==== Front Cureus Cureus 2168-8184 Cureus 2168-8184 Cureus Palo Alto (CA) 10.7759/cureus.39835 Medical Education Quality Improvement Other Is There a Case for Case-Based Learning in Pharmacology? Muacevic Alexander Adler John R Padmanabha Thiruganahalli S 1 Shilpashree Y. D 2 Ajay Ningaiah 3 Kshamaa Haradanahalli G 4 Tejaswi H. L 3 Raghavendra S. K 5 1 Pharmacology, Adichunchanagiri Institute of Medical Sciences, Adichunchanagiri University, Balagangadharanatha Nagara, IND 2 Biochemistry, Adichunchanagiri Institute of Medical Sciences, Adichunchanagiri University, Balagangadharanatha Nagara, IND 3 Anatomy, Adichunchanagiri Institute of Medical Sciences, Adichunchanagiri University, Balagangadharanatha Nagara, IND 4 Psychiatry, Kempegowda Institute of Medical Sciences, Bengaluru, IND 5 Community Medicine, Adichunchanagiri Institute of Medical Sciences, Adichunchanagiri University, Balagangadharanatha Nagara, IND Haradanahalli G. Kshamaa kshamaa.hg@gmail.com 1 6 2023 6 2023 15 6 e3983531 5 2023 Copyright © 2023, Padmanabha et al. 2023 Padmanabha et al. https://creativecommons.org/licenses/by/3.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. This article is available from https://www.cureus.com/articles/156380-is-there-a-case-for-case-based-learning-in-pharmacology Background In a didactic lecture (DL), students listen, take notes, and passively accept the knowledge. Case-based learning (CBL) uses clinical cases for active learning and productive outcome. Although some studies have shown that DL is less effective than CBL, the results were inconclusive. Hence, this study aimed to evaluate the effectiveness of CBL in pharmacology. Methodology This study involved 80 second-year medical students divided into two groups. The results of post-test scores and retention test one month later were compared between the groups using multiple-choice questions. Results DL showed statistically significant better outcomes in immediate learning compared to CBL in both groups (p = 0.000 and 0.002). Although there were slightly better retention scores for CBL compared to DL in both groups, it was not statistically significant. Conclusions DL showed significantly better immediate learning outcomes compared to CBL, with no difference in long-term outcomes for both teaching-learning methods. Hence, DL continues to be the gold standard for teaching pharmacology. case-based learning post-test teaching-learning tool retention evaluation intervention pharmacology didactic lecture ==== Body pmcIntroduction Over decades, teaching medical subjects, especially pharmacology, has been challenging for both facilitators and students during training as it is very volatile. Overall, traditional lecture or didactic lecture (DL) is a commonly used teaching method globally. In the traditional teaching method, students listen, take notes, and passively accept the knowledge, which has been shown to be less effective than other teaching strategies [1]. Students and facilitators noted that traditional teaching methods were not immensely helpful in teaching the subject well and started exploring other teaching-learning (TL) methods [2]. After more than a decade, the Medical Council of India/National Medical Commission implemented competency-based medical education for undergraduate medical students in 2018, emphasizing the need to integrate basic subjects with clinical subjects using case scenarios or case-based teaching. This curriculum also encourages the preclinical and paraclinical disciplines to integrate with relevant clinical disciplines to understand and explore critical thinking skills using case-based discussion and vice-versa [3]. In this context, the goal of case-based learning (CBL) is to prepare and encourage students toward active participation in the learning process for achieving productive outcomes using clinical cases. It links theory to practice through the application of knowledge to cases using inquiry-based learning methods [4,5]. Studies comparing the effectiveness of DL and CBL in knowledge acquisition have yielded inconclusive results, showing no significant differences between the two approaches [6-8]. Therefore, this study aimed to evaluate the effectiveness of CBL over DL in improving learning outcomes, retention levels, and learning satisfaction among second-year medical students. Materials and methods An educational quasi-experimental study was conducted in the Department of Pharmacology after obtaining approval from the Institutional Ethics Committee of Adichunchanagiri Institute of Medical Sciences, B G Nagara (reference number: AIMS/IEC/2259/2019-20). The study included 80 second-year medical students selected using the simple random sampling technique. The research objective and process were explained to the study participants and written informed consent was obtained. The students were randomly allocated into two groups, group A (n = 40) and group B (n = 40), by a random number generator in Microsoft Excel using a 1:1 ratio (Figure 1). Figure 1 Implementation process of CBL and DL methods. CBL = case-based learning; DL = didactic lecture; MCQ = multiple-choice question One clinical case vignette, for each session, was prepared by senior faculty, and the content was validated by external subject experts. To assess the outcome of the educational intervention, multiple-choice questions (MCQs) were prepared and validated by the panel of subject experts. Each topic had 10 MCQs, and one mark was awarded for each correct response and zero for each incorrect response. The MCQs were given to all students immediately after the TL session and one month after completing the last intervention. Student satisfaction level was assessed based on a self-designed questionnaire validated by the panel of experts, enquiring whether the DL and CBL methods helped in understanding difficult concepts, encouraging self-study ability, developing problem-solving and reasoning skills, and overall satisfaction with the teaching methods. Each question was scored on a Likert scale of 1 to 5, where 1 denoted very dissatisfied and 5 denoted very satisfied. The average satisfaction scores were considered to compare between the DL and CBL. All sessions were engaged by the senior faculty trained in medical education technology who were sensitized on the effective engagement of students in both DL and CBL methods before the session. The two-week washout period was considered to eliminate the effect of subjective bias among the faculty before the crossover between DL and CBL methods. Figure 1 depicts the implementation process of the study. Statistical analysis Compilation and statistical analysis were performed using SPSS version 26.0 software (IBM Corp., Armonk, NY, USA). Continuous data were expressed as mean ± standard deviation (SD). The results between the groups were analyzed using an independent-sample t-test and Mann-Whitney U test. The significance level was set at p-values <0.05. Results In this study, post-test scores were statistically significant in both group A and group B before and after the crossover, as shown in Table 1, Table 2, and Figure 2. Table 1 Comparison of post-test scores between group A (CBL) and group B (DL) following session one on antigout drugs. No = number of participants; SD = standard deviation; df = degree of freedom; CI = confidence interval; CBL = case-based learning; DL = didactic lecture Antigout drugs No Mean SD t-value df P-value 95% CI Group A (CBL) 40 6.3 1.786 -4.005 78 0 -2.283 to -0.767 Group B (DL) 40 7.83 1.615 Table 2 Comparison of post-test scores between group A (DL) and group B (CBL) following session two on antimigraine drugs. No = number of participants; SD = standard deviation; df = degree of freedom; CI = confidence interval; CBL = case-based learning; DL = didactic lecture Antimigraine drugs No Mean SD t-value df P-value 95% CI Group A (DL) 40 5.85 1.35 3.234 78 0.002 0.452 to 1.898 Group B (CBL) 40 4.68 1.859 Figure 2 Comparison of mean post-test scores between group A and group B for CBL and DL methods (independent t-test). CI = confidence interval; CBL = case-based learning; DL = didactic lecture Retention scores for group A and group B were slightly higher for CBL sessions, as shown in Table 3, Table 4, and Figure 3. Table 3 Comparison of retention level scores between group A (CBL) and group B (DL) one month after session two on antigout drugs. No = number of participants; SD = standard deviation; df = degree of freedom; CI = confidence interval; CBL = case-based learning; DL = didactic lecture Antigout drugs - retention level No Mean SD t-value df P-value 95% CI Group A (CBL) 40 4.83 1.81 0.641 78 0.524 -0.527 to 1.027 Group B (DL) 40 4.58 1.678 Table 4 Comparison of retention level scores between group A (DL) and group B (CBL) one month after session two on antimigraine drugs. No = number of participants; SD = standard deviation; df = degree of freedom; CI = confidence interval; CBL = case-based learning; DL = didactic lecture Antimigraine drugs - retention level No Mean SD t-value df P-value 95% CI Group A (DL) 40 4.38 1.628 0.243 78 0.808 -0.718 to 0.918 Group B (CBL) 40 4.52 2.025 Figure 3 Comparison of mean retention scores between group A and group B for CBL and DL methods (independent t-test). CI = confidence interval; CBL = case-based learning; DL = didactic lecture Figure 4 shows the satisfaction with the TL method. Satisfaction for the group which attended the antigout CBL session was statistically significant (p < 0.05) compared to the group that attended the DL session. Similarly, the group which attended the antimigraine CBL session had higher satisfaction compared to the DL group. Figure 4 Comparison of perception of satisfaction between group A and group B for CBL and DL methods (Mann-Whitney U test). CBL = case-based learning; DL = didactic lecture; TL = teaching-learning Discussion This study was conducted to evaluate the effectiveness of CBL and DL TL methods in teaching pharmacology. Previous studies have compared the outcomes of CBL and DL as effective TL methods and have reported conflicting and inconclusive findings [4-13]. In contrast to the present findings, studies by Cendan et al., Latif et al., Vedi et al., and Sangam et al. concluded that CBL group performance was better than DL [4,5,12,13]. Another study by Chao et al. observed that there was no significant difference between the two TL methods [14]. Therefore, the faculty should not rely on one TL method alone to promote the required educational objectives. Studies by Majeed et al. and Carrero et al. found DL to be the most effective TL method [10,11]. In our study, both groups scored higher for the DL session compared to CBL. Probable reasons that can be derived for their poor outcome in CBL are attributed to their inability to comprehend the clinical case vignette based on previous theoretical knowledge, which requires more time and voluntary active participation, and interaction among peer students and faculty to achieve the learning objective and outcome [15]. Although there were slightly better retention scores for CBL compared to DL in both groups, it was not statistically significant (Figure 3, Tables 3, 4). However, a study done in Turkey dental schools emphasized that CBL improved deeper learning [16]. A study by Ciraj et al. [17] also concluded that CBL helps in long-term retention in teaching microbiology. Hence, they concluded that CBL enables students to acquire, retain, consolidate, and retrieve the concepts in pharmacology by lubricating and linking the neuronal cells in the brain when students are subjected to higher-order mental tasks. The satisfaction level for TL methods in this study was 46.63% and 44.69% for group A and group B, respectively, who attended CBL, which was higher than that for DL (Figure 4; group A: 36.31% and group B: 34.38%). The CBL method provided a better perception of satisfaction in this study. A study by Kaur et al. [6] also showed that students had a better perception of CBL and there was better attendance in CBL sessions. Study limitations This study was conducted on a small sample for a short duration. The outcome might have been influenced by the faculty handling the topic and the topic chosen. Certain confounding factors such as students’ prior knowledge of the topics and their dynamics with the teaching faculty were not assessed and can be considered a limitation of this study. Further, the gap identified in this study can be considered for future evaluation. Conclusions The current interventional study showed that the DL method had significantly better immediate learning outcomes compared to CBL. However, there was no statistically significant difference between CBL and DL in terms of mean retention score. Therefore, DL appears to be the better TL method for teaching pharmacology compared to CBL. Sincere thanks to the Undergraduate Students for their participation in the study and the Medical Education Unit, St. John’s Medical College, Bengaluru, ACME-2019 A, ACME 2019 B Batch for their constant guidance. Special thanks to Dr. Nachiketh Shankar, Professor, Department of Anatomy, St. John’s Medical College, Bengaluru, Dr. M G Shivaramu, Dean, Health Sciences (Medical), Adichunchanagiri Institute of Medical Sciences, Adichunchanagiri University, and Department Colleagues for their support and cooperation in completing the project under the Advance Course in Medical Education (ACME). Human Ethics Animal Ethics Consent was obtained or waived by all participants in this study. Institutional Ethics Committee, Adichunchanagiri Institute of Medical Sciences issued approval AIMS/IEC/2259/2019-20 Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. The authors have declared that no competing interests exist. ==== Refs References 1 Best practices for teaching pharmacology to undergraduate nursing students: a systematic review of the literature Nurse Educ Today Gill M Andersen E Hilsmann N 15 24 74 2019 30554030 2 Comparison of problem-based learning and traditional teaching methods in medical psychology education in China: a systematic review and meta-analysis PLoS One Gao J Yang L Zhao J Wang L Zou J Wang C Fan X 0 15 2020 3 Medical council of India. Competency Based Undergraduate Curriculum for the Indian Medical Graduate 1 2023 2023 https://www.nmc.org.in/wp-content/uploads/2020/01/UG-Curriculum-Vol-II.pdf 4 Changing the student clerkship from traditional lectures to small group case-based sessions benefits the student and the faculty J Surg Educ Cendan JC Silver M Ben-David K 117 120 68 2011 21338967 5 Impact of case-based lectures on students' performance in vascular physiology module Adv Physiol Educ Latif R 268 272 38 2014 25179618 6 Case-based learning as an effective tool in teaching pharmacology to undergraduate medical students in a large group setting J Med Educ Curric Dev Kaur G Rehncy J Kahal KS Singh J Sharma V Matreja PS Grewal H 2382120520920640 7 2020 32435693 7 Comparison of case-based learning and traditional lectures in an orthopedic residency anatomy course J Surg Educ Demetri L Donnelley CA MacKechnie MC Toogood P 679 685 78 2021 https://www.sciencedirect.com/science/article/pii/S1931720420303238 32888846 8 Comparison of case-based learning and traditional lectures in physiology among first year undergraduate medical students Natl J Physiol Pharm Pharmacol Diwan JS Sanghavi SJ Shah CJ Shah AM 744 748 7 2017 9 Lectures are such an effective teaching method because they exploit evolved human psychology to improve learning Med Hypotheses Charlton BG 1261 1265 67 2006 16949216 10 Effectiveness of case-based teaching of physiology for nursing students J Taibah Univ Med Sci Majeed F 289 292 9 2014 11 Comparison between lecture-based approach and case/problem-based learning discussion for teaching pre-anaesthetic assessment Eur J Anaesthesiol Carrero E Gomar C Penzo W Rull M 1008 1015 24 2007 17261212 12 Students' perception and learning on case based teaching in anatomy and physiology: an e-learning approach J Adv Med Educ Prof Vedi N Dulloo P 8 17 9 2021 33521136 13 Efficacy of case-based learning in anatomy Cureus Sangam MR K P G V Bokan RR Deka R Kaur A 0 13 2021 14 Use of an online curriculum to teach delirium to fourth-year medical students: a comparison with lecture format J Am Geriatr Soc Chao SH Brett B Wiecha JM Norton LE Levine SA 1328 1332 60 2012 22702385 15 Challenges of case-based teaching Behav Anal Today Mostert MP 434 442 8 2007 https://files.eric.ed.gov/fulltext/EJ821490.pdf 16 Comparison of case-based and lecture-based learning in dental education using the SOLO taxonomy J Dent Educ Ilgüy M Ilgüy D Fişekçioğlu E Oktay I 1521 1527 78 2014 25362693 17 Enhancing active learning in microbiology through case based learning: experiences from an Indian medical school Indian J Pathol Microbiol Ciraj AM Vinod P Ramnarayan K 729 733 53 2010 21045402