Small Group Case-based Learning Research Articles

Inclusive LGBTQIA+ healthcare: An interprofessional case-based experience for cultural competency awareness.

Lesbian, Gay, Bi-sexual, Transgender, Questioning, Intersex, and Asexual (LGBTQIA+) patients report experiences of discrimination within healthcare settings due to a lack of provider knowledge and biases of healthcare workers. There is an identified need among all health professions to provide more culturally competent healthcare for this community. Early interventions during healthcare profession training programs may be effective to address this need. The overall goal of this study was to assess the educational impact of an active learning session that was specifically designed to enhance LGBTQIA+ cultural competency awareness using an interprofessional setting. This 2-year study involved students from 16 healthcare professional programs joining virtually to form interprofessional teams. A small group case-based learning approach was used and included pre/post-activity surveys to measure the change in student attitude and confidence, as well as the change in perception of the importance of the activity. Results indicate an increase in perception of importance (p < 0.005) and in overall level of confidence (p < 0.001) with respect to LGBTQIA+ issues post-session. Key themes established through the session represent an overall recognition of the importance of interprofessional education and awareness of LGBTQIA+ healthcare needs. The results demonstrate the effectiveness of a case-based approach for enhancing cultural competency awareness across different healthcare professions programs. This session also provided an interprofessional learning environment to allow multiple healthcare professions program students to interact and share perspectives. The positive impact of this intervention in a highly collaborative virtual learning environment also highlights that this immersive active learning approach that can be adopted across different programs and institutions.

How Am I Doing in Small Group? Student Perceptions of Feedback in Case-Based Learning Sessions.

Small group case-based learning (CBL) facilitators are content experts that may provide feedback to students on cognitive reasoning skills and knowledge acquisition. However, student feedback-seeking behavior and response toward faculty feedback in CBL sessions are not known, and it is essential to maximize feedback in this setting where it can be a challenge to observe student performance while groups may have varied emphasis on individual versus team performance. We explored student perceptions of the effectiveness of faculty feedback processes during CBL sessions. This qualitative study used semi-structured interviews with ten second year medical students enrolled in the Geisel School of Medicine preclinical neurology course. Investigator triangulation was used with interpretation comparisons that included independent content analysis. The constructed themes were discussed and final theme consensus was reached. Three major themes arose: (1) students value frequent feedback on their understanding of key clinical case concepts; (2) the CBL learning environment is not conducive to individual feedback; and (3) student feedback-seeking behavior and response are influenced by self-perceived level of preparedness for the sessions and overall comfort with the CBL facilitator and learning environment. Students value content-based feedback from CBL sessions and need more individualized feedback. The style of the facilitator and overall learning environment can vary widely in the small group setting and has direct impact on feedback opportunities and student feedback-seeking behavior.

Second Year Medical Students Perceive In‐person Pathophysiology and Pharmacology Case‐Based Sessions Promote Learning More Effectively than Zoom

IntroductionCollaborative small‐group case‐based learning (CBL) is essential to active learning and facilitates team building, communication skills, team‐based decision making, and complex problem solving. Evidence showing extensive pathophysiology and pharmacology CBL learning value in preclinical students was derived in the setting of in‐person CBL, but little is known about best practices for virtual zoom CBL. Due to the COVID‐19 pandemic, schools shifted CBL rapidly to virtual modalities, providing an opportunity to study outcomes related to conducting second year medical school (M2) systems pathophysiology and pharmacology CBL by zoom or other virtual learning platforms. At the UCF College of Medicine, we compared M2 cohorts who experienced CBL virtually vs in‐person to evaluate their perceptions of various learning themes. Our objective is to share the outcomes of a survey sent to learners who had experienced both types of CBL as well as to report end‐of‐module evaluation data for cohorts with CBL conducted in‐person versus virtually.MethodsStudents (N=42) who had completed their preclinical education using both zoom and in‐person CBL, volunteered to answer Likert survey items related to the following themes: Learning‐Critical thinking (L‐T), Collaborative‐team learning (Coll‐T), Engagement‐Motivation (E‐M), and Empathy (Emp) for zoom vs in‐person cases. Responses to general end‐of‐module general survey items on CBL (N=116) from an in‐person cohort were compared to responses from a zoom only CBL cohort (N=123) to obtain perceptions from an entire class. Survey items were presented using a Likert scale and the percent affirmative to survey questions was reported for end‐of‐module items. The Likert anchor was as follows: 5:Strongly agree, 4:Mostly agree, 3:Neutral, 2:Mostly disagree, 1:Strongly disagree. Module data percent affirmative combined responses 4 &amp; 5.ResultsData are represented as mean Likert + SD for zoom (Z) vs in‐person (IP), respectively, for the themes: L‐T (Z:3.1+0.6 vs IP:4.3+0.6), Coll‐T (Z:3.0+0.7 vs IP:4.3+0.6), E‐M (Z: 3.2+0.7 vs IP:4.2+0.7), Emp (Z:2.0+0.9 vs IP:3.3+1.2). Results showed zoom CBL was ranked lower than in‐person CBL for all categories; significance was determined by paired t‐tests (p&lt;0.01). Module data comparing a Z cohort with a previous IP cohort showed, reported as % affirmative for Z vs IP, the following by theme: Coll‐L (Z:69% vs IP:75%), L‐T(Z:80% vs IP:84%), preparation for CBL (Z:96% vs IP:88%). When given the option to work as a small group or individual on CBL, 16% of the Z cohort elected group work whereas 69% of the IP cohort elected collaborative work over individual completion.ConclusionThe data show students, when specifically asked to compare 2 methods of CBL on a survey, perceive the in‐person CBL promoted more collaborative team learning, thinking, engagement, and empathy than zoom CBL. At the end of modules, a majority in both cohorts generally agreed that either zoom or in‐person CBL promoted learning, but the in‐person cohort tended to rate their CBL learning experience more highly. After working in‐person, but not by zoom, students were more likely to elect collaborative learning when it was optional, suggesting that the in‐person interactions changed attitudes and behavior about collaborative learning. Given an additional goal of small group CBL is to develop team skills, this finding suggests in‐person CBL has some specific benefits.

Effect of Case-Based Small-Group Learning on Care Workers' Emergency Coping Abilities.

This study aimed to develop and implement an emergency coping education program using a case-based small-group learning method and verify its effect on care workers’ emergency coping abilities. The study was conducted with 72 care workers in older adult care facilities and home care centers. Using a nonequivalent control group pretest–posttest design, 36 participants were assigned to each group (i.e., experimental and control groups). The collected data were analyzed through χ²-test and independent t-test using SPSS for Windows, version 25.0. Compared to the control group, a statistically significant increase in knowledge and performance levels in emergencies, emergency coping abilities, self-efficacy in coping with emergencies, and confidence in communication was observed in the experimental group. This study was able to verify the effectiveness of the emergency coping education program in care workers and recommends its use. To maximize the learning effects of educational programs, future research should develop and apply programs that incorporate simulation education.

Osteoporosis: A Small-Group Case-Based Learning Activity.

IntroductionOsteoporosis is the most common bone disease in the world. Approximately 50% of women and 20% of men over 50 will suffer an osteoporosis-related fracture. Future health care providers must be equipped to prevent, recognize, and treat osteoporosis-related fractures.MethodsTo supplement instruction on osteoporosis, we designed a case-based session. Groups of 10–12 second-year medical students worked with a single facilitator in a roundtable discussion. The 120-minute session integrated foundational sciences (pathology, physiology, pharmacology) and clinical disciplines (clinical skills, radiology, geriatrics, evidence-based medicine). Knowledge gains were assessed by performance on nine session-relevant multiple-choice questions (MCQs) on the final exam. Student satisfaction was assessed by an anonymous postsession survey.ResultsThere were 121 students that participated, and their average performance on nine session-relevant final exam MCQs was 84%. After removal of a single outlier MCQ (15% correct), average performance on the remaining eight MCQs was 93%. A total of 107 students (88%) responded to the postsession survey. On a 5-point Likert scale, 101 of 107 students (94%) agreed or strongly agreed with the statement “The basic science-clinical combination lecture on osteoporosis followed by the small-group case discussion on osteoporosis prepared me adequately to understand the topic” (M = 4.56, SD = 0.63).DiscussionWe developed a case-based learning activity for preclinical medical students to enhance the clinical scaffolding of basic science and medical knowledge around osteoporosis. Students performed well on session-relevant exam questions, demonstrating competency in the educational objectives. Student satisfaction was high, with most students feeling well prepared.

Using the physiology of normal aging as a capstone integration exercise in a medical physiology course.

As the Baby Boomer generation reaches old age, there has been a significant increase in the number of older adults needing healthcare over the past decade. The physiology of aging is therefore a highly relevant topic for the preclinical medical curriculum. I describe a new capstone unit on the physiology of aging, placed at the end a medical physiology course, to provide a vehicle for integration of prior learning about physiology of each individual body system. Students were provided with online self-study modules as preparation for a mandatory small group case-based learning activity. A detailed case of an elderly female patient being assessed for fall risk was provided. Students were required to document a "Review of Systems" predicting decreased system functions due to senescence and to prepare a group concept map illustrating how physiologic deficits contributed to fall risk in the patient. Students successfully completed the activity and reported generally good satisfaction with the experience. The activity was judged an effective tool for students to consolidate prior learning and to apply physiology to an important medical topic. The lesson also provided several opportunities for curriculum integration with cell biology, biochemistry, anatomy, and clinical skills components.

The training needs of Korean intensive care unit nurses regarding delirium

ObjectivesThe aim of this study was to investigate high-priority training needs by analysing the perceived importance and self-reported performance of nurses’ delirium care competency. DesignA cross-sectional survey with a convenience sample of 255 Korean intensive care units nurses. SettingIntensive care units in the Republic of Korea. Main outcome measuresIntensive care unit nurses’ delirium care competency. ResultsExploratory factor analysis of the Nurse Delirium Care Competency Scale showed a six-factor structure, which accounted for 67.51% of the variance in nurses’ delirium care competency: management algorithm, prevention, communication, nursing management, assessment, and collaboration. The self-reported performance scores of all six factors were significantly lower than their perceived importance scores. The delirium assessment factor was identified as a high training priority on the importance-performance matrix for new graduate nurses. ConclusionTraining programmes should be developed considering the six delirium care competency factors identified in this study. Further, nurse educators must adopt active educational modalities such as case-based small group learning and simulation-based learning to improve nurse competency in recognising and managing delirium.

University of Wisconsin School of Medicine and Public Health.

University of Wisconsin School of Medicine and Public Health.

Charles E. Schmidt College of Medicine at Florida Atlantic University.

Charles E. Schmidt College of Medicine at Florida Atlantic University.

Florida International University Herbert Wertheim College of Medicine.

Florida International University Herbert Wertheim College of Medicine.

MEDTalks: a student-driven program to enhance undergraduate student understanding and interest in medical schools in Canada.

Given the lack of programs geared towards educating undergraduate students about medical school, the purpose of this study was to evaluate whether a medical student–driven initiative program, MEDTalks, enhanced undergraduate students’ understanding of medical school in Canada and stimulated their interest in pursuing medicine. The MEDTalks program, which ran between January and April 2018 at the University of Ottawa, consisted of 5 teaching sessions, each including large-group lectures, small-group case-based learning, physical skills tutorials, and anatomy lab demonstrations, to mimic the typical medical school curriculum. At the end of the program, undergraduate student learners were invited to complete a feedback questionnaire. Twenty-nine participants provided feedback, of whom 25 reported that MEDTalks allowed them to gain exposure to the University of Ottawa medical program; 27 said that it gave them a greater understanding of the teaching structure; and 25 responded that it increased their interest in attending medical school. The MEDTalks program successfully developed a greater understanding of medical school and helped stimulate interest in pursuing medical studies among undergraduate students.

Understanding Medical Student Disengagement from Small Group Learning Activities by Comparing Faculty and Student Perceptions

Small group case‐based learning (SGCBL) makes up a significant amount of curricular time in the medical education at the University of Central Florida. Recently, learner engagement in SGCBL activities within our curriculum has been waning. The purpose of this study was to explore reasons for disengagement and faculty efforts towards SGCBL with the aim to improve design of these small group sessions.METHODSSemi‐structured qualitative interviews were done with 15 first‐year medical students (M1) and 14 faculty members that teach to the M1s. Interviews were transcribed. The thematic analysis approach in this study followed a systematic process of review which began with investigators reading the transcripts of interviews multiple times in order to be familiarized with data. Following this, early themes were identified by each investigator and discussed. The preliminary themes found by MR and DH were compared to arrive at larger themes and come up with coding terms. The transcripts were then loaded into the NVivo system and words were keyed in as clusters to identify themes.RESULTSThe four main themes from this analysis were perception (value) of time, case design, group dynamics, and utility of feedback. For perception of time, M1s expressed concern over educational value of time spent on cases. Faculty perceived this as well as they feel students rush through the cases. As for case design, M1s and faculty felt that cases should be clinically relevant, however M1s and faculty were conflicted over the length of the cases. Faculty felt that case design should focus on improving clinical reasoning, whereas M1s focused on how case design aligns with the course examinations. Most M1s felt that SGCBL activities provided opportunities for learning team dynamics and accountability. Students also felt that group dynamics shaped learning more than the actual content. Faculty perceived the students lacked group dynamics as they felt students adopted a divide and conquer approach to the problems. For feedback, students valued faculty versions of feedback/answers and did not refer to their own efforts. Faculty were variable on how to provide ideal feedback.DISCUSSIONThese data suggest that how students approach SGCBL is complex and has many factors. These include pressure for USMLE Step 1 performance for residency applications. Additionally, students in this generation have grown with sophisticated games, cell phones and computer programs that were not available for most of the faculty teaching. Other things includes excellent external resources outside of curricula that are available for content. In order to maintain learner engagement, many faculty will need to re‐tool themselves to address higher order thinking and communication skills in students as opposed to content delivery.Support or Funding InformationN/AThis abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Partnering to Analyze Selection of Resources by Medical Students for Case-Based Small Group Learning: A Collaboration between Librarians and Medical Educators

Librarians and medical educators analyzed the quality of information resources used by first- and second-year medical students in their case-based small group learning summaries. Librarians provided instruction on using library resources and gave formal feedback to students about appropriate resources for basic science and clinical questions. The team found that students used a high number of clinical and basic science journal articles and textbooks with a number of factors influencing their resource choices. The study demonstrates numerous areas where librarians can play a key role in assisting students to find and assess information to answer clinical questions.

Implementing the Flipped Classroom in a Veterinary Pre-clinical Science Course: Student Engagement, Performance, and Satisfaction.

There has been a recent move toward active learning pedagogies in veterinary education, with increasing use of a blended approach that incorporates both online resources and live classroom sessions. In this study, an established veterinary pre-clinical course in introductory animal health was transitioned from a traditional didactic lecture delivery mode to a flipped classroom approach with core content delivered online. This study compared the experiences of two cohorts of students who studied the same course in the different formats in consecutive years. Online learning resources included short video segments and a variety of short problems and activities. Online materials were complemented with weekly small-group case-based learning classes facilitated by academic staff. A mixed methods evaluation strategy was applied using student grades, surveys, and focus groups to compare student academic performance, satisfaction, and engagement between the two cohorts. The flipped classroom cohort achieved significantly higher grades in the written answer section of the final examination. Student satisfaction with learning resources was also higher in this cohort. However, satisfaction with other aspects of the course was largely the same for both cohorts. This study revealed some of the challenges associated with achieving adequate student preparation for class using online resources. The outcomes of this study have implications for veterinary educators considering the design and development of new online learning resources.

Evidence-based medicine skills that last: A transferable model utilizing integration, spaced learning, and repetition with a single study design among second-year medical students

This article was migrated. The article was marked as recommended. Introduction. The medical education literature lacks descriptions of evidence-based medicine (EBM) curricula with competency-based learning outcomes. The objective of this report is to describe an approach to designing, implementing, and assessing long-term learning in an integrated second-year EBM curriculum. Methods. Two complementary approaches were used. The primary deliberate approach incorporated large-group randomized controlled trial (RCT) critical appraisal sessions into existing organ system modules. The second approach added brief applications of EBM content to small-group case-based learning sessions. To assess learning, an open response written examination mapped to EBM competencies was administered at the beginning of the third year. Results. Data were available for 241 students. Using only walking knowledge, 47% of students at the beginning of the third year discussed two major weaknesses of an RCT; an additional 39% did so for only one. The ability to formulate a clinical question, describe elements of an appropriate search strategy and determine applicability to different patients was demonstrated by 84%, 87%, and 81% of examinees, respectively. Conclusion. This early work demonstrates that durable learning of EBM skills, including critical appraisal, is achievable among second-year medical students. Further work to improve learning in the second year and extend learning into subsequent years is forthcoming.

Cognitive Debiasing Strategies: A Faculty Development Workshop for Clinical Teachers in Emergency Medicine.

Medical decision-making is a cornerstone of clinical care and a key contributor to diagnostic accuracy. Medical decision-making occurs via two primary pathways: System 1, pattern recognition, is fast, intuitive, and heuristically driven and occurs largely unconsciously. System 2, analytic thinking, is slow, deliberate, and under conscious control. Biases are systematic errors that can impact reasoning via either pathway but predominantly affect decisions made by pattern recognition. Debiasing strategies involve the deliberate switching from pattern recognition to analytic thinking triggered by a stimulus. This resource describes a faculty development workshop designed to train emergency medicine educators about common biases and debiasing strategies, to improve teaching of diagnostic reasoning to trainees. This workshop was implemented at the 2017 Society for Academic Emergency Medicine Annual Meeting. The workshop consisted of a brief didactic, followed by small-group case-based learning. A retrospective survey and qualitative evaluation were administered to attendees. The participants' self-assessment showed significant improvements (p < .001) in their abilities to recognize how pattern recognition can lead to bias, identify common types of bias in the emergency department, teach trainees about common types of bias, and apply cognitive debiasing strategies to improve diagnostic reasoning. Strengths of the workshop included the interactive case-based format, discussions of bias-mitigation strategies, and take-home resources. Suggestions for improvement included lengthening the discussion time and providing more cases. Cognitive biases can negatively impact patient care. Faculty development is needed to improve instruction about bias and debiasing strategies for all levels of trainees.

Is lecture dead? A preliminary study of medical students' evaluation of teaching methods in the preclinical curriculum.

ObjectivesTo investigate medical students’ perceptions of lecture and non-lecture-based instructional methods and compare preferences for use and quantity of each during preclinical training. MethodsWe administered a survey to first- and second-year undergraduate medical students at the University of Alabama School of Medicine in Birmingham, Alabama, USA aimed to evaluate preferred instructional methods. Using a cross-sectional study design, Likert scale ratings and student rankings were used to determine preferences among lecture, laboratory, team-based learning, simulation, small group case-based learning, large group case-based learning, patient presentation, and peer teaching. We calculated mean ratings for each instructional method and used chi-square tests to compare proportions of first- and second-year cohorts who ranked each in their top 5 preferred methods. ResultsAmong participating students, lecture (M=3.6, SD=1.0), team based learning (M=4.2, SD=1.0), simulation (M=4.0, SD=1.0), small group case-based learning (M=3.8, SD=1.0), laboratory (M=3.6, SD=1.0), and patient presentation (M=3.8, SD=0.9) received higher scores than other instructional methods. Overall, second-year students ranked lecture lower (χ2(1, N=120) =16.33, p<0.0001) and patient presentation higher (χ2(1, N=120) =3.75, p=0.05) than first-year students. ConclusionsWhile clinically-oriented teaching methods were preferred by second-year medical students, lecture-based instruction was popular among first-year students. Results warrant further investigation to determine the ideal balance of didactic methods in undergraduate medical education, specifically curricula that employ patient-oriented instruction during the second preclinical year.

Sustainable Pharmacy: Piloting a Session on Pharmaceuticals, Climate Change, and Sustainability within a U.S. Pharmacy Curriculum.

Objective:To design and assess an innovative session for pharmacy students that addresses the role of pharmaceuticals with climate change and sustainability.Innovation:One hundred and sixteen third-year students at the University of California, San Francisco School of Pharmacy participated during their required Health Policy course. This 3-hour session included guided pre-course activities, an interactive lecture, a panel of healthcare professionals discussing complex decision-making and small group case-based learning. Curricular assessment was conducted through pre-/post-test measures of knowledge acquisition, student evaluations, and course projects.Critical Analysis:One hundred and two students (response rate 88%) completed the pre-test and 115 students (response rate 99%) completed the post-test assessment. We identified a significant increase in the proportion of correct answers on post-test questions addressing drug disposal legislation (75% pre-test vs 91% post-test, p=0.002) and the predicted effects of climate change on health (55% pre-test vs 90% post-test, p < 0.001). The session was also well received; average student evaluation scores were above 4 in all areas of course evaluation (where 5=ideal). In addition, 17% of student groups (relative to 0% in 2015) proposed a sustainability-related policy as their final coursework project.Next Steps:The development and implementation of this brief session resulted in knowledge gain and favorable student response. This project is feasible for other Schools of Pharmacy to adapt and implement.

The past, present, and future of paediatric cardiology training at the Johns Hopkins Hospital, in the tradition of Dr Helen Taussig.

Johns Hopkins has been a leader in paediatric cardiology for over 85 years. In the 1940s, Dr Helen Taussig began training fellows in paediatric cardiology at Johns Hopkins at a time when the diagnosis and treatment of CHD were in the earliest stage. Under her leadership, the fellowship developed a strong foundation that has continued to evolve to meet the current needs of learners and educators. In the current era, the Johns Hopkins programme implements the current theories of adult education and actively engages our fellows in learning as well as teaching. The programme uses techniques such as flipped classroom, structured case-based small-group learning, observed and structured clinical examination, simulations, and innovative educational technology. These strategies combined with our faculty and rich history give our fellows a unique educational experience.

Introduction and evaluation of case-based learning in the first foundational course of an undergraduate medical curriculum

Case-based learning (CBL) has been proposed as an effective method to promote student knowledge and motivation. The timing and methods for implementation have varied among schools, and data regarding the effectiveness of this pedagogy compared to other learning modalities are inconclusive. We introduced five different cases in the first course of our medical school as part of small-group CBL, and monitored student satisfaction and performance in summative evaluations. We observed that (1) students were very satisfied with the CBL sessions; (2) performance in essay examinations was significantly higher in CBL topics, compared to non-CBL topics, as evaluated at the end of the course, and three months after course conclusion; and (3) there was a trend of higher performance in multiple-choice questions about CBL topics, but this was not statistically significant. Our results indicate that CBL is an acceptable pedagogy to be incorporated from the beginning of undergraduate medical education to promote acquisition and retention of knowledge, students’ interest in foundational sciences, and integration of basic science disciplines and clinical medicine. When evaluating knowledge acquired using the CBL method, integrative essays represent a valuable tool to assess the depth of comprehension and application of information.