Multidisciplinary case-based learning for undergraduate students

Application of PRI-E-a combined learning method in oral and maxillofacial oncology education

The traditional lecture-based learning (LBL) method is facing great challenges due to its low efficiency and single proceeding form. We designed a PRI-E learning mode that combined and modified problem-based, case-based, and evidence-based learning with a step-by-step approach. We evaluated the practical learning outcomes of using the PRI-E mode by comparing it with traditional lecture-based learning in oral and maxillofacial oncology education. "PRI-E" consists of the first letters of the English words Passion, Research, Innovation, and Education, and it means "the best Education". This prospective randomized controlled trial included 40 participants. We evenly divided the participants into the PRI-E (n = 20) and LBL group (n = 20) based on the entrance test scores. The same staff group designed and then taught the learning content with different group measures. The evaluation included the final test scores and questionnaire assessments. Without affecting the examination results, the PRI-E teaching method was more satisfactory and popular with participants in terms of ability development and classroom participation. Enacting the PRI-E teaching method required more time, but this did not affect its popularity among the participants. Compared with the LBL learning mode, the PRI-E learning mode was more organized and efficient in oral and maxillofacial oncology education without affecting academic performance. This model has a high degree of satisfaction, which is conducive to training students' comprehensive ability.

Humanising case-based learning

PURPOSE OF THE ARTICLE

Medical undergraduates at St George's, University of London (SGUL) study a weekly clinical case during their clinical science years. Audit of the human stories demonstrated lack of diversity, mono-professionalism, and objectification of some patients. A collaborative partnership with staff, student and patient representation implemented curriculum change, including an inclusive case-writing initiative. We explored whether the reformed written cases supported the development of positive attitudes by sampling perceptions of the cases amongst students.

METHODS

Sixteen semi-structured interviews were conducted (Feb-November 2022) with first year medical students. We applied an interpretative phenomenological analysis approach. Verbatim transcripts were coded and analysed to elucidate themes.

RESULTS

Four themes were identified: (i) effective learning, (ii) clinical authenticity, (iii) authentic human stories, and (iv) opportunity for rehearsing the role of a doctor. Students perceived the cases as an effective, contextual learning method, with a high degree of clinical authenticity, allowing mentalisation of doctor attitudes and behaviours in relation to patient-centredness, multidisciplinary team working and diversity.

CONCLUSION

The results suggest the reformed cases created positive attitudinal change amongst students and supported transition to clinical roles. Memorable human stories had the greatest impact. Dynamic, inclusive, and collaborative case writing initiatives which integrate realism, diversity and multi-professionalism may help to foster positive experiences in students undertaking CBL sessions.

Increasing Collaborative Discussion in Case-Based Learning Improves Student Engagement and Knowledge Acquisition

BACKGROUND

In the transition from academic to clinical learning, the development of clinical reasoning skills and teamwork is essential, but not easily achieved by didactic teaching only. Case-based learning (CBL) was designed to stimulate discussions of genuine clinical cases and diagnoses but in our initial format (CBL'10) remained predominantly tutor-driven rather than student-directed. However, interactive teaching methods stimulate deep learning and consolidate taught material, and we therefore introduced a more collaborative CBL (cCBL), featuring a structured format with discussions in small breakout groups. This aimed to increase student participation and improve learning outcomes.

METHOD

A survey with open and closed questions was distributed among 149 students and 36 tutors that had participated in sessions of both CBL formats. A statistical analysis compared exam scores of topics taught via CBL'10 and cCBL.

RESULTS

Students and tutors both evaluated the switch to cCBL positively, reporting that it increased student participation and enhanced consolidation and integration of the wider subject area. They also reported that the cCBL sessions increased constructive discussion and stimulated deep learning. Moreover, tutors found the more structured cCBL sessions easier to facilitate. Analysis of exam results showed that summative assessment scores of subjects switched to cCBL significantly increased compared to previous years, whereas scores of subjects that remained taught as CBL'10 did not change.

CONCLUSIONS

Compared to our initial, tutor-led CBL format, cCBL resulted in improved educational outcomes, leading to increased participation, confidence, discussion and higher exam scores.

Problem-based learning and case-based learning in dental education

Background

Numerous novel teaching methods have been developed in recent times for use in medical education. Of these methods, problem-based learning (PBL) and case-based learning (CBL) have attracted the most attention. We evaluated and compared the efficiency of these two teaching methods in dental education and discussed the importance of teachers to these courses. This study aims to evaluate the efficiency of PBL and CBL in dental education, and discuss the importance of teachers to the courses.

Methods

In this study, 28 students enrolled in a seven-year program at the College of Stomatology at Shanghai Jiao Tong University were chosen as participants. In the fourth year, PBL combined with independent learning was used to teach students the theory of oral mucosal diseases. During the internship, CBL was used to present specific cases. Both methods were carried out with group discussion. After the PBL course, teachers assessed its effect by the students’ class performance, their ability to collect data, and group cooperation. After the CBL course, its effect was assessed by the students’ ability in history-taking, diagnosis and antidiastole, and case analysis. In addition, the teachers’ roles in both methods were assessed by both the students and the teachers themselves. Data was collected by questionnaire survey and statistically analyzed with SPSS Statistics 20.

Results

PBL significantly improved students’ self-learning abilities in the theory course. CBL helped students make diagnoses and develop treatment plans for actual cases in the internship. Both students and teachers thought that teachers were indispensable to both PBL and CBL. There was no difference between student and teacher views.

Conclusions

Although PBL and CBL have different focuses, their combination may enhance teaching effectiveness in dental education. Additionally, teachers play an important role in the application of both these teaching methods.

Effects of a conflict resolution training program on nursing students: A quasi-experimental study based on the situated learning theory

BACKGROUND

Conflict among nurses within the healthcare system negatively impacts them and patient outcomes. Therefore, it is essential to prepare nursing students for conflict resolution in clinical practice.

OBJECTIVES

This study aimed to develop a conflict resolution training program based on the situated learning theory (SLT) for nursing students and to verify the impact of the program on abilities of communication, problem-solving, and conflict resolution.

DESIGN

This quasi-experimental study was conducted using a non-randomized control group pretest and posttest design.

SETTINGS

A college of nursing with the main campus in South Korea.

PARTICIPANTS

The subjects were 48 senior nursing students in the last semester of their nursing program.

METHODS

The program was developed based on the SLT. It was delivered to the experimental group (90 min per session, a total of eight sessions) while the control group received no intervention. Data were analyzed with χ²-test, Fisher's exact test, unpaired t-test, Mann-Whitney U test, repeated-measures ANOVA, and Bonferroni correction using SPSS/WIN 25.0 program.

RESULTS

There were significant interactions between group and time in problem-solving ability (p = 0.048) and subjective conflict resolution ability (p = 0.005). Problem-solving ability and subjective conflict resolution ability in the experimental group significantly improved compared to the control group based on post-hoc test. After the program, objective conflict resolution ability was significantly higher in the experimental group than the control group (p < 0.001). For communication ability, there was a significant interaction between group and time (p = 0.046). However, it showed no significant difference between the two groups in a post-hoc test.

CONCLUSIONS

The conflict resolution training program based on the SLT was found to be effective in improving the abilities of problem-solving and conflict resolution of nursing students.

Perception of dental students towards case-based orthodontic education

PURPOSE

To evaluate perceptions of fifth-year dental students' towards case-based orthodontic education.

METHODS

The sample population consisted of 108 final year dental students (39 men, 69 women) who volunteered to participate in the project during their orthodontic clinical internship. Patient files including extraoral, intraoral photographs, hand-wrist, panoramic and cephalometric radiographs were randomly distributed. Each group presented their evaluations after 1 week. At the end of case discussions, students were given a questionnaire regarding their perceptions of case-based education. Differences in mean scores between groups were compared by independent samples t‑test.

RESULTS

The response rate was 100%. The majority of students strongly agreed that their interest and ability to interpret and diagnose the orthodontic data were increased. More than 60% strongly agreed that this education had a positive effect on their attention and effective learning. More than 45% strongly agreed that their communication with colleagues was increased, and women were significantly more inclined to group work than men (p < 0.05). More than 45% declared no additional burden.

CONCLUSIONS

Orthodontic case-based education was well received by final year dental students. The most noted improvement was observed in motivation, ability to comment on the diagnosis and treatment planning of orthodontic cases, without feeling an extra workload.

The use of innovative cost-saving audience response system in orthodontic case-based learning: A potential approach in distance learning

OBJECTIVE:

To provide a cost-saving innovative audience response system (ARS) that permits typing texts and compare its efficiency to the paper-based method in case-based learning (CBL).

MATERIALS AND METHODS:

Orthodontic clinical cases were presented to 149 undergraduate dental students for discussion among teammates. Responses were collected using ARS-based and paper-based. ARS was constructed from an online survey platform (Google forms) then QR code was created for easy and fast access. Students used their cellphones to scan code, view questions, discuss, type, and submit answers within 10 minutes. Feedbacks were collected using a feedback survey. Outcome measures included the number of words, spelling mistakes, time required by the instructor to read submissions, and activity time compliance.

RESULTS:

The average number of words submitted by females in ARS-based 47 ± 8 was significantly higher than 35 ± 16 paper-based, and male ARS-based 36 ± 18 (P < 0.05). ARS-based submissions required significantly less time to read compared to paper-based among whole group, females, males (P < 0.001, P < 0.05, P < 0.001), respectively. Spelling mistakes were lower 1 ± 1 in ARS-based compared to paper-based 2 ± 2. The ARS-based first submission was (-4.28) minutes before the deadline, while paper-based last submission was (+2.19) minutes after (P < 0.05). ARS-based submissions were 12.5 seconds faster to read than paper-based (P < 0.001). Out of 56.4% of respondents, 63.1% preferred using ARS-based and 80% agreed that it provided immediate feedback, with high overall satisfaction.

CONCLUSIONS:

This innovated ARS was found to facilitate CBL. It is superior in time and cost-saving to paper-based and other ARSs. It could be useful in distance learning especially during the COVID-19 pandemic.

Dental students' perceptions of case-based learning method and the impact of clinical information in imaging diagnosis

INTRODUCTION

Education in oral imaging diagnosis is provided early in most dental curricula worldwide. Stressing the importance of clinical and radiographic information for oral diagnosis is of utmost importance for dental students. In this context, active learning methods, such as case-based learning (CBL), represent contemporary tools in the armamentarium of dental education. This study aimed to investigate (a) dental students' perceptions on CBL and (b) the importance of clinical data for image-based diagnosis.

METHODS

Fifteen cases of bone lesions were presented to 56 undergraduate students; group 1 (n = 24) was provided with the imaging data alone from each case, while group 2 (n = 32) received clinical information followed by the imaging data. Students' performance and perception on the teaching approach were assessed using a structured questionnaire. Their differential diagnoses for each of the lesions figured as variables to be compared with the known diagnosis.

RESULTS

All the students reported a positive experience with the case-based teaching method and confirmed this approach as a valuable tool in dental education. The diagnosis of a simple bone cyst, a periapical cyst or an ameloblastoma improved when they were provided with clinical data prior to the complementary images. No significant difference was detected, however, when the total amount of correct diagnoses were combined together and compared between groups (P > .05).

CONCLUSION

Case-based learning was corroborated as an optimal method for educating undergraduate dental students. Clinical data might contribute to diagnostic imaging, especially regarding lesions with multiple differential diagnoses.

It is all about patients' stories: Case-based learning in residents' education

Background: Problem-based learning (PBL) is an inquiry-based learning strategy which is learner centered and facilitates group discussion and critical thinking. Case-based learning (CBL), which is a more guided approach of PBL, enables students to learn within the context of patients and formulate their knowledge around patients' scenarios. Midweek (MW) activity is an important educational activity in the internal medicine residency program (IMRP). CBL has shown many benefits in postgraduate education. The aim of our study was to describe the implementation of a teaching resident's management of acute medical conditions encountered during their call utilizing the CBL format and to evaluate resident satisfaction with the new teaching style. Methods: This study describes the implementation of CBL in residents' education at the IMRP. CBL was introduced in five of the 10 acute medical sessions taught in the noon activity. A mixed-method study was employed using both a structured questionnaire and a focus group to compare the two methods to evaluate the residents' satisfaction and perception of knowledge acquisition. Results: The focus group discussion showed that sessions conducted in CBL format were more engaging, interactive, and resulted in better knowledge acquisition through sharing and peer-to-peer teaching than the traditional lecture format. Thirty-nine out of 83 (47%) residents ranging from PGY2 to PGY4 responded to the survey. Overall satisfaction with CBL was good. Sixty-four percent preferred it over the lecture format; 87% found that they did improve their knowledge; 84% agreed that they were excellent and more interactive. Seventy-nine percent stated that they would like to have this type of teaching in the MW activity sessions. Conclusion: Based on the present study, we conclude that incorporation of CBL resulted in more engagement, interaction, peer-to-peer education, and overall residents' satisfaction. The key elements for a successful implementation of this format are both instructors' and residents' orientation and careful selection of the case scenarios (problems) that trigger the learning process. Incorporation of various teaching strategies in residents' education is mandatory to enhance learning and create excellent educational experiences.

Perceptions of Australian and Malaysian Educators in an Undergraduate Pharmacy Program on Case-based Learning

Objective. To determine the perceptions of lecturers toward case-based learning (CBL) and to elicit their feedback and opinions regarding the design of CBL sessions within the pharmacy curricula. Methods. One-on-one interviews were conducted with 10 academic staff members involved in teaching an undergraduate Bachelor of Pharmacy (BPharm) program. All sessions were audio-recorded and field notes were compiled. The recordings were transcribed, and thematic analysis of responses was performed. Results. Four key themes were identified: perceived benefits of CBL, challenges in implementing CBL within the curricula, characteristics of effective and engaging CBL, and relevance and implementation of CBL within the curriculum. Some of the specific benefits of CBL identified by participants included the applicability of knowledge learned to students' future role as pharmacists. Participants also identified challenges such as the design of CBL cases and course time constraints. Respondents also emphasized the need for more training for facilitators in how to design cases and facilitate sessions. Conclusion. While participants identified numerous benefits of CBL, they also identified challenges to implementing this learning method within the pharmacy school curriculum. Paying careful attention to selecting facilitators and providing appropriate facilitator training, in terms of facilitation and case design, is paramount in effectively implementing CBL sessions.

Health Career Academy: Addition of a Surgical Case-Based Learning Curriculum Captures the Interest of High School Students

OBJECTIVE

The Health Career Academy (HCA) is a national program which provides a structure to introduce underserved high school students to healthcare careers. Utilizing the HCA framework, we adapted the curriculum to emphasize surgical cases and invited physicians to enrich the learning experience.

DESIGN, SETTING, AND PARTICIPANTS

Medical students adapted a surgical case-based learning (CBL) curriculum at a local high school serving students from a primarily ethnic minority and low-income community (61% Black, 20% Hispanic; 58% free or reduced lunch). Each grade level received a minimum of ten, 90-minute CBL sessions. Expert faculty lecturers supplemented lessons. Medical student volunteers and 10th and 11th grade students completed postsemester surveys.

RESULTS

Over four semesters, HCA held 44 sessions, with 81 students graduating from the program. A total of 66% of sessions featured at least one faculty volunteer. A total of 36 students in 10th and 11th grade and 15 medical student volunteers completed postparticipation surveys. A total of 46.2% of 11th grade students previously participated in the 10th grade curriculum. On a scale of 1 to 4, students rated HCA highly in its overview of career options (mean 3.61, [SD 0.5]) and instilling understanding of patient care (3.78 [0.42]). Students enjoyed learning about career paths (3.61 [0.50]) and health topics (3.83 [0.39]). Of 10th and 11th grade students, 100% considered a healthcare career, with 34.8% of 10th and 61.5% of 11th grade students expressing interest in pursuing a surgical specialty. After volunteering, medical students felt like better educators (4.47 [0.64]) and were more likely to pursue teaching roles (4.2 [0.86]).

CONCLUSIONS

The Duke HCA chapter implemented the HCA program featuring CBL sessions emphasizing surgical cases. This program engaged minority students and potentially contributed to student interest in surgical careers. It helped to prepare medical students for future teaching roles. An interactive, surgery-focused program may increase the number of minority youth interested in pursuing health careers.

Debate as an Adjunct Tool in Teaching Undergraduate Dental Students

This work is an attempt to explore the potential of a new educational method that integrates debate as a teaching tool. This new teaching method was implemented into a single academic semester of an undergraduate bachelor of dentistry program. We sought to combine knowledge delivery with high-level debate between student debaters, and with the active participation of the audience who were themselves students. The teaching method comprised of three elements namely debates, reply speeches, and policy papers. Debating followed the World School Debate Championship (WSDC) format. Debate evaluation involved five main categories; argument, rebuttal, style, definition and strategy, and points of information (POIs). Student perception towards this educational method was evaluated using a Likert-scale questionnaire. Students gained valuable knowledge from the experience as reflected by the favorable Likert outcome scores. This work sheds light on the potential advantages of utilizing debate as a teaching tool from a student's perspective. Implementing debate in teaching improved students' ability to search and appraise scientific papers and proved to be meaningful and enjoyable. The carefully tailored 10-week format ensured good student responsiveness and engaged the entire class in an interactive, participatory setup. This educational method proved to be very effective in evidence-based dentistry teaching by promoting a deeper approach to learning that can help students to learn meaningfully and enhance their critical thinking skills.

A case-based medical curriculum for the 21st century: The use of innovative approaches in designing and developing a case on mental health

The introduction of case-based learning (CBL) by the School of Medicine at Cardiff University has encouraged innovation in medical teaching and learning. During years one and two of the modernized MBBCh program, students complete 17 cases as part of the newly developed C21 curriculum that emphasizes a patient-oriented and student-centered approach to learning. The mental health case, which is presented in year 2, incorporates a number of novel teaching resources that aim to enhance the students' learning experience and to further reinforce the patient-oriented and community-based philosophy of C21. These include the use of fictionalized video diaries, virtual patient cases, e-learning workbooks, an interactive practical session, and community placements. Novel teaching methods and resources were evaluated by students in terms of effectiveness and value as learning resources through the administration of a structured mixed questionnaire. The results revealed that students valued the inclusion of these resources, which they evaluated as having contributed to their understanding of the subject area. Furthermore, the case was found to have had an impact on student interest in psychiatry as a specialty as well as a career choice. The positive student evaluation of this case supports the innovations in teaching delivery inspired by C21.

Students' perceptions of vertical and horizontal integration in a discipline-based dental school

INTRODUCTION

Integration is a key concern in discipline-based undergraduate dental curricula. Therefore, this study compared feedback on integration from students who participated in different instructional designs in a Comprehensive Patient Care course.

METHODS

The study was conducted at the University of Pretoria (2009-2011). Third-year cohorts (Cohorts A, B and C) participated in pre-clinical case-based learning, whilst fourth-year cohorts (Cohorts D and E) received didactic teaching in Comprehensive Patient Care. Cohorts A, D and E practised clinical Comprehensive Patient Care in a discipline-based clinic. Cohort B conducted their Comprehensive Patient Care patient examinations in a dedicated facility supervised by dedicated faculty responsible to teach integration. Students had to indicate on visual analogue scales whether the way they were taught at the school helped them to integrate knowledge from the same (horizontal integration) and preceding (vertical integration) year of study. The end-points of the scales were defined as 'definitely' and 'not at all'. Analysis of variance (ANOVA) was employed to measure the differences between cohorts according to the year of study.

RESULTS

Third-year case-based learning cohorts rated the horizontal integration close to 80/100 and vertical integration ranging from 64 to 71/100. In year four, Cohort B rated vertical and horizontal integration 9-15% higher (ANOVA, P < 0.05) than Cohorts A and D. In year five, Cohort A rated vertical and horizontal integration 11-18% higher (ANOVA, P < 0.05) than Cohorts D and E.

CONCLUSION

Pre-clinical case-based learning and Comprehensive Patient Care supervised by dedicated faculty were associated with more favourable perceptions about integration in the discipline-based undergraduate dental curriculum.

Perception and knowledge of dental interns toward interdepartmental coordination for successful prosthodontic treatment: A pilot study

Background:

The graduating dentist should be trained in providing treatment utilizing the interdisciplinary approach because of the rapid advancements and increase in patient expectations, which demands for collaboration between the different specialists.

Purpose:

A pilot study was undertaken with an aim to assess the perception and knowledge of dental interns toward interdepartmental coordination for successful prosthodontic treatment.

Subjects and Methods:

Dental interns from two dental colleges in Sangli (India) participated in the study. A 24-item self-administered, structured closed-ended questionnaire was used to collect the data. Four questions assessed the perception and 20 questions assessed the knowledge, which were based on the four domains viz.: General, Endodontics, Orthodontics, and Prosthodontics. They were framed from case scenarios reporting to the Department of Prosthodontics, which required interdepartmental consultation. The questionnaire was validated before its application and reliability were also assessed. The final score for each question was calculated based on the correct responses. Descriptive analysis was calculated using the frequencies, percentages, and mean values by using SPSS 16 software.

Results:

Among 117 interns who participated in the study, 79.5% reported that they lacked training in an interdisciplinary approach. Approximately, 96% reported that the curriculum should be designed to include interdisciplinary training. Nearly, 88% reported that specialist from different specialty should be posted in one interdisciplinary department. Around 60% reported that they did not have the confidence of treating the patient as a whole. When the overall mean scores were considered, the highest scores were obtained for the general domain (95.3) and the lowest for the prosthodontic domain (83.6).

Conclusion:

The dental interns perceived that they lacked training in interdisciplinary approach, and the curriculum should include interdisciplinary training.

Cognition of and Demand for Education and Teaching in Medical Statistics in China: A Systematic Review and Meta-Analysis

Background

Although a substantial number of studies focus on the teaching and application of medical statistics in China, few studies comprehensively evaluate the recognition of and demand for medical statistics. In addition, the results of these various studies differ and are insufficiently comprehensive and systematic.

Objectives

This investigation aimed to evaluate the general cognition of and demand for medical statistics by undergraduates, graduates, and medical staff in China.

Methods

We performed a comprehensive database search related to the cognition of and demand for medical statistics from January 2007 to July 2014 and conducted a meta-analysis of non-controlled studies with sub-group analysis for undergraduates, graduates, and medical staff.

Results

There are substantial differences with respect to the cognition of theory in medical statistics among undergraduates (73.5%), graduates (60.7%), and medical staff (39.6%). The demand for theory in medical statistics is high among graduates (94.6%), undergraduates (86.1%), and medical staff (88.3%). Regarding specific statistical methods, the cognition of basic statistical methods is higher than of advanced statistical methods. The demand for certain advanced statistical methods, including (but not limited to) multiple analysis of variance (ANOVA), multiple linear regression, and logistic regression, is higher than that for basic statistical methods. The use rates of the Statistical Package for the Social Sciences (SPSS) software and statistical analysis software (SAS) are only 55% and 15%, respectively.

Conclusion

The overall statistical competence of undergraduates, graduates, and medical staff is insufficient, and their ability to practically apply their statistical knowledge is limited, which constitutes an unsatisfactory state of affairs for medical statistics education. Because the demand for skills in this area is increasing, the need to reform medical statistics education in China has become urgent.

Developing clinical reasoning in the classroom - analysis of the 4C/ID-model

OBJECTIVES

The purpose of this study is to provide a theoretical rationale for the implementation of the four-component instructional design model for complex learning (4C/ID-model) at the University of Pretoria with the aim of systematically developing the clinical reasoning of undergraduate dental students in a classroom setting.

METHODS

Recent literature provides a rationale for the use of the 4C/ID-model to teach clinical reasoning in terms of four strategic teaching and learning needs: (i) the need for authenticity in the learning process; (ii) the need to manage cognitive load during the learning process; (iii) the need for repeated practice; (iv) a need for valid assessment, feedback and reflection.

RESULTS AND DISCUSSION

The literature review indicated that the 4C/ID-model makes provision for teaching and learning in an authentic context and proposes systematically structured methods that could be practically applied to manage cognitive load during repetitive exercises. The model also makes provision for cognitive feedback following assessment in order to eliminate misconceptions about content and to develop the cognitive strategies of the learner.

CONCLUSIONS

On the basis of the literature review above, it is recommended that the 4C/ID-model be considered as a basis for classroom teaching and learning to develop competence in clinical reasoning in undergraduate dental students, even at pre-clinical level. The model may also have an application in medical education.

The effectiveness of case-based learning in health professional education. A BEME systematic review: BEME Guide No. 23

BACKGROUND

Case-based learning (CBL) is a long established pedagogical method, which is defined in a number of ways depending on the discipline and type of 'case' employed. In health professional education, learning activities are commonly based on patient cases. Basic, social and clinical sciences are studied in relation to the case, are integrated with clinical presentations and conditions (including health and ill-health) and student learning is, therefore, associated with real-life situations. Although many claims are made for CBL as an effective learning and teaching method, very little evidence is quoted or generated to support these claims. We frame this review from the perspective of CBL as a type of inquiry-based learning.

AIM

To explore, analyse and synthesise the evidence relating to the effectiveness of CBL as a means of achieving defined learning outcomes in health professional prequalification training programmes.

SELECTION CRITERIA

We focused the review on CBL for prequalification health professional programmes including medicine, dentistry, veterinary science, nursing and midwifery, social care and the allied health professions (physiotherapy, occupational therapy, etc.). Papers were required to have outcome data on effectiveness.

SEARCH STRATEGIES

The search covered the period from 1965 to week 4 September 2010 and the following databases: ASSIA, CINAHL, EMBASE, Education Research, Medline and Web of Knowledge (WoK). Two members of the topic review group (TRG) independently reviewed the 173 abstracts retrieved from Medline and compared findings. As there was good agreement on inclusion, one went onto review the WoK and ASSIA EndNote databases and the other the Embase, CINAHL and Education Research databases to decide on papers to submit for coding. Coding and data analysis: The TRG modified the standard best evidence medical education coding sheet to fit our research questions and assessed each paper for quality. After a preliminary reliability exercise, each full paper was read and graded by one reviewer with the papers scoring 3-5 (of 5) for strength of findings being read by a second reviewer. A summary of each completed coding form was entered into an Excel spread sheet. The type of data in the papers was not amenable to traditional meta-analysis because of the variability in interventions, information given, student numbers (and lack of) and timings. We, therefore, adopted a narrative synthesis method to compare, contrast, synthesise and interpret the data, working within a framework of inquiry-based learning.

RESULTS

The final number of coded papers for inclusion was 104. The TRG agreed that 23 papers would be classified as of higher quality and significance (22%). There was a wide diversity in the type, timing, number and length of exposure to cases and how cases were defined. Medicine was the most commonly included profession. Numbers of students taking part in CBL varied from below 50 to over 1000. The shortest interventions were two hours, and one case, whereas the longest was CBL through a whole year. Group sizes ranged from students working alone to over 30, with the majority between 2 and 15 students per group. The majority of studies involved single cohorts of students (61%), with 29% comparing multiple groups, 8% involving different year groups and 2% with historical controls. The outcomes evaluation was either carried out postintervention only (78 papers; 75%), preintervention and postintervention (23 papers; 22%) or during and postintervention (3 papers; <3%). Our analysis provided the basis for discussion of definitions of CBL, methods used and advocated, topics and learning outcomes and whether CBL is effective based on the evaluation data.

CONCLUSION

Overwhelmingly, students enjoy CBL and think that it enhances their learning. The empirical data taken as a whole are inconclusive as to the effects on learning compared with other types of activity. Teachers enjoy CBL, partly because it engages, and is perceived to motivate, students. CBL seems to foster learning in small groups though whether this is the case delivery or the group learning effect is unclear.

The evaluation of learner outcomes in interprofessional continuing education: a literature review and an analysis of survey instruments

BACKGROUND

Interprofessional education (IPE) is thought to be important in fostering interprofessional practice (IPP) and in optimizing patient care, but formal evaluation is lacking.

AIM

To identify, through review of IPE evaluation instruments in the context of Barr/Kirkpatrick's hierarchy of IPE learner outcomes, the comprehensiveness of current evaluation strategies and gaps needing to be addressed.

METHODS

MEDLINE and CINAHL were searched for work relating to IPE/IPP evaluation published between 1999 and September 2010 that contained evaluation tools. Tool items were stratified by learner outcome. Trends and gaps in tool use and scope were evaluated.

RESULTS

One hundred and sixty three articles were reviewed and 33 relevant tools collected. Twenty-six (78.8%) were used in only one paper each. Five hundred and thirty eight relevant items were identified, with 68.0% assessing changes in perceptions of IPE/IPP. Fewer items were found to assess learner reactions (20.6%), changes in behaviour (9.7%), changes in knowledge (1.3%) and organizational practice (0.004%). No items addressed benefits to patients; most were subjective and could not be used to assess such higher level outcomes.

CONCLUSIONS

No gold-standard tool has been agreed upon in the literature, and none fully addresses all IPE learner outcomes. Objective measures of higher level outcomes are necessary to ensure comprehensive evaluation of IPE/IPP.

Case based learning--a review of the literature: is there scope for this educational paradigm in prehospital education?

This paper discusses the findings of a literature review of case based learning (CBL) from a multidisciplinary health science education perspective and attempts to draw comparisons with the available literature relating to prehospital education and CBL.CBL is an exciting educational prospect in which to develop research capacity, strategies, and opportunities. This paper provides an examination of the literature exploring the major consistencies and inconsistencies, and reveals areas of potential future research for prehospital education institutions.

Renewal of the clinical-phase dental curriculum to promote better learning at the University of Oulu

The degree awarded to a dentist in Finland is Licentiate of Dentistry, and it takes 5 years to achieve it. The old curriculum at the Institute of Dentistry, University of Oulu, Finland, was based on the departmental division, and there was minimal integration between the disciplines. According to student feedback, the old curriculum was overloaded. The amount of contact teaching was up to 40 h per week throughout the academic year. Based on the workload regulation model launched at the University of Oulu, the actual workload of students for three clinical years was found to exceed the confirmed curriculum (40 study weeks per year for 3 years, representing 180 European Credit Transfer System (ECTS) credits) by 68 ECTS credits (representing 45.3 study weeks). Because of the heavy workload, students did not have time actively to deepen their scientific reasoning. To tackle this problem and to maintain the high academic standards, the Institute of Dentistry, University of Oulu, Finland, decided to change the dental curriculum. The properties and qualities of the competent dentist were listed and arranged in the corners of an octagonal to provide the model of the key dental competencies. Based on this, a thorough core analysis of the courses was carried out by the departments. The new curriculum consists of 10 broader integrative entities, so called dental teaching strands (DTSs), wherein the teaching given by the different departments has been combined. The effort was successful. We managed to remove overlap in the substance of the courses to reduce the students' actual workload by about 45 ECTS credits (representing 30 study weeks and 1200 h of studying) and to promote better scientific reasoning and learning results. The authentic learning and comprehensive patient care comprise the core of the clinical practice.