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Case-Based Teaching

Case-based teaching is a pedagogical approach that engages students in the process of making real-world decisions. You create cases that represent authentic workplace situations to encourage students to apply knowledge gained from the classroom or through additional research in order to solve the case. Case-based teaching allows you to gauge the ability of students to synthesize, evaluate, and apply course concepts while students are engaged in the process of authentic problem solving.

About Case-Based Teaching

Opportunities and Challenges

Design of a Case Study

Facilitation Strategies

General tips

Extensions

About Case-Based Teaching

Since the focus of case-based learning is on problem solving and decision making, the approach can be very useful in health professions education. Cases can be drawn from actual events or created entirely by you, but they should present students with the type of situation that they are likely to encounter in the clinical setting.

The goal is for students to engage in the decision-making process and determine likely or possible solutions. In health professions education, cases can be designed to require students both to draw on existing subject knowledge as well as conduct research to resolve unanswered questions. 

Opportunities:

  • Engages students in authentic application of knowledge
  • Promotes collaboration and cooperation
  • Facilitates assessment of student knowledge

Challenges:

  • Design process can be time intensive

Design of a Case Study

Case studies involve participants in the effort to answer questions or solve authentic problems. Hence, when designing an effective case study the first place to start is by considering a question or problem that helps achieve the course outcomes and is tied to professional goals.

A case can be drawn from an actual occurrence, or it could be created to address a specific learning objective for the course. Regardless, it needs to be authentic. The question or problem at the heart of the case needs to be practical, relevant, and timely. It may have multiple possible answers, even if one answer is more appropriate than others. The goal is to create a scenario that the students will want to explore; students are interested in cases that they can recognize as both “real” and important.

Step 1: Determine learning outcomes

Before determining the specific case or outlining the steps to explore the case, the expected learning outcomes need to be clarified. Ultimately, the correct resolution of the problem presented in the case is only one purpose served by a case-based assignment. Equally, or perhaps more important, is the effort of students to develop a skill set for identifying and resolving authentic problems while recognizing appropriate resources that are applicable to the clinical setting. Hence, a learning outcome could be a correct diagnosis, or a redesign of a treatment protocol, or the development of public health policy.

The scope of the case-based assignment may vary with the learning goals for that part of the course. For example, an introductory course may present several relatively simple, non-complex cases that students can engage with and solve in a short period, with the goal of introducing them to authentic professional scenarios and effective and efficient research methods. A more advanced or specialized course may engage students in a long-term case-based assignment that draws on professional knowledge and research skills developed over time, perhaps involving multiple courses.

Step 2: Know your students

The success of a case-based assignment is measured by the accomplishment of the students. The case cannot be so difficult that the students will become frustrated, nor can it be so simple that they will be bored or will accomplish the task too soon.

In order to develop a case that will engage your students and prod them to learn more, consider what you know about your students. Take into account knowledge students have already gained from your course, as well as skills or information gathered from clinical work or courses they have already taken. Ideally, your case-based assignment will draw on students’ existing knowledge and skills while also challenging them to acquire new knowledge and skills to complete the assignment.

Step 3: Build the case

After deciding on the topic of the case, you need to determine the relevant resources that may be accessed by the students. These resources may include standard academic resources (journal articles, textbooks, etc.), as well as newspaper articles, personal commentary, or interviews with practitioners. For example, a case study that asks students to determine a patient diagnosis may include a medical record, lab report or x-rays, and a transcript of the patient-doctor conversation.

Once the relevant resources have been determined, the case can be organized and the scenario written. The case as a whole should include explicit outcome objectives, a central scenario (see also Extensions below), and expectations for student activity and deliverables for completion of the case. The scenario may be presented as a narrative which tells a story. The narrative might include information about who was involved in the case, what happened, and perhaps some possible explanations of why it happened.

The case can be presented chronologically either through the viewpoint of one character (as in a detective story) or from the perspective of an omniscient narrator. Cases often include a timeline of events and enough information about the scenario so that as students become invested in the case, they will seek out critical information to help them resolve the central issue(s) of the case.

Facilitation Strategies

A case can be introduced to a class through an initial presentation or discussion before the groups break off to work independently with the case materials. Once the investigations are underway, observe the conversations and clarify any unclear components.

In general, your role is to provide feedback on students’ progress with accessing appropriate resources, analyzing and synthesizing information, and accurately applying information relevant to the case. You might encourage students to probe deeply into the cases through questioning the group’s assumptions or perhaps encouraging them to research more deeply before drawing any conclusions. You might also draw upon your own clinical expertise and guide students to consider an alternative approach to the case.

You should actively listen to each group while circling the classroom. In a large class, it can be helpful to plan for time to sit in on the group’s conversation, or consult with the groups outside of class time. If a group feels discouraged by investigative dead-ends, or is heading in the wrong direction with their analysis or resolution, it is important to help redirect the group to revisit previous coursework or explore additional research avenues, but without providing clues on the resolution.

Once the student groups have developed their resolutions, establish a debate format if there are diametrically opposed positions, or you can facilitate a whole-class discussion of the methods used by the groups as well as the results. Each resolved case-based assignment should end with student’s reflecting on the process they undertook to investigate and resolve the case. This reflection could be done in a whole-class setting, in groups, or individually.

General tips:

Groups and group sizes

The exploration and resolution of a case is most often performed in groups. Groups can range from 4-8 participants, depending on the size of the class. One person within the group may be assigned the role of reporter, with the expectation that he or she will present the results of the group investigation to the entire class. If your course contains multiple case studies, it is usually advisable to maintain the group assignments for the duration of the course while rotating the reporter role within the group.

Pre-written cases

There are websites and printed resources that have pre-packaged cases for use in health care education classrooms (see resources below). When using a pre-written case, consider whether the goals of the case are aligned the goals for the course. Cases may be able to be modified by extending or trimming parts of the initial scenario. 

Library Resources

While much of the central information will be presented to the students as part of the case study, the students will most likely need to explore further resources in order to complete the case. Consider collecting library resources or identifying personnel in advance who may assist students in acquiring the necessary information.

Extensions

Mini-cases

You can create a short-mini case dealing with a very specific topic, such as a pharmacist’s interview, or a pre-surgical consult. Mini cases take less than a class period and can be used in a lab or lecture class to assess previous knowledge or prepare students for the content of the class period.

Interrupted cases

Most cases are presented to students in their entirety at the beginning of the session. In this extension, you can present elements of the case at different intervals. Students generate likely solutions or resolutions based on the information received up to that point, after which they receive further information that guides future investigation.

Interrupted cases can also be used to gradually increase the complexity of the case by presenting additional elements that may challenge student assumptions and prompt deepened exploration of the topic.

Online cases

In a technology-enhanced setting, you can present the case material through a website or a learning management system. The students can work together in groups through discussion forums or online collaboration tools such as Google Docs or Wikis. In a technology-enhanced face-to-face or blended course, the students can work together in the research and exploration stages online, and then collaborate in the face-to-face environment to present and defend their results. In a fully online setting, the students can present their results through a discussion posting, an audio podcast or a virtual presentation tool (Adobe Connect, for example). 

Clicker cases

Students can use in-class audience response systems (clickers) to answer questions posed during a presentation. Clickers are useful to quickly gauge anonymous answers to questions posed in class. You can use clickers to gain an understanding of the baseline of student understanding of a topic, which will influence the scope of the case-based assignment. Clickers can also be used to guide a whole-class case-based investigation by determining likely scenarios and outcomes through majority vote. The aggregated responses are displayed to students and can guide the next steps in the investigation of the case.

Resources

"Teaching with Case Studies," Speaking of Teaching, Stanford University Newsletter on Teaching, Vol. 5, No. 2, Winter 1994.
http://www.stanford.edu/dept/CTL/cgi-bin/docs/newsletter/case_studies.pdf

Case Method Website (John Foran, Department of Sociology, UC Santa Barbara).
http://www.soc.ucsb.edu/projects/casemethod/intro.html

National Center for Case Study Teaching in Science (State University of New York at Buffalo).
http://sciencecases.lib.buffalo.edu/cs/

Williams, B. (2005) Emerg Med J. “Case based learning—a review of the literature: is there scope for this educational paradigm in prehospital education?” 22, p. 577-581.

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