Increasing Collaborative Discussion in Case-Based Learning Improves Student Engagement and Knowledge Acquisition

Background: In the transition from academic to clinical learning, the development of clinical reasoning skills and teamwork is essential, but not easily achieved by didactic teaching only. Case-based learning (CBL) was designed to stimulate discussions of genuine clinical cases and diagnoses but in our initial format (CBL'10) remained predominantly tutor-driven rather than student-directed. However, interactive teaching methods stimulate deep learning and consolidate taught material, and we therefore introduced a more collaborative CBL (cCBL), featuring a structured format with discussions in small breakout groups. This aimed to increase student participation and improve learning outcomes. Method: A survey with open and closed questions was distributed among 149 students and 36 tutors that had participated in sessions of both CBL formats. A statistical analysis compared exam scores of topics taught via CBL'10 and cCBL. Results: Students and tutors both evaluated the switch to cCBL positively, reporting that it increased student participation and enhanced consolidation and integration of the wider subject area. They also reported that the cCBL sessions increased constructive discussion and stimulated deep learning. Moreover, tutors found the more structured cCBL sessions easier to facilitate. Analysis of exam results showed that summative assessment scores of subjects switched to cCBL significantly increased compared to previous years, whereas scores of subjects that remained taught as CBL'10 did not change. Conclusions: Compared to our initial, tutor-led CBL format, cCBL resulted in improved educational outcomes, leading to increased participation, confidence, discussion and higher exam scores.