Academic Performance and Perceptions of Undergraduate Medical Students in Case-Based Learning Compared to Other Teaching Strategies: A Systematic Review with Meta-Analysis

Abstract

Case-based learning (CBL) is a teaching method centered on active student learning that can overcome the limitations of traditional teaching methods used in undergraduate medical education. The aim of this systematic review was to compare the effectiveness of CBL against other teaching methodologies in terms of academic performance and perceptions (intra-individual, interpeer and student–faculty) of undergraduate medical students. Literature searches were performed using PubMed, EMBASE and Web of Science databases up to 28 April 2021. We included studies that quantitatively compared the academic performance and perception outcomes of CBL against other teaching methodologies in undergraduate medical students. The risk of bias was judged using the RoBANS tool and certainty of evidence using the GRADE framework. Meta-analyses were conducted using a random-effects model and reported as standardized mean differences (SMD) with 95% confidence intervals (CI). Of a total of 4470 records, 41 studies comprising 7667 undergraduate medical students fulfilled the eligibility criteria and were included in our systematic review. The CBL group was superior to the other teaching method groups in terms of academic performance measured by exam scores (SMD = 2.37, 95% CI 1.25–3.49, large effect, very low certainty) and interest and motivation (SMD = 0.79, 95% CI 0.13–1.44, moderate effect, very low certainty). Other academic performance or perception outcomes were not statistically different between CBL and other teaching methods when considering the pooled effect. Still, they were often superior in the CBL group for specific subgroups. CBL showed superior academic performance (especially compared to didactic lectures and tutorial-based teaching) and interest and motivation compared to other teaching methods used with undergraduate medical students. However, the certainty of evidence was very low and further studies are warranted before a stronger and more definitive conclusion can be drawn.