Case-Based Learning: Exploring the Advantages and Disadvantages

Education for healthcare students has transformed from traditional instructional models focused on lecture-based instruction to other pedagogical approaches, including problem-based and case-based learning (CBL). Case-based learning (CBL) is a newer modality of teaching healthcare. CBL is currently used in multiple health-care settings around the world. CBL is a teaching tool used in a variety of medical fields using human cases to impart relevance and aid in connecting theory to practice.

What is Case-Based Learning?

Case-based learning (CBL) is an approach to teaching and learning where students show growth through demonstrating mastery of specific skills or knowledge before advancing to the next unit. Sometimes referred to as competency-based education or competence-based teaching, the teacher’s goal is to pace classroom units around the individual students instead of a fixed calendar. Students only progress forward when they demonstrate that they truly understand and have mastered the current material.

There is not a set definition for CBL. An excellent definition has been proposed by Thistlewaite et al in a review article. In their 2012 paper, a CBL definition is “The goal of CBL is to prepare students for clinical practice, through the use of authentic clinical cases. Others have defined CBL by comparing CBL to a similar yet distinct clinical integration teaching method, problem-based learning (PBL).

CBL is a pedagogical approach that aims to forge clear links between theoretical knowledge and clinical practice by engaging students with authentic clinical cases that contextualize knowledge and promote high-order competencies, including critical thinking. The exploring that students or trainees do factors into other definitions. A modern definition of CBL is that CBL is a form of learning, which involves a clinical case, a problem or question to be solved, and a stated set of learning objectives with a measured outcome. Included in this definition is that some, but not all, of the information is presented prior to or during the learning intervention, and some of the information is discovered during the problem solving or question answering. The learner acquires some of the learning objectives during the CBL session, whether it is live, web based, or on paper.

Case-Based vs. Traditional Learning

The conventional lecture-based instruction method concentrates on delivering the content and does not allow discussion or active student involvement. In the traditional teaching method, little attention is given to problem-solving, collaborative learning, and lifelong learning strategies. This makes students lose motivation and lack self-study ability, and the integration of curriculum and clinical work is insufficient to train students’ critical thinking. Traditional teaching often relies on age, where students are sorted into grades and curriculum with the expectation of moving at the same pace as their peers, regardless of individual learning needs.

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Case-Based vs. Problem-Based Learning

Others have defined CBL by comparing CBL to a similar yet distinct clinical integration teaching method, problem-based learning (PBL). PBL sessions typically used one patient and had very little direction to the discussion of the case. The learning occurred as the case unfolded, with students having little advance preparation and often researching during the case. Srinivasan et al compared CBL with PBL4 and noted that in PBL the student had little advance preparation and very little guidance during the case discussion. However, in CBL, both the student and faculty prepare in advance, and there is guidance to the discussion so that important learning points are covered. Often the objectives are less clearly defined at the outset of the learning session, and learning occurs in the course of solving the problem. There is a teacher, but the teacher is less intrusive with the guidance than in CBL.

Advantages of Case-Based Learning

CBL is learner-centered because students work collaboratively in small groups to solve the case. The evidence from this review demonstrates that CBL significantly improved critical thinking, problem-solving, teamwork and communication skills, clinical skills development, and student satisfaction. This could be because students receiving CBL are more actively engaged in their learning and thus do not lose attention in class compared to other passive teaching methods. For example, the didactic method, which is the most conventional and economical way of teaching a large group of students, is boring, causing attention lapses among students.

Improved Skills

Pooled data demonstrated that critical thinking scores were significantly higher among those receiving CBL than those receiving LBL (standardized mean difference (SMD): 0.75, 95% confidence interval (95%CI): 0.21-1.29). Similarly, significantly greater scores for teamwork and communication were identified in the CBL group than in the LBL groups (SMD: 0.24; 95%CI: −0.19-0.66). The improvements in critical thinking and problem-solving skills among students can be attributed to the characteristics of CBL, which include supplementation of theoretical knowledge with real-life cases that students would encounter in the clinical environment. Consequently students’ understanding and learning were improved as the real-life cases provided a context for the theoretical concepts and encouraged critical thinking through action and problem-solving. These methods used in CBL encourage students to raise more questions and make critical comments, thus fostering lateral thinking. For example, CBL facilitates feedback, where students can discuss the issues with each other and the teacher, thus enhancing their critical thinking.

The results of this review demonstrated that students who received the CBL approach to learning developed significantly better teamwork and communication skills. This could be because CBL is generally a group activity requiring students to be actively involved in the sharing of opinions and interact with each other during group discussions. As a result, students learn teamwork in order to achieve a common goal. Students also develop active and passive communication skills to sensitively communicate with each other during discussions.

Increased Engagement and Motivation

CBL is a pedagogical approach that aims to forge clear links between theoretical knowledge and clinical practice by engaging and motivating students. Students are more likely to be engaged in this method, primarily when delivered in small groups and provided with constructive feedback. Second, teachers also had a positive attitude toward CBL, potentially leading to a productive classroom experience.

The evidence from this review demonstrates that students who received CBL had higher satisfaction with their learning compared to those who received LBL. This could be because students receiving CBL are more actively engaged in their learning and thus do not lose attention in class compared to other passive teaching methods.

Real-World Application

This deeper engagement reduces learning gaps within the classroom and helps ensure retention instead of memorization. CBL often integrates real-world connections and projects to demonstrate learning, providing students with choice. This often makes lessons more meaningful to students. The primary goal of using case studies in learning is to provide students with the opportunity to apply their knowledge and skills to solve real-world problems. Case-based learning allows students to apply their knowledge and skills from lessons, assignments, and assessments to solve new and unfamiliar problems.

Flexibility

This learning method is also very flexible, as it can be used in both physical and virtual classes.

Disadvantages of Case-Based Learning

Despite these advantages, some limitations have been reported in the literature as factors that may negatively impact case studies’ retention in training programmes. No teaching approach is perfect, and CBL is no exception.

Implementation Challenges

Making the switch from a traditional classroom format to CBL requires a significant shift in mindset, as well as changes in curriculum design and assessment methods. It likely requires teacher training and effective professional development as well. As a result, overall teacher buy-in can be difficult.

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Time and Effort Demands

Teachers must create personalized learning pathways and track individual progress. This requires significant time at the beginning of planning and can be overwhelming, especially in large classes and with limited resources.

Assessment Difficulties

Defining mastery can sometimes get complicated. Without clear rubrics or guidelines, grading can often become subjective and inconsistent.

Potential for Inequity

CBL relies on digital tools for personalized instruction and accurate tracking. Not all students or school districts have equal access to technology. This, as teachers already know, widens the achievement gap unless there is reliable funding to provide necessary resources.

Inconclusive Evidence

However, no significant difference in knowledge and comprehension scores (SMD: 0.41; 95%CI: 0.20-0.62) and self-directed learning (SMD: 0.30; 95%CI: 0.10-0.49) was identified among those who received CBL compared to those who received LBL. The evidence of the benefit of CBL on knowledge and comprehension remains inconclusive. According to the Revised Bloom’s Taxonomy of cognitive skills, knowledge and comprehension are two lower levels of skills and are inherent in any course. The evidence relating to the effect of CBL on self-directed learning is also inconclusive. This could be due to the small number of studies assessing this outcome.

Integrating Virtual Case Studies

Given these constraints, virtual case studies are now recognised as one of the most recommended innovative teaching approaches in nursing. Previous studies report that the integration of virtual case studies into teaching activities as a pedagogical tool promotes short- and long-term knowledge appropriation as well as the development of reflective skills, clinical skills and decision-making.

Our results suggest that learning facilitated by virtual case studies is an innovative and well-received educational tool for student nurses compared to traditional case studies. In particular, the qualitative and quantitative results demonstrate that virtual case studies significantly improved students' skills in clinical reasoning, data collection and the development of nursing care plans. In addition, this approach helped students to feel more confident in their abilities and reduced their anxiety.

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