Comparative Study of Case Based Learning (CBL) with Didactic Lectures as a Teaching–Learning (T-L) Method for Improvement of Ethical Skills of M.Sc. Pharmaceutical Medicine Students

 

Dr. Amit Naik*, Dr. Dhananjay Sangle*

University Department of Interpathy Research and Technology (UDIRT), Maharashtra University of Health Sciences (MUHS), Nashik.

*Corresponding Author E-mail:- sangle_dhananjay@rediffmail.com

 

ABSTRACT:

Objective: The primary objective of this study was to compare Case Based Learning (CBL) with didactic lectures as a Teaching – learning (T-L) method for improvement of ethical skills of M.Sc. Pharmaceutical Medicine students. The secondary objective was to assess and compare the   perception of students about these teaching learning methods.

Method: This study was undertaken as a pilot project to introduce Case Based Learning (CBL )as an innovative T-L method in curriculum of M.Sc. Pharmaceutical Medicine over a period of 4 months. 18 students of first year M.Sc. Pharmaceutical Medicine course participated after written informed consent. Students were randomly distributed in 2 groups of 9 each. 2 ethical issues were conducted by CBL sessions and 2 different ethical issues were conducted by didactic lectures. A Short Answer Question (SAQ) test was conducted at the end and students’ knowledge gain assessed. Students’ feedback about both the TL methods was collected by a questionnaire.

Result: Knowledge gain by both methods (CBL and didactic lectures) was same and not statistically significant. Students perceived CBL as a better TL method than conventional didactic lectures which was highly statistically significant. Students’ feedback revealed they were comfortable and satisfied with CBL .They felt that understanding and skill development was better achieved with CBL.  

Conclusion: This study concludes that Students perceived CBL as a superior T-L method as compared to conventional didactic lecture .The knowledge gain by both methods remain same.

 

KEYWORDS: Pharmaceutical Medicine Curriculum, Teaching Learning Methods, Case Based Learning, Didactic Lectures

 

 


INTRODUCTION:

Teaching – learning (T-L) methods used for teaching M.sc pharmaceutical students involve Didactic lectures, Seminar, Tutorials and Practicals. All these are conventional, Teacher friendly and passive T-L methods. These methods do not inculcate problem solving ability in learners. Adult T– L methods should involve active participation of learners hence any new Adult T-L method should be student centric involving their active participation. Case Based Learning (CBL) is an educational paradigm closely related to the more common problem based learning (PBL).

 

This PBL approach is andragogical (adult teaching/ learning), posing contextualized questions that are based upon “real life” problems that may be clinical or non-clinical1,2. CBL is a continuous active learning process. It has been proved that students learn better when actively involved in their learning tasks, topics are better understood, remembered and subsequently applied if learned in a practically implementable format3. It is a common observation that there is a difference in what is taught and what is actually practiced. This leaves a student in a confused state after completing any medical curriculum as his knowledge gain does not give him adequate experience and confidence to solve different cases in actual practice. For this same reason in recent years, Problem based Learning is being widely used in Medical Education all over the world 4,5. CBL’s main traits derived from PBL are that a case, problem, or inquiry is used to stimulate and underpin the acquisition of knowledge, skills, and attitudes. Cases place events in a context or situation that promote authentic learning.6

Case Based Learning (CBL) is an Interactive, Student centered novel teaching–learning method where the students learn by discussing case in small groups and teacher acts only as a facilitator. The case is used as a starting point to understand the issue. They raise certain questions themselves and try to find out an adequate answer to the problem by discussion, which always needs to be supported by adequate and correct references. Students thus develop ability to ask valid questions and channelize their strengths to reach a correct answer with adequate reasoning thus acquiring integrated knowledge. In the process students determine their own level of ignorance, accept their limitations in terms of knowledge base and try to acquire new knowledge based on recognition of a need to learn thus promoting self-study, self confidence and encouraging learning through enquiry and exploration. The process involves disclosing the case-scenario to the students in a progressive manner. The learning objectives and goals for study are defined by the teacher. The teacher guides the discussion to match the learning issues identified by the students with these learning objectives.

 

The CBL method is an effective adjunct to the traditional lecture format. Students undertaking the CBL format are able to generate questions and make comments during the CBL class. Students in the CBL groups perform better in the Short Answer Question (SAQ) tests and marginally better in the prescription writing as compared to the tutorial batch.

 

In the present study, the CBL method was implemented to a group of students; its impact evaluated and compared with the conventional teaching method i.e. the didactic lectures.

 

The study done by Pearson et al discussed the comparison of CBL with traditional lecture/didactic formats. This study concluded that the innovative CBL paradigm appeared to be an effective adjunct to the traditional lecture format.7 Kassebaum et al observed in their study that students undertaking the CBL format were better able to ask questions and make comments during class and CBL made the learning more enjoyable. At the same time students felt the lecture method was more helpful in preparing for a written exam8.  

 

In the study done by Hansen et al, it was observed that Faculty favored lecture format whereas student participants favored a case-based presentation9. Student perception indicated that clinical reasoning, diagnostic interpretations, and the ability to think logically were also improved with CBL1.

 

Observation of a gap between the qualitative and quantitative advancement in medical education and achievements in the field of health care also prompted the Medical Council of India to adopt a need based curriculum for undergraduate medical education in India. "Regulations on Graduate Medical Education, 1997"  also recommends integrated teaching using  problem based learning approach so as to achieve both horizontal and vertical integration in different phases 10.

 

OBJECTIVES:

To compare Case Based Learning (CBL) with didactic lectures as a T-L method for improvement of ethical skills of M.Sc. Pharmaceutical Medicine students.

 

The secondary objective was to assess and compare the   perception of students about these teaching learning methods.

 

METHODOLOGY:                

This study was undertaken as a pilot project to introduce Case Based Learning (CBL) as an innovative T-L method in curriculum of M.Sc. Pharmaceutical Medicine at University Department of Interpathy Research and Technology (UDIRT), Maharashtra University of Health Sciences (MUHS) Nashik over a period of 4 months. 18 students of first year M.Sc. Pharmaceutical Medicine course participated after written informed consent. Students were randomly distributed in 2 groups of 9 each.

 

Conduct of Case Based Learning (CBL) method:

Faculties and students were sensitized for procedure of CBL by an interactive seminar. Mock CBL sessions (two) were conducted for students to get adapted to this new TL method. Two Cases of ethical issues were constructed by discussion with all faculty members and Two CBL sessions conducted for each batch. Specific learning objectives were decided.CBL sessions were conducted. In each group there was one Leader, one Time keeper, one Scribe and a Teacher as a facilitator.CBL session lasted for 1 hour every day. Groups discussed and extracted learning areas for case understanding and solving. Case was given to students and unfolded in stepwise manner .Early sessions were directed towards understanding different unknown scientific words and to extract the exact meaning of sentences. Later sessions were directed towards understanding different ethical interactions using various permutations of answers for these cases. These students conducted self directed search to the identified problem areas and studied different learning areas, they had previously identified during discussion. The groups of students sat together daily and discussed facts they had self studied about the problem. They analyzed if there was any learning area which still required more search and understanding. They searched these topics and discussed it again. They repeated the procedure till they were satisfied about the solution and knowledge gain about the case. The teacher acted as a facilitator to keep students focused on the topic.SAQ were devised based on specific learning objectives of the two cases. A Short Answer Question (SAQ) test was conducted at the end of the CBL sessions. Assessment was done to assess students’ knowledge gain on the topic.

 

Conduct of didactic lectures method:

Two didactic lectures were conducted based on discussion with all faculty members for two different ethical issues. Specific learning objectives were decided. Didactic lectures were conducted covering both the topics completely. SAQ was devised based on specific learning objectives of the two lectures. A SAQ test was conducted and students’ knowledge gain was assessed on the topic.

 

Feedback was taken from the students about both the teaching–learning methods using a pre validated questionnaire. Feedback included constructed response with open ended question and selected response with Likert scale and overall Global Rating Scale.

 

 

 

RESULTS:

18 students participated in this study and the feedback was received from all 18 students. Unpaired T Test was applied for comparison in between test scores obtained after both TL methods.

 

Table 1.1: Group statistics for comparison in between post CBL test score and post didactic lecture test  score

Groups

N

Mean

Std. Deviation

Std. Error Mean

CBL TEST

18

17.28

2.396

0.565

Didactic lect

18

17.11

2.61

0.615

 


 

Table 1.2 : Statistical analysis (unpaired t test)

t-test for Equality of Means

95% CI of the difference

Groups

Mean Difference

Std. Error Difference

t test value

df

p value

Lower

Upper

CBL TEST and Didactic Lect.

0.167

0.835

0.2

34

P = 0.843 (NS)

-1.53

1.864

NS- Not significant at p> 0.05

Statistically there was no significant difference in the knowledge gain of the students amongst both the groups

 

Table 2.1 : Group Statistics for student’s perception about Teaching learning method using Questionnaire

Points given to each question of feedback form

DON’T AGREE

1 point

SOMEWHAT AGREE

2 point

AGREE

3 point

STRONGLY AGREE

4 point

VERY STRONGLY AGREE

5 point

 

Total obtained by giving points

Teaching method

Q

1

Q

2

Q

3

Q

4

Q

5

Q

6

Q

7

Q

8

Q

9

Q

10

Q

11

Q

12

Q

13

Q

14

Q

15

 Total

 Mean

Didactic lectures

51

48

44

39

31

37

44

37

50

44

45

46

57

50

43

666

44.4

CBL

68

64

60

46

61

57

64

66

70

62

68

70

68

72

64

960

64

 

Table 2.2 : Statistical analysis (unpaired t test)

Teaching Methods

N

Mean

Std. Deviation

Std. Error Mean

CBL

15

64

6.492

1.676

Didactic

15

44.4

6.555

1.693

 

t-test for Equality of Means

95% CI of the difference

Teaching methods

Mean Difference

Std. Error Difference

t test value

df

p value

Lower

Upper

CBL  and Didactic

19.6

2.382

8.228

28

0.000       

 (Highly significant)

14.721

24.479

Significant at P<0.05

 

 

 

 

 

 

 

 


Students perceived CBL as a better TL method than conventional didactic lectures which was highly statistically significant.

          

100% participants opined that they understood the topic better and were comfortable with CBL.  95% of participants were satisfied with CBL as a teaching technique as compared to 39 percent in conventional method. 55% participants opined that discussions did not take place in and after conventional teaching. 83% participants opined discussions did take place in and after CBL sessions and 94.5% accepted that discussions held in class helped in understanding the subject better. 94.5% opined that CBL sessions were interactive but only 38% were of the view that conventional lectures are interactive. 100% opined that CBL helps students clear their doubts as compared to 55% with conventional technique. 89% students expect to score better in exams due to CBL. 100% students believed that skills acquired by CBL will help in future practice.  100% students opined that teacher has taken collaborative efforts and provided guidance for self learning for CBL sessions as against 55% opined that teacher has provided guidance for self learning in conventional teaching. 84% students opined that teacher paid personal attention for students learning in CBL sessions as against only 38% students opined the same for conventional teaching method.

 

The feedback received from students reflected that CBL is a good TL method provided members are cooperative and non dominating .They felt that CBL improves presentation skill, Team work skills and all doubts can be cleared at the same moment as there is more freedom for discussion amongst peer group. They opined that conventional lectures are monotonous but few lectures are irreplaceable. They agreed that CBL sessions are more time consuming than lectures.

 

DISCUSSION:

The majority of the evidence outlined in the literature review has revealed that as a whole CBL was enjoyed   by both students and tutors9. Problem based learning (PBL) is considered the founding paradigm that models such as CBL have been based upon .Cases of ethical situation posed to students make the inquiry driven and need based learning more interesting. Our study revealed that CBL allows students to develop a collaborative, team based approach to their education and their profession. It is intended to foster learning for competence, deep level understanding and provide opportunities for vertical and horizontal integration of the syllabus. This is also a feature within the paper by Pearson et al who describe a similar structure within their Preventive Medicine Faculty at the University of Rochester7.

           

Student’s response towards CBL as a novel TL method was excellent; moreover the knowledge gain of students by both methods was almost same. Considering both these facts CBL should be continued as a TL method to teach ethical issues to students of M Sc Pharmaceutical medicine. Further feasibility studies can be undertaken to ascertain if CBL/PBL can be used to teach other modules like preclinical, clinical research and pharmacology to these students of M Sc Pharmaceutical medicine.

                             

REFERENCES:

1.       B Williams Case based learning—a review of the literature: is there scope for this educational paradigm in prehospital education? Emerg Med J 2005; 22: 577-581 doi:10.1136/ emj.2004.022707

2.       Schmidt H . Assumptions underlying self-directed learning may be false. Med Educ. 2000 Apr; 34(4):243-5.

3.       Berkson L. Problem based learning: Have the expectations been met? Acad Med. 1993 Oct; 68 (10 Suppl):S79-88

4.       Albanese, M. A., and S. Mitchell. Problem-based learning: a review of literature on its outcomes and implementation issues. Acad Med. 1993 Jan; 68(1):52-81

5.       Barrows, H. S. Problem-based learning in medicine and beyond: a brief overview. New Dir. Teach. Learn. 68: 3–12, 1996

6.       Mullins G. The evaluation of teaching in a problem-based learning context. In: Chen SE, et al, eds. Reflections on problem based learning. NSW: Australian Problem Based Learning Network, 1995

7.       Pearson T , Barker W, Fisher S, and Trafton SH . Integration of the Case-Based Series in Population-Oriented Prevention into a problem-based medical curriculum. Am. J. Prev. Med. 2003 May; 24 (4 Suppl):102-7.

8.       Kassebaum D, Averbach R, Fryer G. Student preference for a case-based vs. lecture instructional format. J. Dent. Educ.1991; 55 (12):781–4.

9.       Hansen W., Ferguson K., Sipe C., and Sorosky J. Attitudes of faculty and students toward case-based learning in the third-year obstetrics and gynecology clerkship. Am J. Obstet Gynecol. 2005 Feb;192(2):644-7

10.    Medical Council of India: Salient features of Regulations on Graduate Medical Education 1997 [http://www.mciindia.org/ know/rules/ rules_mbbs.htm]. Accessed Oct 08, 2007

 

 

 

 

Received on 26.05.2013       Modified on 17.06.2013

Accepted on 22.06.2013      © RJPT All right reserved

Research J. Pharm. and Tech. 6(8): August 2013; Page 912-915