBL in the Medicine Program
• Graduateentry,4-year,DoctorofMedicine(MD)Program• CBListhecornerstoneofthecurriculuminyears1&2• 500studentsperyear->50CBLgroups• Groupsmeettwiceaweekfor2-2.5hourseachtutorial• Facilitatedbyanindustry-qualifiedtutor
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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
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Trigger 1• YouaretheinternondutyintheEmergencyDepartmentata
metropolitanhospitalwhenamaninhisearly30sisbroughttoyou.Helooksdistressedandisbendingoverwithbotharmswrappedaroundhisabdomen.HeapparentlyspeaksnoEnglish,butisaccompaniedbyamalefamilymemberwhopointstothepatient'sabdomenandsays“bellyache!"
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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
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Discussion Starters• Whatsystems/organsmayberesponsibleforthispatient’spain?• Howdoesvisceralpaindifferfromsomaticpain?• Whatshouldweaskwhentakingahistorytohelpusworkout
whattheproblemis?• Whatconstraintsareplacedonthehistory-takingprocessbythe
factthatthepatientisunabletospeakEnglish?• WhatadditionaldifficultiesfacepatientsofCALD(culturallyand
linguisticallydiverse)backgroundswhopresentformedicaltreatment?
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What our students say about CBL
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What our students say about CBL• “CBLsgetyouthinkingandapplyingprincipleslearnedinlecturesand
inlearningmaterials.Ilikethatmental/cognitiveexercise.”• “TheCBLcaselearninglinkedtothetopicsoftheweekallowed
practicalapplicationoftheweek’scontent.”• “CBLtutorialswerefantastic;agreatlearningopportunityandan
excellentwaytodevelopclinicalreasoning.”• “TheCBLsetupisbrilliant.Suchagoodenvironmentforlearning.”• “TheCBLsessionswereveryhelpfulfordeepeningmyunderstanding
ofthecoursematerial…”• “IreallyenjoyedtheCBLasIfeltithelpeddrawtogetherallthatwe
werelearningintotheclinicalenvironment.”
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What our students say about CBL
• “(CBL)seemedtoputintopracticewhatwelearnedinourlectureswhichisverydifferenttomostundergraduatecourses,asitmadeuscollateallthematerialinourmindswhichnotonlyhelpedthelearningbutalsostartedmakingusfeellike‘realdoctors’andasenseofwhatwe’reworkingtoward.”
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What our students say about CBL
• Removesthe‘tunnelvision’effectofPBL
• Moreopportunitiesfordevelopmentofclinicalreasoningskills
• Moreefficientutilisationoftime
• Enhancedstudentengagementandenjoyment“CBListhebestthingever!” Studentpreference
(n=225)
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Alternate CBL settings?
• Individualstudentformat?Online?
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Alternate CBL settings?
• Individualstudentformat?Online?• Team-basedLearningmodel?(TBL)
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Team-based Learning
6
66
6 6 6
6 6 6
66
• Inlecture• Studentsine.g.10x
teamsof6• Triggerspresented
fromthefront• 2-3“roving”
facilitators
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Practical Implementation of CBL
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1. Decide your setting• Learningenvironment
ØTutorial,lecture,online….
• GroupsizeØIndividual,pairs,smallvs.largegroup….
• FrequencyØ‘1plus2’model,weekly,endofcourse‘module’….
• FacilitationØLecturer,tutors,peer-led,written….
• Timeallocation
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2. Identify your objectives … and therefore your case
• “Startwiththeendinmind”• ConsiderLearningOutcomes• Considerpriorknowledge– pre-requisites,earlierlearninginthe
samecourse,whatpreparationwillbeset• Consideropportunityforintegration– withinowncourse,with
othercourses/disciplines• Considercommonandimportantgraduatescenarios
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For consideration …• Willyoumandateparticipation?• Willyouassess?
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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….
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4. Writing Your Scenario – Discussion Process / Discussion Questions• GeneralProcess– whatdo“hypotheses”and“mechanisms”
meaninyourdiscipline?• ConsiderthepurposeofDiscussionQuestions• RememberBloom’sTaxonomy• Posequestionsthatpromotedeeplearning
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Finish Well – Reflection and Planning (RAP)Attheendofeachsession:
• reflectongroupprocessanddynamics– anyareastoimprove?
• identify“gaps”inlearningandhowthesewillbeaddressed
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Challenges? Questions?
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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
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10 TIPS
• Ourowntop tipsfromourownCBLimplementationexperienceforyoutotakeaway!
• Pleasecontactuswithanyqueries:[email protected] or [email protected]
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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:[email protected]:[email protected]