Case-based learning in the teaching of pharmacology for medical students (2023)

Background

With the entry into force of the new competence-based curriculum, it is necessary to introduce new teaching-learning methods that help students improve their learning and acquire the necessary knowledge and skills. Therefore, to integrate pharmacology with the clinical sciences and to involve students in their learning process, case-based learning (CBL) has been very successful. Therefore, the present study was proposed to present the CBL as a new teaching-learning method in pharmacology and to know the students' perceptions about this method.

Objectives

The study aimed to introduce CBL to Bachelor of Medicine and Bachelor of Surgery (MBBS) students as a pharmacology teaching method and observed students' perceptions of CBL.

Methodology

After obtaining approval from the institutional ethics board and sensitizing students and teachers about this new teaching-learning method, CBL sessions were held on some topics. Students' perceptions were recorded in a feedback questionnaire and the results were analyzed.

Results

Ninety-five percent of students agreed that CBL helped them better understand concepts. Ninety-six percent of students found CBL interesting and 96% of students said CBL will help them clinically correlate pharmacology.

conclusions

Students felt that CBL is an effective learning tool and would promote the clinical application of pharmacology.

Introduction

Restructuring our way of teaching pharmacology is the need of the moment to determine how knowledge of clinical pharmacology is applied in patient care, as documented by Vasundara et al. in a survey carried out by them[1]πŸ‡§πŸ‡· Researchers have tried several new teaching and learning methods, such as introducing interactive problem-solving seminars or integrating two or more disciplines, in an attempt to teach more effectively, and the results have favored more advanced methods.[1-3].

Pharmacology involves a wide variety of concepts that cannot be learned or retained through conventional teaching. To help students improve their overall academic performance, we must focus on their progress in learning, retention, recall, and practical application.[1]πŸ‡§πŸ‡· This requires your active participation. One of the simple approaches to facilitate student engagement is Case-Based Learning (CBL).[2]πŸ‡§πŸ‡· CBL is used in all countries of the world to cover a part of the curriculum or the entire curriculum. In the business environment, the technique is often used for learning. The approach supposedly emphasizes active learning and is student-centered. Adoption of various related CBL strategies is advantageous for students. Early in their careers, they acquire better self-directed learning skills, communication skills, and decision-making skills. The ultimate goal of medical students is to be competent physicians, and for that they need to have a solid base of knowledge and skills. It has been shown that basic scientific knowledge gradually disappears during clinical practice unless its relevance and usefulness in clinical situations are emphasized during the formative years of learning.[3].

CBL is an andragogy-based educational paradigm that integrates multiple disciplines. It is an opportunity for the student to assimilate knowledge in a constructive way. CBL is essential for improving interpersonal skills and encourages critical thinking along with lifelong learning.[2,4]πŸ‡§πŸ‡· Cases are designed to be similar to real-life scenarios. They provide basic information about a patient as well as supporting data such as clinical signs, symptoms and laboratory tests. Based on this, students work in teams, using their analytical and problem-solving skills, to design a management strategy for the case at hand. Faculty members act as moderators, steering the discussion in the right direction and ensuring it stays on track.

Many studies have shown that CBL is an effective method of teaching pharmacology, therefore the current study is designed to introduce CBL for teaching pharmacology to second-degree (Phase II) students of Bachelor of Medicine and Bachelor of Surgery (MBBS ) and gather their perspectives on this new teaching method in our midst. Therefore, this study aims to present case-based learning (CBL) as a teaching and learning method for pharmacology and to evaluate students' perceptions after the introduction of CBL in pharmacology.

Materials and methods

The questionnaire-based survey was carried out in the department of pharmacology after obtaining approval from the Institutional Ethics Committee of Adesh Medical College & Hospital, Shahbad, with certificate number AMCH/BIO/2018/11/016. The sample size was calculated considering a 95% confidence interval and the population of the area and the enrolled individuals. Among 150 second-year professional students, 135 students who attended all CBL sessions were included in the study and those who did not attend all previous sessions were excluded. Faculty and students were sensitized to CBL. Participants also received written material about CBL. Case scenarios in four themes (hypertension, anaemia, peptic ulcer and malaria) were developed with the help of clinical specialists and department professors. Before starting the study, written informed consent was obtained from the students. Each theme was treated in two sessions, with an interval of one week. Students received the case topics to be covered in the next class, along with reference resources and learning materials for self-study two days in advance. Students were divided into two groups of 75 each (Lot A and B) for practical classes. To carry out the CBL, lots A and B were subdivided into 7 subgroups with 10-11 students in each subgroup under the supervision of one teacher each. Eight sessions of two hours each were performed for each batch. In the first session, the predetermined theme in the form of clinical case scenarios was given to each subgroup of Lot A. Students were encouraged to interact and deliberate among themselves to find answers to the presented case.

In the next session, students refined and discussed their responses. Then, one student from each subgroup presented their case to the whole group, and the facilitator further clarified their doubts. Students received a feedback questionnaire pre-validated by members of the Institute's medical education unit to collect their perceptions of this new teaching method (Table1πŸ‡§πŸ‡· The same procedure was followed for batch B and for the other subjects.

S. No.Questions
1.CBL helps to better understand pharmacology concepts.
2.CBL sparked my interest in pharmacology
3.CBL will help me to correlate pharmacology with clinical sciences
4.CBL improves motivation for SDL (self-directed learning)
5.The cases facilitated an active discussion
6.The discussion sessions improved the interaction between teachers and students.
7.CBL helped me to develop my communication skills and attitude
8.CBL is a useful preparation in solving clinical problems.
9.The CBL must also teach other pharmacology topics.
10Future lots must also be taught by CBL
11The course was well organized.
12I liked the case-based learning
13What are the advantages of CBL in your opinion?
14What are the limitations of CBL?
mesa1: Feedback questionnaire to discover students' perceptions of case-based learning as a teaching-learning method in pharmacology

CBL: case-based learning; SDL: self-directed learning

Students who participated in all sessions were given feedback forms to fill out at the end. The questionnaire consisted of 12 questions based on a 5-point Likert scale (strongly disagree, disagree, neutral, agree, strongly agree) and two open questions. The data were then analyzed quantitatively using Microsoft Office Excel and the results were expressed as percentages.

Results

Ninety-five percent (95%) of students found that CBL helps them better understand pharmacology concepts. Most students said that CBL stimulated their interest in pharmacology (Table2).

QuestionsI totally agree (n%)a green %)Neutral (n%)disagree (n%)Strongly disagree (n%)
Better understanding of concepts.3758410
stimulated my interest33412240
He helped to correlate pharmacology with the clinical sciences.5145400
Enhanced self-directed learning3056941
Active discussion facilitated37411561
Better interaction between teachers and students.41331961
mesa2: Students' perceptions

Ninety-six percent (96%) of students felt that CBL would help them correlate pharmacology with the clinical sciences, and over 86% of students also agreed that CBL improves SDL (self-directed learning). Seventy-four percent (74%) of students agreed that CBL improves teacher-student interaction and enhances their interpersonal skills, especially communication skills. About 89% of students were of the opinion that CBL should also teach some other important and difficult topics in pharmacology. Almost all students said that CBL should be used as a TLM (teaching-learning method) for the next classes. Most students felt that all sessions were well organized and enjoyed the case-based learning (Table3).

QuestionsI totally agree (n%)a green %)Neutral (n%)disagree (n%)Strongly disagree (n%)
I developed my soft skills45441100
Useful for preparation in solving clinical problems.37333000
Other disciplines must also be taught by CBL5138740
Future lots must also be taught by CBL44451100
The course was well organized.56331100
I liked cbl37441540
mesa3: Students' perceptions

on meat2student responses to open-ended questions on the feedback form, as well as some suggestions such as teaching and learning methods, should be taught more frequently and should be a regular component of the MBBS curriculum; learning through CBL will help us in clinics where we can apply that knowledge; and these sessions should be designed to cover important and difficult topics such as the autonomic nervous system (ANS) and central nervous system (CNS), which provide more clarity of concepts. Students said that CBL would help build interpersonal relationships.

Discussion

The education system has gone through a sea of ​​change since traditional learning methods have been replaced by self-directed learning and active student participation.[5]πŸ‡§πŸ‡· CBL is a student-centered teaching method that acts as a stimulus and creates self-directed learning environments for students to explore and improve their performance and analytical skills. CBL is a structured approach to handling clinical case scenarios. The main stakeholders are the students, whose opinions matter most[6-7].

In our study, 95% of students felt that CBL provided clarity of concepts and would help them to correlate pharmacology with the clinical sciences. CBL will help students apply the knowledge they have gained in real-life situations. Similar findings were also observed in some other studies.[8-11]πŸ‡§πŸ‡· Most students felt that CBL motivates them towards self-directed learning. They are encouraged to seek additional resources. The same was demonstrated by Gupta et al. in your studio[12].

CBL is essential for improving your communication skills. They interact with each other, actively participate, discuss, fill in gaps in their learning and work as a team. Several studies have concluded that CBL improves students' self-reported analytical and communication skills, as well as their confidence, satisfaction, enthusiasm, and engagement.[13-15]πŸ‡§πŸ‡· Because pharmacology classes are difficult to retain, students wanted CBL to also teach some important and difficult topics in pharmacology, such as the ANS, CNS, and cardiovascular system (CVS).

As Kamat et al. reported in their study, 89% of students responded favorably to the introduction of CBL in subsequent batches[sixteen]πŸ‡§πŸ‡· Several other studies have reported similar results where CBL has been studied and shown to have a good impact on student learning.[15,17].

CBL can be used to spark a strong interest in the subject and a desire to learn more about it, along with acquiring the necessary knowledge, skills and attitudes. It also encourages self-assessment and critical reflection. This approach, like any other teaching-learning method, is not perfect. This strategy requires a lot of planning and effort at multidisciplinary levels, coordination and prior organization. Also, it is not an exam prep activity, so over time students may lose interest. In a study by Kassebaum et al., students reported that preparing for written exams was easier using the reading method.[18].

There were certain limitations in our study, as the number of professors to facilitate the CBL was smaller. Greater teacher involvement would have led to better student-teacher interaction. Due to time constraints, the CBL sessions could only cover four topics. Also, as the CBL was not included in the university exams for evaluation, some students were concerned about participating. To introduce some more recent methodologies in our teaching and learning, teacher awareness and training is essential. Regular interaction between teachers would help to remove some of the barriers.

conclusions

CBL was well received by students and was considered feasible and appropriate to include in the curriculum, although it required a lot of effort on their part. It is essential that more contemporary interactive teaching strategies such as CBL be incorporated into pharmacology teaching in light of the aforementioned findings and the implementation of the new competency-based curriculum of the National Medical Commission. The present study concluded that CBL is substantially more successful than traditional education in improving understanding of pharmacology. A strong foundation will be created through the judicious and proper application of the CBL approach along with other conventional teaching techniques during students' medical training, with the aim of producing an Indian medical graduate who is competent, self-confident and prepared. to serve society. We analyzed only the short-term CBL results. It is necessary to look at the long-term effects that may occur during subsequent years of clinical and internship exposure to determine whether this knowledge results in better prescribing capabilities. It will complement existing pharmacology teaching resources. To determine whether it can replace conventional teaching and learning methods, more research is needed.

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  2. Rao BB, Kate V:Interactive problem-solving clinical seminars for college students. J Pharmacol Pharmacother. 2012, 3:205-6.10.4103/0976-500X.95539
  3. Vyas R, Jacob M, Faith M, e outros:An effective integrated learning program in the first year of medical school. Natl Med J India. 2008, 21:21-6.
  4. Kate MS, Kulkarni UJ, Super A, Deshmukh YA:Introduction of integrated teaching in the medical graduation curriculum.. Int J Pharm Sci Res. 2010, 1:18-22.
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  6. Hansen WF, Ferguson KJ, Sipe CS, Sorosky J:Teachers' and students' attitudes towards case-based learning in the third-year gynecology and obstetrics internship. Soy J Obstet Gynecol. 2005, 192:644-7.10.1016/j.ajog.2004.10.595
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  8. Parekh M, Munjappa H, Shinde S, Vaidya S:Students' perceptions of activity-based learning in physiology. Natl J Physiol Pharm Pharmacol. 2018, 8:590-3.10.5455/njppp.2018.8.1248218122017
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  11. Sood M, Kaur K, Arora R:Introducing case-based learning to teach pharmacology to second-year MBBS students. Int J Basic Clin Pharmacol. 2021, 10:176-81.10.18203/2319-2003.ijbcp20210187
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