Constructivism and Case Based Learning

Simulation is a form of case based learning.

Case based learning grew out of the problem based learning discipline. PBL employs an open inquiry approach, in which students independently discover knowledge within a domain. Self directed learning is central to a PBL curriculum. The knowledge base is integrated through the discovery of its applicability across cases and problems. Barrows argues that the core of problem based learning lies in allowing students to “analyze and resolve the problem as far as possible before acquiring any information needed for better understanding.”(1)

PBL’s proponents have argued that it encourages lifelong learning, fosters the development of superior problem solving skills, and is firmly grounded in adult learning theory (self-directed, building on prior experience, relevant to the lives and work of learners). Critics of problem-based learning have argued that the open inquiry approach is inefficient, wastes faculty time, and leads to sometimes inaccurate or erroneous constructs which the learner establishes out of inexperience or lack of knowledge. Despite its theoretical strengths, learning outcomes in problem based learning curricula are mixed, leading educators to speculate on and attempt to mitigate the shortcomings of PBL and the reasons for the disconnect between theory and outcome.(2)

Case based learning leverages the theoretical underpinnings of PBL, but adopts a guided inquiry approach, in which the expertise of the instructor is used to guide the discussion toward relevant and accurate knowledge, and to mitigate group dysfunction that inhibits learning. Case based teaching requires both content expertise and expertise in group facilitation.

Case based learning has its critics as well, and they argue that the “guided” nature of CBL stifles creativity, and that the guidance may well be ineffective unless there is adequate attention to faculty development.

In a comparison of satisfaction and perceived value of PBL vs. CBL at two medical schools, Srinivasan et al reported that students and faculty overwhelmingly preferred CBL. Students felt that CBL was more efficient, provided better opportunity for applying skills learned, and provided valuable feedback.(3)

Simulation is grounded in the philosophies of case based teaching and learning, using the experience of the simulation to provide active engagement with the case, and guided inquiry to achieve the reflective observation necessary for learning.

In her primer on cases based teaching, Colich(4) reviews attributes and advantages of case based teaching. At its best, simulation will share these attributes. Learners will make and implement decisions by sorting out pertinent information from irrelevant information, they will apply prior knowledge to identify core problems, and they will formulate narratives about problems and strategies to address them. The learning outcomes (knowledge, skills and attitudes) match the ability of the case to challenge students in these areas.

Case based learning is a constructivist approach. Constructivism relies on the notions that learning is based on interactions with the environment, that cognitive puzzlement is a powerful stimulus for learning, and that social negotiation is an important contributor to knowledge acquisition.(5) Simulation is grounded in these ideas and in the principles of designing an authentic task, anchoring the learning in a larger problem, and providing opportunity for guided reflection. The idea of social negotiation is particularly interesting in its application to the desired learning for the simulation. Teaching the need to “speak up”, to avoid assumptions and to engage in error correction are substantial challenges for medical educators. The collaborative learning process gives us an opportunity to reinforce the notion that lack of comment or question implies agreement.

1. Barrow HS. Problem based Learning in Medicine and Beyond: A Brief Overview. New Directions for Teaching and learning 1996; 68: 3-12
2. Onyon C. Problem-based learning a review of the educational and psychological theory. The Clinical Teacher 2012; 9: 22-26
3. Srinivasan M. Comparing problem-based learning with case-based learning. Acad Med 2007; 82(1): 74-82
4. Golich C. The ABC’s of Case Based Teaching. International studies perspectives 2000; 1: 11-29.
5. Savery J and Duffy T. Problem based learning: An instructional model and its constructivist framework. in Wilson, BG. Constructivist learning environments: case studies in instructional design. Educational Technology Publications Inc., Englewood Cliffs, NJ. 1996