Problem based learning and the case method--medical students change preferences during clerkship

Learning Experiences of Nursing Students With Case-Based Learning Technique: A Qualitative Study

Objective: The aim of this study was to explore the experiences of undergraduate nursing students of the implementation of case-based learning technique with group work in in clinical setting at the Surgical Diseases Nursing. Material and methods: A qualitative design was used. The sample consisted of sophomore students (n=84) who took Surgical Diseases Nursing at a University School of Health in the Spring Semester of 2018-2019. The students were divided into 14 groups by random sampling method according class list. The practice instructors advised the gropus in the process of Case-Based Learning technique for 8 weeks and groups took real case (patient) in clinical setting and gave nursing care. Groups used Surgical Diseases Nursing Patient Assesment form. The students planned their nursing care plans using NANDA nursing diagnoses with group work and then evaluated the result by applying the care plan. In the last two weeks of the academic year, the students were able to present their presentations. Results: The experiences of the students are explained in three main themes and 9 sub-themes. Main themes were; case presentation experience, case presentation in nursing practice, a good case presentation. Conclusion: As a result, Case-Based Learning facilitates learning, provides materialization and permanence of knowledge, offers the opportunity to combine the application with the theory and preparing students for the profession.

The experiences of nursing master's students with dialogic case-based learning in an evidence-based nursing course: A qualitative study

BACKGROUND

Evidence-based nursing (EBN) is a complex subject for teachers and students due to the abstract concepts involved. It requires combining theory with practice and is included in the major courses required for a master's education in many countries. Case-based learning (CBL), which is a student-centred teaching method, has been widely used in numerous disciplines because it can bridge the gap between theory and practice and foster critical thinking and communication skills. However, to adapt CBL to EBN coursework for a Master of Nursing degree, improve evidence-based practice (EBP) and enhance core competencies, the case design and operational procedures of CBL need to be further examined.

OBJECTIVES

To explore nursing master's students' experiences of dialogic CBL and case design and operational procedures regarding dialogic CBL.

DESIGN

A descriptive-qualitative study design was used.

SETTING AND PARTICIPANTS

The study was carried out in the nursing master's programme at a university in China. Twenty first-year nursing master's students who completed a 10-week EBN course were recruited using purposive sampling.

METHODS

Data were collected between September and December 2020 via in-depth semistructured interviews. The data were analysed using thematic analysis.

RESULTS

Four themes were identified: (1) 'learning theoretical EBN knowledge'; (2) 'improving clinical nursing ability'; (3) 'enhancing core competencies'; and (4) 'barriers to implementing dialogic CBL'.

CONCLUSIONS

The study provided a standardised CBL procedure based on students' experiences, which included preparation, group discussions, presentations, and teachers' feedback following the presentations, and these operational procedures were shown to be indispensable. The student experiences in this study should be referenced by nursing educators who apply this teaching method in other graduate and undergraduate nursing courses such as surgical nursing and nursing research.

Taking CBL to the Lecture Hall: a Comparison of Outcomes Between Traditional Small Group CBL and a Novel Large Group Team-Based CBL Teaching Method

PURPOSE

Case-based learning (CBL), an important component of medical school curricula, is an effective inquiry-based teaching method associated with high levels of student and teacher satisfaction. However, because traditional CBL requires small groups, its feasibility is limited by faculty and resources. We developed and tested a novel team-based CBL (TB-CBL) method to be implemented in the lecture hall.

METHODS

All second-year students at our institution (n = 121) were randomized to either traditional small group CBL or TB-CBL during the Endocrine block and to the other modality during the Renal block. All students were exposed to both methods. Case content was identical, and sessions were run concurrently. This cross-over, non-inferiority study tested the hypothesis that no difference in knowledge acquisition, clinical reasoning, or student satisfaction would be detected between groups.

RESULTS

Based on student performance on case-relevant exam questions, no difference in knowledge acquisition was seen between groups for either block (p = 0.62 Endocrine, p = 0.38 Renal). There was also no difference in overall final exam performance between groups (p = 0.56 Endocrine, p = 0.26 Renal). Case-relevant script concordance testing revealed no difference in clinical reasoning skills between groups (p = 0.87 Endocrine, p = 0.17 Renal). Satisfaction was higher for the TB-CBL format (p = 0.005). Cost analysis revealed that each small group CBL session costs $2654, while each TB-CBL session costs approximately $221.

CONCLUSIONS

TB-CBL, a novel case-based teaching method, appears to produce similar learner outcomes and higher student satisfaction when compared with small group CBL. TB-CBL may be used to supplement case-based curricula while optimizing resource allocation.

Medical student self-efficacy, knowledge and communication in adolescent medicine

OBJECTIVE

To evaluate student self-efficacy, knowledge and communication with teen issues and learning activities.

METHODS

Data were collected during the 8-week pediatric rotation for third-year medical students at a local children's hospital. Students completed a self-efficacy instrument at the beginning and end of the rotation; knowledge and communication skills were evaluated during standardized patient cases as part of the objective structured clinical examination. Self-efficacy, knowledge and communication frequencies were described with descriptive statistics; differences between groups were also evaluated utilizing two-sample t-tests.

RESULTS

Self-efficacy levels of both groups increased by the end of the pediatric rotation, but students in the two-lecture group displayed significantly higher self-efficacy in confidentiality with adolescents (t(35)=-2.543, p=0.02); interviewing adolescents, assessing risk, sexually transmitted infection risk and prevention counseling, contraception counseling were higher with marginal significance. No significant differences were found between groups for communication; assessing sexually transmitted infection risk was marginally significant for knowledge application during the clinical exam.

CONCLUSIONS

Medical student self-efficacy appears to change over time with effects from different learning methods; this higher self-efficacy may increase future comfort and willingness to work with this high-risk, high-needs group throughout a medical career.

The deaf strong hospital program: a model of diversity and inclusion training for first-year medical students

Recent research indicates that the cultural competence training students receive during medical school might not adequately address the issues that arise when caring for patients of different cultures. Because of their unique communication, linguistic, and cultural issues, incorporating deaf people who use sign language into cultural competence education at medical schools might help to bridge this gap in cross-cultural education. The Deaf Strong Hospital (DSH) program at the University of Rochester School of Medicine and Dentistry, started in 1998, exposes first-year medical students to the issues that are relevant to providing effective patient care and to establishing multicultural sensitivity early in their medical education. Because medical students better acquire cross-cultural competence through hands-on experience rather than through lectures, the DSH program, which includes a role-reversal exercise in which medical students play the role of the patients, provides such a model for other medical schools and health care training centers to use in teaching future health care providers how to address the relevant cultural, linguistic, and communication needs of both their deaf patients and their non-English-speaking patients. This article describes the DSH program curriculum, shares findings from both medical students' short-term and long-term postprogram evaluations, and provides a framework for the implementation of a broader cultural and linguistic sensitivity training program specific to working with and improving the quality of health care among deaf people.

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.

Case seminars open doors to deeper understanding - Nursing students' experiences of learning

BACKGROUND

The Case Method is a teaching method in which cases from real life inspire students to actively seek knowledge that they discuss in structured seminars. Case seminars in health education have been evaluated, compared and discussed, but descriptions that can help us understand how students learn in the seminars have not previously been published. In a Swedish nursing programme, where case seminars have been used for several years, students were asked to write about their experiences of learning in the seminars. The aim of the present study was to describe this learning process from the students' point of view.

METHOD

Written data were analysed using content analysis.

FINDINGS

A theme concerning how the Case Method opens doors to deeper understanding was identified as a thread running through different codes and categories. Students described the importance of new perspectives and their wish to participate in discussions with other students. The students indicated that the structure, which involved pre-prepared cases and writing on the white board, positioned their own knowledge in a wider context and that the learning atmosphere enabled everyone to participate.

CONCLUSIONS

The Case Method seems to involve students in a way that deepens their understanding and critical thinking.