Abstract
Cased-based studies (CBS) is defined as a student-centered approach that prepares students for clinical practice using real clinical cases in the pre-clinical curriculum. CBS supports development of students’ clinical reasoning skills, which requires knowledge, understanding and integration of basic sciences and clinical information using a problem-solving approach. Ross University School of Veterinary Medicine (RUSVM) offers CBS I-IV in semesters 2 through 5, respectively. This study compared CBS in developing clinical reasoning skills through assessment and time spent between two cohorts of first year veterinary students. Thirty-one students enrolled in CBS, and 46 students served as the control. All students processed a clinical case and individually submitted three clinical reasoning assignments. A seven-item rubric was used to grade each assignment and these were scored overall using a scale from 0 to 4 with a maximum result of 28. Descriptive statistics for clinical reasoning assignment scores based on the rubric for enrolled students in CBS versus the control cohort were [m = 13.3; SD = 3.8], [m = 14.6; SD = 4.5], respectively. The control cohort had a significantly higher score on the explanation of the diagnosis (p = 0.02). Additionally, time spent for both cohorts resulted in higher scores of specific rubric items of prioritizing patient’s problems (r = 0.27, p = 0.02), identifying differential diagnoses (r = 0.23, p = 0.04) and ranking differential diagnoses (r = 0.23, p = 0.04). Lastly, the total rubric score of both cohorts was significantly associated with the time spent completing assignment 2 (r = 0.22, p = 0.05). Overall, the outcomes for the intervention cohort did not reflect the predicted effectiveness of CBS. Study outcomes reinforced the importance of student engagement that is pivotal in adult learning theory and self-directed learning.
Similar content being viewed by others
Refesrences
Lane EA. Problem-based learning in veterinary education. J Vet Med Educ. 2008;35(4):631–6. https://doi.org/10.3138/jvme.35.4.631.
Harden R, Crosby J. Education guide no. 20—the good teacher is more than a lecturer: the twelve roles of the teacher. Association for Medical Education in Europe: Dundee; 2000.
Setia S, et al. Case based learning versus problem based learning: a direct comparison from first year medical students perspective. 2011. https://doi.org/10.9754/journal.wmc.2011.001976.
Crowther E, Baillie S. A method of developing and introducing case-based learning to a preclinical veterinary curriculum. Anat Sci Educ. 2016;9(1):80–9. https://doi.org/10.1002/ase.1530.
Thistlethwaite JE, Davies D, Ekeocha S, Kidd JM, MacDougall C, Matthews P, et al. The effectiveness of case-based learning in health professional education. A BEME systematic review: BEME guide no. 23. Med Teacher. 2012;34(6):e421–44. https://doi.org/10.3109/0142159X.2012.680939.
Eshach H, Bitterman H. From case-based reasoning to problem-based learning. Acad Med. 2003;78(5):491–6. https://doi.org/10.1097/00001888-200305000-00011.
Patterson JS. Increased student self-confidence in clinical reasoning skills associated with case-based learning (CBL). J Vet Med Educ. 2006;33(3):426–31. https://doi.org/10.3138/jvme.33.3.426.
Hmelo-Silver CE. Problem-based learning: what and how do students learn? Educ Psychol Rev. 2004;16(3):235–66. https://doi.org/10.1023/B:EDPR.0000034022.16470.f3.
Srinivasan M, Wilkes M, Stevenson F, Nguyen T, Slavin S. Comparing problem-based learning with case-based learning: effects of a major curricular shift at two institutions. Acad Med. 2007;82(1):74–82. https://doi.org/10.1097/01.ACM.0000249963.93776.aa.
Bowe CM, Voss J, Thomas Aretz H. Case method teaching: an effective approach to integrate the basic and clinical sciences in the preclinical medical curriculum. Med Teacher. 2009;31(9):834–41. https://doi.org/10.1080/01421590902922904.
Dolmans DH, Snellen-Balendong H, van der Vleuten CP. Seven principles of effective case design for a problem-based curriculum. Med Teacher. 1997;19(3):185–9. https://doi.org/10.3109/01421599709019379.
Malher X, Bareille N, Noordhuizen JPTM, Seegers H. A case-based learning approach for teaching undergraduate veterinary students about dairy herd health consultancy issues. J Vet Med Educ. 2009;36(1):22–9. https://doi.org/10.3138/jvme.36.1.22.
Kassirer JP. Teaching clinical reasoning: case-based and coached. Acad Med. 2010;85(7):1118–24. https://doi.org/10.1097/ACM.0b013e3181d5dd0d.
Hawkins DR, Paul R, Elder L, The thinker's guide to clinical reasoning. Dillon. California: Foundation for Critical Thinking; 2010. p. 58.
Farnsworth CC. Measuring the effects of problem-based learning on the development of veterinary students' clinical expertise. Acad Med. 1997;72(6):552–4. https://doi.org/10.1097/00001888-199706000-00024.
Schmidt H, et al. The development of diagnostic competence: a comparison between a problem-based, an integrated, and a conventional medical curriculum. Acad Med. 1996;71(6):658–64. https://doi.org/10.1097/00001888-199606000-00021.
Lasater K. Clinical judgment development: using simulation to create an assessment rubric. J Nurs Educ. 2007;46(11):496–503.
Adamson KA, Gubrud P, Sideras S, Lasater K. Assessing the reliability, validity, and use of the Lasater Clinical Judgment Rubric: three approaches. J Nurs Educ. 2012;51(2):66–73. https://doi.org/10.3928/01484834-20111130-03.
Team RDC. R: A language and environment for statistical computing. Austria: R Foundation for Statistical Computing: Vienna; 2014.
Kim S, Phillips WR, Pinsky L, Brock D, Phillips K, Keary J. A conceptual framework for developing teaching cases: a review and synthesis of the literature across disciplines. Med Educ. 2006;40(9):867–76. https://doi.org/10.1111/j.1365-2929.2006.02544.x.
Struthers CW, Perry RP, Menec VH. An examination of the relationship among academic stress, coping, motivation, and performance in college. Res High Educ. 2000;41(5):581–92. https://doi.org/10.1023/A:1007094931292.
Nonis SA, Hudson GI. Academic performance of college students: influence of time spent studying and working. J Educ Bus. 2006;81(3):151–9. https://doi.org/10.3200/JOEB.81.3.151-159.
Bandura A. Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev. 1977;84(2):191–215. https://doi.org/10.1037/0033-295X.84.2.191.
Saretsky G. The OEO PC experiment and the John Henry effect. The Phi Delta Kappan. 1972;53(9):579–81.
Harden RM, Laidlaw JM. Essential skills for a medical teacher: an introduction to teaching and learning in medicine. London: Elsevier Health Sciences; 2016.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
The authors declare that they have no conflict of interest.
Electtronic Supplementary material
ESM 1
(DOCX 35.8 kb)
Rights and permissions
About this article
Cite this article
Mauldin Pereira, M., Artemiou, E., Conan, A. et al. Case-Based Studies and Clinical Reasoning Development: Teaching Opportunities and Pitfalls for First Year Veterinary Students. Med.Sci.Educ. 28, 175–179 (2018). https://doi.org/10.1007/s40670-017-0533-y
Published:
Issue Date:
DOI: https://doi.org/10.1007/s40670-017-0533-y