This post is provided by guest blogger, Nicole Fischer, CNMT, graduate student University of St. Francis, MS Training and Development program

There are many pathways that learners can take to fulfill knowledge gaps related to personal interests as well as professional endeavors. While much value is still placed on traditional face to face lectures, the implementation of innovative teaching strategies such as case based learning (CBL) has been implemented in medical curricula worldwide and shown great promise (Braeckman, Kint, Bekaert, Cobbaut & Janssens, 2014; Dolmans & Schmidt, 1996; Onyon, 2012).

Background

The American Registry of Radiologic Technologists (ARRT) offers a number of Radiology certifications, however not all require a learner to participate in an accredited, structured learning program. According to their website, certification and registration of an individual is recognized after a set of standards have been achieved, typically through the demonstration of clinical competence and educational expertise as determined through a specific certification examination related to an area of study.

Typically, individuals interested in performing MR imaging first earn certification in Radiography through the ARRT. History has shown that these technologists then participate in on-the-job training to learn specific imaging procedures as well as face to face lectures with staff physicists to gain the didactic knowledge needed to pass the ARRT MRI Certification Examination. Therefore the purpose of this literature review is to review the use of CBL in health professions education programs and evaluate the perceived effectiveness with regards to the demonstration of clinical competence.

According to a review by Thistlewaite, Davies, Ekocha, Kidd, Macdougall, Matthews, Purkis & Clay (2012), CBL in health professional education was described as a form of inquiry based learning geared towards preparing learners for clinical practice. Furthermore, the authors discussed the importance of using authentic clinical cases to promote the application of learned theories to real life situations in an effort to assist with the integration of learning into practice.

Active Learning

            Active learning approaches have been shown to positively impact student performance (Braeckman et al., 2014; Thistlewaite et al., 2012). Learners must be challenged to acquire knowledge by means greater than attending face to face lectures in which they sit as a receptacle collecting information presented. Likewise, teaching strategies must be designed with learners in mind and focus on the need for learners to develop skills of inquiry, problem solving, critical thinking and clinical reasoning (Vittrup & Davey, 2010) as these skills are vital for all medical professionals including physicians, nurses and allied health staff.

Utilizing technology as a means to present learners with a clinical problem and provide time to consider the possible causes, effect and solutions, while utilizing a mentor’s guidance highlights ways in which CBL is effective and promotes learning (Thistlewaite et al., 2012). Likewise, opportunities for learning are enhanced when they challenge the basis of knowledge already established by the learner and encourage reflection of prior experiences (Vittrup & Davey 2010).

Motivation

            A number of studies have demonstrated increased confidence and motivation to learn as a result of participation in CBL (Hege, Ropp, Adler, Radon, Masch, Lyon & Fischer, 2007; Maleck, Fischer, Kammer, Zeiler, Mangel, Schenk & Pfeifer, 2001). The use of CBL can be useful for learners of all abilities as a means to identify gaps that exist in knowledge and may spark the desire to acquire more knowledge when gaps are recognized (Williams, 2005). As learners become more familiar with the structure and expectations of CBL, evidence suggests that health professions students enjoy the experience and believe they learn better as a result of participation (Thistlewaite et al., 2012).

Hege et al., discussed a number of aspects that should be considered when developing cases for learning which include usability of software, accessibility of cases or content and the relevance of the content or cases to the learner. This theory can be demonstrated in a study performed by Maleck et al. (2001) who reported on a case based teaching study using Radiology images in which interactivity was highly utilized and valued by the learners to whom it was offered. This format of teaching image interpretation demonstrated clear advantages when compared to utilizing multiple choice questions to assess image interpretation. It is believed that these findings are reflective of the nature and necessity to identify imaging findings in radiology (Maleck et al., 2001).

In addition, CBL when offered in an electronic format, has the potential to provide learning opportunities to users when it is convenient. Learners can access the content or cases and participate in self-directed, self-paced learning (Mishra, Snow-Lisy, Ross, Goldfarb, Goldman & Campbell, 2013).

Perceived Effectiveness

As has been discussed previously in this review, the effectiveness of CBL is contingent on the ability of the learner to link theory to practice through real-life situations. In a rather substantial study, Thistlewaite et al. (2012), evaluated 104 papers comparing the number and type of students involved, research methods used and the level of evaluation according to Kirkpatrick’s hierarchy (Kirkpatrick, 1967). The results of this study show that there is an emphasis on evaluating students according to levels one and two of Kirkpatrick’s hierarchy, student reactions and changes in attitude and knowledge as a result of participating in CBL. Their research did not however evaluate the effectiveness of CBL to influence changes in behavior, such as the demonstration of clinical competence.

A study performed by Ramaekers, Van Keulen, Van Beukelen, Kremer & Pilot (2012), evaluated the perceived effectiveness of a CBL program with regards to student competence in solving clinical problems. As a result of participation, learners in this program demonstrated increased competence in solving clinical problems as well as the ability to solve more complex cases than their counterparts within the same amount of time and with a similar level of interaction. While this research is only evaluating the competence of learners to problem solve in clinical situations, this demonstrated ability could carry over to the evaluation of clinical competence in the performance of radiology imaging studies as well.

Conclusion

CBL can serve as a springboard for critical thinking and promote in depth thinking to engage the application of knowledge gained as a result of participation in learning activities. The benefits of CBL will not only benefit individual learners, but rather, the medical institutions for which learners practice in and the patients in which these specific learners care for. The teams that learners are a part of within individual workgroups as well as interprofessionally may experience increased collaboration and teamwork. Finally, the health care system as a whole may benefit from the integration of CBL as physicians, nurses and allied health staff will have a greater understanding for procedures, processes and the manner in which patient care is delivered using today’s complex, multidisciplinary care teams.

References

Braechman, L., Kint, L. T., Bekaert, M., Cobbaut, L. & Janssens, H. (2014) Comparison of two case-based learning conditions with real patients in teaching occupational medicine. Medical Teacher, 36, 340-346.

Dolmans, D. & Schmidt, H. (1996). The advantages of problem-based curricula. Postgrad Medical Journal, 72, 535-538.

Hege, I., Ropp, V., Adler, M., Radon, K., Masch, G., Lyon, H. & Fischer M. (2007). Experiences with different integration strategies of case-based e-learning. Medical Teacher29, 791-797.

Kirkpatrick D. (1967). Evaluation of training. In: Training and development handbook. R. Craig & L. Bittel (Eds.). New York, NY: McGraw Hill. pp 131–167.

Maleck, M., Fischer, M. R., Kammer, B., Zeiler, C., Mangel, E., Schenk, F. & Pfeifer, KJ. (2001). Do computers teach better? A media comparison study for case-based teaching in radiology. RadioGraphics 21, 1025-1032.

Mishra, K., Snow-Lisy, D. C., Ross, J., Goldfarb, D. A., Goldman H. & Campbell, S. C. (2013). Evaluation of a case-based urology learning program. Urology, 82 (6), 1207-1210.

Onyon, C. (2012). Problem-based learning: A review of the educational and psychological theory. The Clinical Teacher, 9, 22-26.

Ramaekers, S., Van Keulen, H., Van Beukelen, P., Kremer, W. & Pilot, A. (2012). Effectiveness of a programme design for the development of competence in solving clinical problems. Medical Teacher, 345, e309-e316.

Thistlewaite, J. E., Davies, D., Ekocha, S., Kidd, J. M., Macdougall, C., Matthews, P., Purkis, J. & Clay, D. (2012). The effectiveness of case-based learning in health professional education. A BEME systematic review: BEME guide No. 23. Medical Teacher, 34, e421-e444.

Vittrup, AC. & Davey, A. (2010). Problem based learning – ‘Bringing everything together’ – A strategy for graduate nurse programs. Nurse Education in Practice, 10 (2), 88-95.

Williams, B. (2005). Case based learning – a review of the literature: Is there scope for this education paradigm in prehospital education? Emergency Medicine Journal 22, 577-581.