Case-based Learning

Why should I use CBL?

Cases help learners to develop critical thinking skills and to deal with ambiguous situations and problems, as well as to develop an ability to assess contextual information. Case-based learning provides an interactive, engaged learning experience that helps learners discover new information, retain important factual information, and engage in self-directed learning, which is important to develop lifelong learning habits.

How do I start?

  • Consider your topic and what types of stories might help the learners to accomplish the objectives for that session. Think: How do I want the discussion to play out? What questions do I want the students to answer?
  • Know your learner demographics. Novice learners typically need more guidance and are unsure about approaching ambiguous information. Take this into consideration when you are composing the groups. Groups can be composed in a variety of ways, but should be organized based on your learning objectives. Diversity in groups is good, but avoid grouping students together who might have the same perspective or attitude toward the topic.
  • Use case-like materials (ie: medical cases, published reports, book excerpts, etc.)
  • Make sure you know the case inside and out. Then anticipate what reactions and questions your learners will have. With that in mind, write a case plan for the general flow of session.
  • Prepare your teaching notes. (see concepts, components of a case)
  • Practice facilitating discussion using open-ended questions. This allows learners to do more exploration and practice the application of concepts or skills. While nearly anyone is able to use case-based teaching and learning (CBL), everyone should be aware of the demands CBL will place on the primary session facilitator.

What makes CBL different from the situation in which a student reports on a patient case on rounds?

When a learner describes a patient case on rounds, it generally follows a set format with basic patient characteristics, history, and laboratory findings, followed by a narrow differential of two or three possibilities, and a suggested management plan. This is NOT the type of case used in case-based learning. Cases used in CBL involve a full, complex scenario with many more details of the patient history and life situation described in detail. The learner is expected to wrestle with decisions and “next steps” that must be determined from the perspective of the characters in the case, which may include the patient perspective, the doctor’s perspective, and the family member’s perspective.

The goal is to create a richly characterized, lifelike scenario with all the complexity and drama inherent in real life. In many cases, the learner is required to research additional information to inform decision-making. The learner is then asked to assume the role of one of the main characters to make decisions in the case, and to follow them through to a logical, best possible outcomes situation. Sometimes cases are multi-layered and unfold over time, with additional information, decisions, and consequences of past decisions as part of the problem-solving process. Your goal is to make the case unfold as a real-life patient situation would, and explore possible avenues of action and their results.

How long does it take to prepare a good CBL session?

You will need to devote significant time to the development of the case and any information needed for the cases teaching file. This will vary based on the level of the learner and the case objectives.

What are the key elements of CBL?

  • Student-led groups: Students should have a role in defining content and pace.
  • Facilitator: As the instructor, you will serve in a facilitator role to answer clarifying questions or assist if student get stuck.
  • Case Teaching notes (see concepts, components of a case)

How can I ensure a successful CBL session?

Use a realistic case that develops over time as you progress through each part. This should include distinct details and historical context. Learners value the opportunity to problem solve and apply their learning.

What size class should be used for CBL?

Cases can be used for any size group from 5-6 students to a room of 200 or more, if students are broken down into 5-6 student groups for discussion. In large group discussions it will be important to structure your class to allow plenty of time for the group discussions. Too few students leads to a dearth of creativity and fresh ideas about solving the case; too many means that some learners will not be as actively involved.

Are there any rules for the session?

It is suggested that you create a list of ground rules to agree upon in the course. For example:

  • Ground Rules for CBL Professors: Commit to encouraging learner contributions because they make a positive difference in the learning environment.
  • Students: Respect the learning process of others. Prepare for and contribute to discussions, take chances, express and test ideas.

Teaching Case

The key difference here between presenting a case for rounds and for CBL is that presenting a case on rounds is not the same as a fully developed teaching case for in-depth discussion. A teaching case depends upon learners having the opportunity to investigate the case before engaging in group discussion. Such investigation might include research on the facts of the situation, alternative approaches to care, or alternative strategies recommended in the literature. The case describes or is based on actual events and circumstances, and is told with a definite teaching purpose in mind. It rewards careful study and analysis. When presenting the teaching case, you want to be mindful to not solely list facts about the case, but rather to elaborate a fully-developed narrative.

Teaching Note

A teaching note is the complete lesson plan for the CBL session. Teaching notes outline details for the instructor about the case, key points and the teaching strategy or the way you intend to help the learner accomplish the learning objectives; they include the allocation of time for each part of the case.

Delineate Steps

  1. Know what you want to accomplish and what you want the learner to take away (learner objectives);
  2. Know your learner: What level are they and what abilities have they already attained? For example, cases for residents will be more complex than those for medical students;
  3. Decide on the focus for the case;
  4. Write a plan for the session;
  5. Write pre-class questions for students to answer that will prepare them for the session that you have planned.

Components of a case

  • Ground rules for group discussion
  • The teaching note:

To include

  1. Abstract, synopsis, or overview of the case
  2. Learner demographics
    1. Audience (For what level of learner is this case most relevant?)
    2. Prerequisites (What do the learners already need to know in order to work through this case?)
  3. Learning objectives for the case
  4. Pre-work assignment questions for the learner
    For example: Who is the decision maker? What decision is to be made? What are the decision maker’s objectives? Who are the other important actors? What are the key issues? What are the environment, constraints and opportunities? What actions can the decision maker take? With what consequences? What would you do and why?
  5. Class plan
    1. Discussion Content:
      1. Fact confirmation (who, what, when, where?)
      2. Analysis (why, how?)
      3. Challenge (so what?)
      4. Action (What would you do?)
      5. Hypothesis (What if?)
      6. Prediction (What will happen?)
      7. Lessons (This is an example of?) 
  • Student role and prep – Analyze the case and answer the pre-work assignment questions. This can be done before class individually and during class with their group.
  • Teacher role and prep – Teacher’s role is to present the case, facilitate any clarifying questions and to be the case discussion guide. To introduce the case, you can offer a summary of facts, a timeline or rational analysis then pose a question to get the students started in unpacking the details of the case. Teacher preparation involves carefully crafting pre-class questions to focus the student’s attention on appropriate areas, anticipating the reactions that the learner may have to the case, planning the intended flow of the session.
  • Paradox – While the in class case discussion will be spontaneous and somewhat unpredictable, using cases in the classroom requires a significant amount of preparation to find or develop a case, organize earner groups, and create teaching notes. This idea of planning for spontaneity may be paradoxical but doing so will contribute to a rich, content focused discussion that will be different from one year to the next.
  • Closure – Closing the case discussion is the most crucial part and also the most challenging because closure summarizes the key learning from the case, but this must be done without marginalizing the conclusions and work the students have put into working through the case.