Integrating Case-Based Learning in a Cambodian Medical School: A Three-Cycle Plan-Do-Study-Act Study of Curriculum Reform

Introduction: Cambodia’s transition toward competency-based medical education (CBME) requires active learning strategies to enhance clinical reasoning and decision-making. Traditional lecture-based teaching limits students' ability to apply basic science knowledge clinically. This study aimed to implement and evaluate case-based learning (CBL) through a structured three-cycle Plan-Do-Study-Act (PDSA) approach in a Year 2 Physiology course. Methods: Three iterative PDSA cycles were implemented from October 2022 to May 2025: Cycle 1 (initial CBL integration), Cycle 2 (faculty development and structured cases), and Cycle 3 (alignment of assessments). Evaluation methods included pre/post-tests, and student perception surveys. Results: CBL was well received across all cycles. Students reported improved self-efficacy in critical thinking (Cycle 1), satisfaction with learning experience and analytical skills development (Cycle 2), and stronger alignment between CBL and assessments (Cycle 3). Statistically significant learning gains were observed in Cycle 3 pre/post-tests (p < 0.001). Faculty development was essential but challenged by time constraints and the part-time status of most faculty. Conclusions: CBL can be effectively implemented in a resource-limited setting using a PDSA approach. Key enablers included structured case design, faculty training, and iterative feedback. These findings provide practical insights for advancing CBME reform in Cambodia and similar contexts.