Case-based learning (CBL) is an established approach used across disciplines where students apply their knowledge to real-world scenarios, promoting higher levels of cognition (see Bloom’s Taxonomy). In CBL classrooms, students typically work in groups on case studies, stories involving one or more characters and/or scenarios. The cases present a disciplinary problem or problems for which students devise solutions under the guidance of the instructor. CBL has a strong history of successful implementation in medical, law, and business schools, and is increasingly used within undergraduate education, particularly within pre-professional majors and the sciences (Herreid, 1994). This method involves guided inquiry and is grounded in constructivism whereby students form new meanings by interacting with their knowledge and the environment (Lee, 2012).
There are a number of benefits to using CBL in the classroom. In a review of the literature, Williams (2005) describes how CBL: utilizes collaborative learning, facilitates the integration of learning, develops students’ intrinsic and extrinsic motivation to learn, encourages learner self-reflection and critical reflection, allows for scientific inquiry, integrates knowledge and practice, and supports the development of a variety of learning skills.
CBL has several defining characteristics, including versatility, storytelling power, and efficient self-guided learning. In a systematic analysis of 104 articles in health professions education, CBL was found to be utilized in courses with less than 50 to over 1000 students (Thistlethwaite et al., 2012). In these classrooms, group sizes ranged from 1 to 30, with most consisting of 2 to 15 students. Instructors varied in the proportion of time they implemented CBL in the classroom, ranging from one case spanning two hours of classroom time, to year-long case-based courses. These findings demonstrate that instructors use CBL in a variety of ways in their classrooms.
The stories that comprise the framework of case studies are also a key component to CBL’s effectiveness. Jonassen and Hernandez-Serrano (2002, p.66) describe how storytelling:
Is a method of negotiating and renegotiating meanings that allows us to enter into other’s realms of meaning through messages they utter in their stories,
Helps us find our place in a culture,
Allows us to explicate and to interpret, and
Facilitates the attainment of vicarious experience by helping us to distinguish the positive models to emulate from the negative model.
Neurochemically, listening to stories can activate oxytocin, a hormone that increases one’s sensitivity to social cues, resulting in more empathy, generosity, compassion and trustworthiness (Zak, 2013; Kosfeld et al., 2005). The stories within case studies serve as a means by which learners form new understandings through characters and/or scenarios.
CBL is often described in conjunction or in comparison with problem-based learning (PBL). While the lines are often confusingly blurred within the literature, in the most conservative of definitions, the features distinguishing the two approaches include that PBL involves open rather than guided inquiry, is less structured, and the instructor plays a more passive role. In PBL multiple solutions to the problem may exit, but the problem is often initially not well-defined. PBL also has a stronger emphasis on developing self-directed learning. The choice between implementing CBL versus PBL is highly dependent on the goals and context of the instruction. For example, in a comparison of PBL and CBL approaches during a curricular shift at two medical schools, students and faculty preferred CBL to PBL (Srinivasan et al., 2007). Students perceived CBL to be a more efficient process and more clinically applicable. However, in another context, PBL might be the favored approach.
In a review of the effectiveness of CBL in health profession education, Thistlethwaite et al. (2012), found several benefits:
Students enjoyed the method and thought it enhanced their learning,
Instructors liked how CBL engaged students in learning,
CBL seemed to facilitate small group learning, but the authors could not distinguish between whether it was the case itself or the small group learning that occurred as facilitated by the case.
Other studies have also reported on the effectiveness of CBL in achieving learning outcomes (Bonney, 2015; Breslin, 2008; Herreid, 2013; Krain, 2016). These findings suggest that CBL is a vehicle of engagement for instruction, and facilitates an environment whereby students can construct knowledge.
Science – Students are given a scenario to which they apply their basic science knowledge and problem-solving skills to help them solve the case. One example within the biological sciences is two brothers who have a family history of a genetic illness. They each have mutations within a particular sequence in their DNA. Students work through the case and draw conclusions about the biological impacts of these mutations using basic science. Sample cases: You are Not the Mother of Your Children; Organic Chemisty and Your Cellphone: Organic Light-Emitting Diodes; A Light on Physics: F-Number and Exposure Time
Medicine – Medical or pre-health students read about a patient presenting with specific symptoms. Students decide which questions are important to ask the patient in their medical history, how long they have experienced such symptoms, etc. The case unfolds and students use clinical reasoning, propose relevant tests, develop a differential diagnoses and a plan of treatment. Sample cases: The Case of the Crying Baby: Surgical vs. Medical Management; The Plan: Ethics and Physician Assisted Suicide; The Haemophilus Vaccine: A Victory for Immunologic Engineering
Public Health – A case study describes a pandemic of a deadly infectious disease. Students work through the case to identify Patient Zero, the person who was the first to spread the disease, and how that individual became infected. Sample cases: The Protective Parent; The Elusive Tuberculosis Case: The CDC and Andrew Speaker; Credible Voice: WHO-Beijing and the SARS Crisis
Law – A case study presents a legal dilemma for which students use problem solving to decide the best way to advise and defend a client. Students are presented information that changes during the case. Sample cases: Mortgage Crisis Call (abstract); The Case of the Unpaid Interns (abstract); Police-Community Dialogue (abstract)
Business – Students work on a case study that presents the history of a business success or failure. They apply business principles learned in the classroom and assess why the venture was successful or not. Sample cases: SELCO-Determining a path forward; Project Masiluleke: Texting and Testing to Fight HIV/AIDS in South Africa; Mayo Clinic: Design Thinking in Healthcare
Humanities - Students consider a case that presents a theater facing financial and management difficulties. They apply business and theater principles learned in the classroom to the case, working together to create solutions for the theater. Sample cases: https://yaletmknowledgebase.org/category/case-studies/.
Finding and Writing Cases
Consider utilizing or adapting open access cases - The availability of open resources and databases containing cases that instructors can download makes this approach even more accessible in the classroom. Instructors can consider in particular the National Center for Case Study Teaching in Science, a database featuring hundreds of accessible STEM- and social science - based case studies.
- Consider writing original cases - In the event that an instructor is unable to find open access cases relevant to their course learning objectives, they may choose to write their own. See the following resources on case writing: Cooking with Betty Crocker: A Recipe for Case Writing; The Way of Flesch: The Art of Writing Readable Cases; Twixt Fact and Fiction: A Case Writer’s Dilemma; And All That Jazz: An Essay Extolling the Virtues of Writing Case Teaching Notes.
Take baby steps if new to CBL - While entire courses and curricula may involve case-based learning, instructors who desire to implement on a smaller-scale can integrate a single case into their class, and increase the number of cases utilized over time as desired.
Use cases in classes that are small, medium or large - Cases can be scaled to any course size. In large classes with stadium seating, students can work with peers nearby, while in small classes with more flexible seating arrangements, teams can move their chairs closer together. CBL can introduce more noise (and energy) in the classroom to which an instructor often quickly becomes accustomed. Further, students can be asked to work on cases outside of class, and wrap up discussion during the next class meeting.
Encourage collaborative work - Cases present an opportunity for students to work together to solve cases which the historical literature supports as beneficial to student learning (Bruffee, 1993). Allow students to work in groups to answer case questions.
Form diverse teams as feasible - When students work within diverse teams they can be exposed to a variety of perspectives that can help them solve the case. Depending on the context of the course, priorities, and the background information gathered about the students enrolled in the class, instructors may choose to organize student groups to allow for diversity in factors such as current course grades, gender, race/ethnicity, personality, among other items.
Use stable teams as appropriate - If CBL is a large component of the course, a research-supported practice is to keep teams together long enough to go through the stages of group development: forming, storming, norming, performing and adjourning (Tuckman, 1965).
Walk around to guide groups - In CBL instructors serve as facilitators of student learning. Walking around allows the instructor to monitor student progress as well as identify and support any groups that may be struggling. Teaching assistants can also play a valuable role in supporting groups.
Interrupt strategically - Only every so often, for conversation in large group discussion of the case, especially when students appear confused on key concepts. An effective practice to help students meet case learning goals is to guide them as a whole group when the class is ready. This may include selecting a few student groups to present answers to discussion questions to the entire class, asking the class a question relevant to the case using polling software, and/or performing a mini-lesson on an area that appears to be confusing among students.
Assess student learning in multiple ways - Students can be assessed informally by asking groups to report back answers to various case questions. This practice also helps students stay on task, and keeps them accountable. Cases can also be included on exams using related scenarios where students are asked to apply their knowledge.
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