Case Presentations - A case study is a descriptive document based on real-life situations, problems or incidents.

casebasedbannercomponent

Janet Hafler, EdD, Director of the YSM Teaching and Learning Center and Amy Wrzesniewski, PhD, Associate Professor of Organizational Behavior at the Yale School of Management leading a discussion "Facilitating Case Based Discussions".

Cases can be used to enhance a lecture or frame a small group teaching session. Cases can be written in a variety of formats from a short paragraph to a complete write-up. Cases are usually brief stories with one particular focus.

Hafler JP. Case Writing: Case Writer’s Perspectives. In Boud D and Feletti G (eds.). The Challenge of Problem Based Learning, London: Kogan Page, 1991.

Questions to Consider in Designing Small Group Learning Experiences

The Teaching and Learning Center (TLC) can provide support to faculty interested in designing case-based small group learning experiences. Assistance is available in creating and implementing cases, planning teaching exercises, providing feedback through observation and evaluating the outcomes.

Case-based learning can encourage:

  • Application of basic science knowledge,
  • Linkage of knowledge between the basic and clinical sciences,
  • Deeper understanding of content,
  • Development of clinical reasoning skills, and 
  • Development of social intelligence.

Research in medical education suggests that the more medical students work through a variety of case discussions with appropriate feedback, the better their clinical reasoning abilities.  

In the literature the number of students working in a group on a case varies. As a rough guideline, we suggest that groups of 4 to 12  are appropriate for small group exercises. The context of the learning objectives and intended outcomes must be taken into account in determining group size, as well as the physical space being amenable to working in small groups to allow discussion. 

How long should small groups remain together? The longer that students work together within their small groups, the more time they have to achieve goals regarding working in a team and developing cohesiveness and trust. Therefore it would be appropriate for groups to remain together with the same faculty depending on the learning goals. Students in a small group learn group dynamics as well as content, including the important ability to take on different roles in a group setting. Groups need time to form, understand how to identify and move through conflicts to accomplish their goals. Dysfunctional groups usually require intervention from the faculty member. The TLC is available to consult with faculty on effective group formation and how to work through conflicts.

Based upon the research, there may be 1 or 2 facilitators depending  on the number of student groups, group size, and learning goals. For example, if the major learning objective for the case were to delve deeper into content, then it would be appropriate to have at least one expert facilitator. If the main objective is to generate student-led discussion, having one non-expert facilitator can encourage this process. However, two co-facilitators may be used in cases where two experts are needed for their content knowledge, or an additional person is desired to facilitate student discussion. In general, it is recommended to choose faculty well suited for the role of facilitator, and to provide them guidance on how to co-facilitate a case discussion. The TLC can provide workshops on how to facilitate small groups and construct facilitator guides.
A single case has been reportedly used from a minimum of 30 minutes to upwards of an entire academic year in the literature . Cases can unfold over multiple sessions, and multiple cases can be used in a single session. The length of a case is at the discretion of the instructor and should take into account the teaching context as well as the intended learning objectives.

Case-based workshops can have sessions with the facilitator having a range of expertise in the case content.

  •  “Expert facilitators” have a thorough understanding of the case, with specialized knowledge in the case content.
  •  “Non-expert facilitators” have a thorough understanding of the case and guide the discussion as needed.

Each type of facilitator has strengths and weaknesses. The literature has reported that sessions run by “expert” facilitators:

  •  Tend to be more directive.
  • Generate fewer student-led discussions,

Non-expert facilitators have been found to elicit more student-student dialogue in small group sessions. The outcomes of studies with advanced medical students as facilitators are mixed and show faculty experts to be superior in encouraging effective learning, or advanced students to be just as effective as faculty. The use of trained tutors who are facilitators and have an in-depth knowledge of the case (such as advanced medical students or faculty) can also be considered.

In general, being explicit to the students about “why” different types of facilitators are guiding workshops will help students understand the underlying rationale behind the teaching methodology.

Cases designed for early first year students should be constructed differently than those used for more advanced students, acknowledging the prior knowledge and experiences that the students bring to the case. Second and third year cases should be constructed differently than those used for more advanced students, acknowledging the prior knowledge and experiences that the students bring to the case. Second and third year will typically be more competent than early first years in devising a differential diagnosis with information presented in a case, thus cases with a lot of direct guidance are more appropriate for first years. For example, early students may be provided the differential diagnosis at the beginning of the case rather than be asked to produce it themselves. Questions in their cases may focus more on creating linkages between material presented in the case and basic biology. More advanced medical students, however, can be expected to construct a differential diagnosis from the information provided in the case and be more competent at linking basic and clinical science. If you have any further questions, feel free to contact the Teaching and Learning Center.

References 

Albanese MA, Mitchell S. Problem-based learning: A review of the literature on its outcomes and implementation issues. Academic Medicine 1993; 68(1): 52-81.

Papa FJ, Aldrich D, Schumacker RE. The effects of immediate online feedback upon diagnostic performance. Academic Medicine 1999;74S: 16–8.

Thistlethwaite JE, Davies D, Ekeocha S, Kidd JM, MacDougall C, Matthews P, Purkis J, Clay D. The effectiveness of case-based learning in health professional education: A BEME systematic review. Medical Teacher 2012; 34(6): e421-44.

University of New Mexico School of Medicine. Constructing Tutorial Cases. Retrieved from: http://som.unm.edu/omed/_docs-dev/tools_constructing_wkbk.pdf

Cases can be presented in a number of formats

a. Descriptive Case

b. Vignette or mini case: a brief paragraph with one main focus, generally used to exemplify one point or, with other mini cases, to compare and analyze focused issues
c. Bullet:  one or two sentences with a single focus.

Online Web-based Cases

Digital video (YSM Created Videos, YouTube, Vimeo),DVD

Trained actors who assume the role of a patient for the purpose of education, e.g., medical students’ history taking and physical examination skills. Contact Tracie Addy  for more information.

Real patients can be incorporated into the curriculum for educational purposes.

More Information

For more information about any of our services (e.g. Education Workshops, Peer Observation, How to join the Medical Education Fellowship, Standardized Patients, MedEd Discussions ...) email us at tlc@yale.edu

TLC Brochure

TLC Upcoming Events

TLC News

Standardized Patient Request Form
(Requires Yale CAS login)