What is Case-Based Learning

• Cases are narrative accounts of actual, or realistic, situations in which policy makers are confronted with the need to make a decision. Cases supply students with information, but not analysis.
• Case method teaching--the use of such cases in the classroom--is a form of discussion teaching in which students prepare a case, either individually or in groups, and then seek collectively through in-class discussion to discover a solution to the problem presented by the case.
• Unlike problem sets and papers, case method teaching is a group enterprise in which the emphasis is on self-discovery by the class, working together with the guidance of the instructor. The method has been employed effectively with class sizes ranging from less than 10 to well over 100.
• Students are asked to come to class with a detailed knowledge of the case, prepared to analyze and to take a position on the problems raised.
• As part of their preparation, students may be asked to provide written analyses of the case.
• The in-class discussion, the core of case-method teaching, is flexible enough to accommodate a variety of different strategies for involving students.
• Role playing, for example, heightens the identification of students with actors in the case.
• Groups may be organized, either to prepare the case, or more spontaneously during the course of discussion, as a means of building consensus or of sharpening conflict.
• An important dynamic of case-method teaching, that the students be allowed the freedom to determine their own solution, does not imply an abdication of responsibility by the instructor for involving all students, for facilitating the discussion, and for ensuring that important factual and analytical issues are addressed.
• Since the boundaries of the discussion are sharply defined by information in the case, the instructor can relatively easily limit tangential or irrelevant comments and thereby avoid the kind of "bull-session" that makes some teachers wary of class discussion.

The Directed-Case Approach

Four distinguishing features characterized our directed case approach:

1. Defined, inclusive learning objectives

2. An informative, engaging case scenario

3. Pertinent, didactic questions

4. Information needed to answer the case questions is readily available to students

We found a well-prepared series of learning objectives to be invaluable in the construction of an instructive case.

Example --begin with a list of anatomical and physiological principles that are to be illustrated by the case (i.e., "Three phases of the control of gastric secretion").

Then we defined the particular aspects of each principle that were to be emphasized ("the interaction between neural and hormonal mechanisms in the control of each phase of secretion").

Finally, we considered what idea or fact the student should know after completing the case analysis ("understand the relations between the neural and hormonal control of gastric secretion").

In our experience, the best case objectives should not be so narrow as to exclude key principles or essential concepts. On the other hand, the objectives should not be so broad as to make the case too diffuse or unrealistic.

The case scenario could be a clinical case history or a situation of medical importance, but this is not required. It could be a scientific or real-world concern related to human anatomy and physiology. For example, to reinforce skeletal anatomy one could construct a puzzle about the peculiar shapes of human bones found at an ancient burial site.

In our experience, the best scenarios were short (5-10 sentences at most), informative and clearly written - giving all relevant information without unnecessary or obscuring detail. They were not too complex, difficult or involved. Nor were they too simple, easy or brief.

They were interesting -- sparking a reader's curiosity. They could be entertaining -- but not to the detriment of their instructional value.

Throughout the development of the scenario, careful consideration was given to the relevant principles of anatomy and physiology that are to be emphasized and how the scenario illustrated them.

We also constructed the questions with the underlying principles of anatomy and physiology in mind. The questions needed to be relevant - they must direct the reader to apply his/her anatomical and physiological knowledge to the case at hand.

The questions needed to be instructive - their intent is to force the reader to gain a greater understanding of human anatomy and physiology (What specific types of cells, tissues, organs, or organ systems are involved? I.e., what is the normal anatomy? How do these structures work normally? i.e., what is the normal physiology?).

Since we wanted to place emphasis on the basic sciences, we decided that most of the questions should not have a clinical focus (i.e., what is the disease, what is its prognosis, what is the treatment?).

We believe that students should be able to successfully answer the case questions with information that can be obtained in the lectures, the course textbook and supplements.

This approach focuses student attention on the lectures and the textbook, and

discourages inefficient searches through advanced source materials. Occasionally we directed our students to specialized readings, but only if it enhanced their understanding of the subject.

For some cases, it was not unreasonable to expect students to create answers to all of the questions from information found solely in the textbook. In doing so, case work enabled students to learn a wider scope of material than could be presented in the lecture.

We wrote case studies for each of the major systems (i.e., muscular, nervous, cardiovascular) covered in a typical two- semester, integrated anatomy and physiology course. All of the cases drew upon concurrent knowledge of the anatomy and physiology of each major body system.

Tables of data or figures for drawing graphs were provided. Diagrams were given for exercises involving labeling or identifying anatomical structures. Research literature or short general interest articles were made available on reserve in the library.

A detailed handout giving suggestions for successfully answering the case study questions was given out at the beginning of the semester.

We found that a short, focused scenario combined with 10-15 directed questions provided sufficient depth of analysis without requiring excessive time or effort by the students.

Since students would typically complete six to eight case analyses per semester, a requirement for short and concise cases was appreciated by students and instructors alike.

Faculty wanting further information about any of these topics are encouraged to contact Terry Doyle at doylet@ferris.edu

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