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Advan 00076 2012
Advan 00076 2012
Gade S, Chari S. Case-based learning in endocrine physiology: an the recent Vision 2015 document, recommended curricular
approach toward self-directed learning and the development of soft reforms for undergraduates that included foundation courses
skills in medical students. Adv Physiol Educ 37: 356 –360, 2013; toward the orientation of students to national health scenarios,
doi:10.1152/advan.00076.2012.—The Medical Council of India, in
learning skills and communication, integration both horizontal
the recent Vision 2015 document, recommended curricular reforms for
undergraduates. Case-based learning (CBL) is one method where and vertical to bridge the gap between theory and practice, and
students are motivated toward self-directed learning and to develop an emphasis on early clinical exposure in the form of intro-
analytic and problem-solving skills. An overview of thyroid physiol- duction of case scenarios for classroom discussion/case-based
ogy was given in a didactic lecture. A paper-based case scenario of learning (CBL). This will done as a coordinated effort by pre-,
multinodular goiter was given to phase I Bachelor of Medicine, paraclinical, and clinical faculties, a student-doctor method of
Bachelor of Surgery students in two sessions. An attitude survey of clinical training, secondary clinical exposure, electives, skill
the students and teachers was done using a Likert scale ranging from development and training, and secondary hospital exposure (7).
strongly disagrees to strongly agree. A pretest and posttest were Our college, which is recognized by the Medical Council of
conducted. The students opined that CBL helped them to better their
understanding of a particular topic, gave them better retention of India, also planned to introduce a new teaching-learning
knowledge, helped them to relate clinical conditions to basic sciences, method in the form of CBL. It was first implemented in the
improved soft skills such as communication skills and group dynam- preclinical phase, and a topic from endocrine physiology was
ics, and promoted a better teacher-student relationship. There was chosen.
significant improvement in student’s performance when pre- and Conventionally, teaching of undergraduate students is done
posttest scores were compared (P ⫽ 0.018). Furthermore, faculty with the help of didactic lectures, practicals, a tutorial, and
members opined that CBL promoted self-study and problem-solving clinics, which are mostly used as passive teaching and learning
abilities of the students. In conclusion, CBL motivates students methods; however, they lack in the development of problem-
toward self-directed learning and to develop analytic and problem-
solving skills; thus, CBL could be beneficial for students’ entry into solving or reasoning skills of the students. Furthermore, there
clinical departments and, finally, in managing patients. is hardly any involvement of students in the teaching-learning
process.
case-based learning; self-directed learning; soft skills Various alternative methods are being used in many medical
colleges to reinforce didactic lectures in endocrine physiology,
MEDICAL COLLEGES in India have traditionally followed a curric- such as case-stimulated learning (16), problem-based learning
ulum overloaded with a large amount of knowledge pertaining (17), patient-centered learning (13), and multiple-format ses-
to basic sciences and clinical disciplines. Once qualified, stu- sions (5).
dents are expected to synthesize this information and apply it CBL is one method where students are motivated to learn on
to the care of patients (11). It has been reported that medical their own so as to inculcate the habit of self-learning and
graduates in India generally possesses reasonably sound integrating knowledge from different subjects to solve prob-
knowledge of medical science but they are often found defi- lems. It is a small-group method in which both students and
cient in the performance of clinical skills and problem solving, faculty members contribute to discussion, learning issues are
which form the core of clinical competence (14). Compartmen- preidentified, and preparatory readings are assigned while
talization among departments, lack of integration, poor coor- student discussion and guided inquiry around clinical problems
dination between basic sciences and clinical subjects, and are still promoted (12).
adherence to traditional didactic pedagogical methods of in- This study was undertaken with the following aims and
struction could be possible areas for improvement in the objectives:
existing curriculum. The changing needs of society, advances 1. To motivate students to adopt a problem-solving approach
in scientific knowledge, and innovations in the field have by relating basic science subjects with a clinical scenario and
prompted the Medical Council of India to adopt a needs-based to apply concepts of theory to clinical conditions through
curriculum toward self-directed learning for undergraduate self-learning.
medical education in India. The Medical Council of India, in 2. To develop soft skills such as communication skills and to
understand principles of group dynamics.
3. To motivate the peer group to adopt a new teaching-
*S. Gade and S. Chari contributed equally to this work.
Address for reprint requests and other correspondence: S. Gade, 51, New
learning methodology.
Sneh Nagar, Wardha Rd., Nagpur, Maharashtra, India (e-mail: shubhagade Thus, the study was mainly focused toward developing prob-
@gmail.com). lem-solving or reasoning skills among the students.
356 1043-4046/13 Copyright © 2013 The American Physiological Society
Downloaded from journals.physiology.org/journal/advances (110.137.037.008) on December 28, 2021.
How We Teach
CASE-BASED LEARNING IN ENDOCRINE PHYSIOLOGY 357
METHODS 12 Pre-intervention
90
Strongly disagree
80 Disagree
Number of responses
70 Neither agree or disagree
60 Agree
50 Strongly agree
10
0
Q1 Q2 Q3 Q4 Q5 Q6 Q7 Q8 Q9
tion is given without application or a problem-solving ap- According to previous study (13) teaching endocrine phys-
proach. iology in a patient-centered learning curriculum, students are
There has always been a need for an alternative to the better equipped to analyze clinical problems, find and apply
traditional didactic format of lectures in medical education (2, appropriate basic science knowledge, and present their patients
6). Hence, we thought of adopting a judicious mixture of compared with students from a traditional curriculum.
didactic lectures and CBL sessions as a pilot project in our In a comparative study (12) between problem-based learning
institute so as to retain the lectures and supplement them with and CBL, both students and faculty members preferred the
a new teaching learning methodology, which will give a CBL method, as it offers more opportunities for problem-
problem-solving approach. solving skills within a session. In a similar type of study carried
As medical teachers, we provide students a large amount of out in India, the majority of students reported CBL as a more
information, but, at same time, it is necessary to ensure that it suitable way of learning compared with problem-based learn-
should be used to establish and optimize students’ understand- ing and that CBL helped to improve their diagnostic skills and
ing. lateral thinking (10).
What is CBL? By discussing a clinical case related to the The teachers who were facilitators in the CBL project
topic taught, students evaluated their own understanding of admitted that with this exposure to a new teaching-learning
the concept using a high order of cognition. This process process, their knowledge about the new teaching-learning
encourages active learning and produces a more productive method has increased and they are now ready to experiment
outcome (4, 8). with new methods of teaching (theory or practical), assess-
Why use CBL? (1) ment, and evaluation. Thus, we recommend the incorporation
1. To provide students with a relevant opportunity to see of this new teaching-learning method for a few systems in
theory in practice. physiology, which can be experimented further in other depart-
2. To require students to analyze data to reach a conclusion. ments.
3. To develop analytic, communicative, and collaborative Summary. The present teaching-learning intervention in the
skills along with the content knowledge. form of CBL was an attempt toward making students respon-
4. To provide an opportunity for students to put themselves sible for their own learning and narrow down the gaps between
in the decision maker’s shoes. students and teachers. Both believe that a proper balance of
The results of this study indicate that the learning of students faculty time and available space would lead to a successful
is significantly enhanced with this new teaching learning meth- program implementation.
odology, as students were able to answer application-based Challenges faced. First, the most difficult task in introducing
questions as well. The results of the study also indicate that the this new teaching-learning methodology was to change the
assimilation of the knowledge was also improved because mindset of the senior teachers to drift them away from the
discussing a case after the didactic lecture was helpful in existing curriculum.
reinforcing the key elements of the topic. The retention of Second, as CBL requires teamwork, we were required to
knowledge was also better because students were required to convince each and every staff member to seek their coopera-
study the same topic from all subjects simultaneously so as to tion.
integrate the knowledge to solve the given problem. Limitations of the study. This study has certain limitations,
Similar types of studies have been introduced in some such as more time and space, infrastructure, and facilitators are
medical colleges in India, and the results have been encourag- required to cover the topic and sometimes it is difficult to
ing (3, 15). An early clinical exposure program consisting of convince some faculty members. As the new methodology was
CBL in endocrine physiology in a medical college in India also introduced to all phase I MBBS students, a control group was
demonstrated that the majority of students (96.4%) gave an missing in the study.
overall rating of the program as good to excellent on a Lessons learned. A greater number of new interventions
five-point Likert Scale (9). should be adopted in the teaching-learning process, as it helps
D. Agree results of experiments; S.A.G. drafted manuscript; S.A.G. edited and revised
E. Strongly agree manuscript; S.N.C. approved final version of manuscript.
7. CBL deprives students of an opportunity to acquire knowledge
from experienced and good teachers. REFERENCES
A. Strongly disagree
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No conflicts of interest, financial or otherwise, are declared by the author(s). 16. Walters MR. Case-stimulated learning within endocrine physiology lec-
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AUTHOR CONTRIBUTIONS
1999.
Author contributions: S.A.G. and S.N.C. conception and design of research; 17. Walters MR. Problem-based learning within endocrine physiology lec-
S.A.G. performed experiments; S.A.G. analyzed data; S.A.G. interpreted tures. Adv Physiol Educ 25: 225–227, 2001.