CASE AND PROBLEMS-BASED
LEARNING – [CBL]
Using specific cases to teach and learn
how to deal with clinical problems
AN INTRODUCTION
By;
Col Abrar Hussain Zaidi
1
SEQUENCE
1.
2.
3.
4.
5.
6.
7.
8.
NOMENCLATURE
INTRODUCTION
THE SPECTRUM OF STUDIES
CASE SELECTION
THE LEARNING OBJECTIVES [SLO’S]
METHODOLOGY/FORMATS
THE PROCESS/STEPS OF LEARNING
CBL IN AMC
2
NOMENCLATURE
• PROBLEM BASED LEARNING--PBL
• CASE BASED LEARNING -CBL
• SUBJECT BASED LEARNING-- SBL
• TARGET BASED LEARNING-- TBL
3
NOMENCLATURE
PBL - A scientific problem could be of
any type
-Term used in broader perspective
CBL - In clinical studies
the problems
are the individual cases /the patients
4
INTRODUCTION
CBL – The learning that
stems out from;
studying a given;
individual case/problem/subject
and involves clinical process of
Understanding the problem
[investigations and diagnosis] and
Rationalizing the resolution of a
problem [treatment].
5
INTRODUCTION
CBL vs conventional learning
The problem is encountered first
in the learning process
[opposite to conventional]
6
INTRODUCTION
The method of problem-based learning
(PBL) has been used in different fields of
sciences for decades.
In medical education it began at McMaster
University in the mid-1970s.
[Barrows and
Tamblyn (1980):]
7
INTRODUCTION
Problem-based learning (PBL) has
been widely adopted in U.S. medical
schools and is believed to be highly
effective for knowledge acquisition
and clinical performance.
1-Colliver JA. Effectiveness of problem-based learning
curricula: research and theory. Acad Med2000;75(3):259266.
2-Galey WR. What is the future of problem-based learning in
medical education? Adv Physiol Educ 275:12-15, 1998.
8
INTRODUCTION
PBL/CBL
learning strategy that builds on
linkages between basic science and
clinical knowledge.
9
THE SPECTRUM OF STUDIES
A broad range of
topics in a clinically relevant context.
Define your learning objectives
10
CASE SELECTION
Usual Practice
Clinical cases are generally organized
around organ systems.
Major, typical, model cases
common clinical problems
of all body systems
11
THE LEARNING OBJECTIVES [SLO’S]
DOMAINS
1.
COAGNITIVE
2.
3.
PSYCHOMOTOR
AFFECTIVE
SU-CATEGORY [LEVEL]
1.
C-1
BASIC KNOWLEDGE
2.
C-2
INTERPRETATION
3.
C-3 SOLVING THE PROBLEM
IMPORTANCE OF DEFINING THE SLO’S--?
12
METHODOLOGY/FORMATS
PBL/CBL method of teaching /learning can be
used in many formats
•
•
•
•
Problem-based lectures
Small-group tutorials
large-group case discussion,
Problem-based laboratories (Kaufman, 1995).
most common -- small groups with a facilitator
13
05/%
Assessed after
02 wks
14
15
[AFTER HAVING DEFINED OUR SLOS AND HAVING
SELECTED THE CASES ]
Most practical for student teaching
Small-group tutorials
16
THE PROCESS/STEPS OF LEARNING
It is a student-centered approach
•
•
•
•
•
•
•
•
•
Small groups of students
Facilitator
Steps wise discussion
Information gathering
Problem identification
The judicious application of diagnostic tests
Evaluation and interpretation of data
Management decisions or therapy and intervention
Outcomes monitoring
17
THE PROCESS/STEPS OF LEARNING
PBL/CBL method involves the three
steps :
• Confronting the problem
• Engaging in independent study
• Returning to the problemDiscussion
(Wilkerson & Feletti, 1989).
18
THE PROCESS/STEPS OF LEARNING
CBL discussion utilizes
A deductive process that
parallels the steps
used routinely in the evaluation and care
of patients in actual clinical practice
(Figure next).
19
THE PROCESS/STEPS OF LEARNING
THE PATIENT
CASE SCENARIO- HISTORY AND PHYSICAL EXAM
THE
ON
GOING
SUMMARY PROBLEMS
DIAGNOSIS AND TREATMENT PLAN
DISCUSSION
INTERPRET/EVALUATE THE DATA
QUESTIONING
D/D
MODERATION
LEARNING
INVESTIGATION
LAB/X-RAYS
20
CBL IN AMC
•-In AMC the CBL started last year[2008]
•-We are trying to address it critically and are
in the process of assessing its effectiveness
in our set-up
•-Total 36 topics were covered during previous
session /same no to be covered in new class
•-The process of improvement is continuous
•-Students and teachers feed back is important
for improvement
21
CBL IN AMC
PBL/CBL method involves the three
steps :
• Confronting the problem
• Engaging in independent study
• Returning to the problemDiscussion
(Wilkerson & Feletti, 1989).
22
CBL IN AMC
 Case scenario are given to students
 Have a full week for own study
 Students develop their approach of dealing with the
problem;

Study different aspects of history [pain /mass etc]

Study D/D

Study main aspects of pathology

Rationalize investigations

Re-assess and give one diagnosis

Give a plan of treatment
• Small Group discussion -weekly
• Moderated and guided by a teacher
• Every student has to participate
• Individual student grading will be done by teacher 23
CBL IN AMC
Limitations/flaws/loopholes
1.
5.
Students may not take the task seriously
No active participation
Remain passive learners with low retention
Every student may not have enough participation
Time may be too less to cover all aspects of topic
Some teachers may convert the discussion into a
kind of lecture
Students grading is not always accurate
7.
Others
2.
3.
4.
6. Interest and efforts expressed by teachers
?
24
CBL IN AMC
Limitations/flaws/loopholes
How to overcome--?
Reward:
CME credits for the teachers
Grading for students
25
CBL IN AMC
Is the system effective in our set up -?
How to objectively assess
Needs an observational study
26
CBL - ?
27
28