Chapter 1: Introduction and background 1
2.3 Pharmacy education 16
2.5.3 Case-based curricula 34
The relationship between PBL and cases studies is not always clear. At times, case studies are included as a strategy within commonly described PBL approaches, especially if the case is unstructured and student-centered, at other times not. Herreid (2011) highlighted this difficulty stating that often the terms “cases” and “case studies” are used without a definition and meanings can therefore vary depending on
the context. This also creates difficulties in terms of evaluation as many different approaches can be grouped together. Herreid (2007) simply defined case studies as stories with an educational message.
Using this definition of case studies, Herreid (2011) acknowledged that cases can be presented in a variety of ways, ranging from use in lectures to discussion groups, PBL or large classes using clickers21 (Herreid, 2011; Wolter, Lundeberg, Kang & Herreid, 2011). Herreid’s (2011) taxonomy of case study methods provides some clarity and distinguishes between the various options available, such as lecture methods, discussion methods, small group methods, individual cases and computer simulation cases. Le Roux and Khanyile (2012) defined case-based learning (CBL) in terms of active participation in a real or hypothetical problem, which is reflective of specific experiences to the discipline being studied. Nkosi and Thupayagale-Tshweneagae (2013), described the case-based method within a nursing context as problem-based, student-centered and small group driven. They believed that the use of situation specific cases promoted critical thinking skills and learning strategies.
Several case study approaches feature in a lecture setting and depending on the approach, academics and students take on different roles. In the lecture method, academics take the role of story teller and students are passive recipients when cases are presented. The whole classroom discussion of case studies, however, has been described as the classical case. In this format, case studies can be presented in a variety of forms such as debates, symposia, public hearing or trials (Herreid, 2011) and increased student participation can result. The clicker cases involving case studies offer interactive participation despite huge class sizes and features cases studies presented in Power-Point, where students can respond to multiple choice questions pertaining to the case using clickers. Clickers’ benefits include their ability to relate to real time assessment, allowing academics to provide instant feedback on learning.
While some comparative studies between lectures and clickers yielded clickers as being favourable (Wolter et al., 2011), Morgan (2008) reported no differences in
21 Clickers are known by several names: student response systems, classroom response systems, audience response systems or personal response systems. Clickers are used to refer to the handheld transmitters which work on radio frequencies, allowing students to answer questions posed by academics. These results are then illustrated on the academics’ computers (Bruff, n.d).
learning when clickers were used. Morgan (2008) made the point that class size plays a crucial role in determining the effectiveness of clickers, while Wolter et al. (2011) believed that students’ perceptions of using response systems with cases also matters.
While different studies have indicated preferences for a particular case study approach (Herreid, 2011; Johnson & Johnson, 1989), there are no conclusive findings on which method promotes better learning or assists in developing critical skills. Kim et al.’s (2006) meta-analysis of 100 case articles revealed little evidence that the use of cases improved critical thinking skills.
Many studies have, however, been conducted to measure the impact that different teaching methods have in pharmacy education (Khan, Hassali & Rasool, 2013). While the chalkboard method can be replaced with innovative multimedia approaches, the authors (Khan et al., 2013) acknowledged that lecture room learning is still beneficial and should not be discounted, as electronic teaching materials run the risk of contributing towards short term memory retention (Hossein & Abdus, 2005; Yousif et al., 2013). Pearson and Hubball (2012) also made the point that there is little evidence or substantive improvement in learning outcomes or other parameters when an integrated curriculum is compared to traditional curricula. While claims are made regarding the benefits of CBL in fostering problem solving, decision making, critical thinking skills and independent learning and motivation (Jesus, Gomes & Cruz, 2012;
Yoo, Park & Lee, 2010), very few studies have provided empirical evidence of their effectiveness over other pedagogical approaches (Thistlethwaite et al., 2012).
Numerous studies have been conducted on pharmacy students’ feelings or preferences regarding pedagogy. For example, a study of pharmacy education instruction based on preference and practices in Saudi Arabian colleges revealed that from the 300 students sampled, the dominant (53.7%) approach was direct lecturing (Yousif et al., 2013), however, students preferred a mixture of traditional lecture delivery and electronic aids (68%).
Professional education has also been affected by situated or “authentic” learning, where it is believed that in order for students to transfer their knowledge to contexts beyond education, they need learning tasks that mirror the realities of practice (Maton 2009). Dolmans and Snellen-Balendong (1997), in their seven principles of how to
design effective cases for a problem-based curriculum, discussed how cases should be presented in a context that is relevant to the future profession. Situated knowledge is believed to provide easier access for later use. Research on human memory indicates that information is better recalled if there is a link between the context in which the information is learned and that where it is applied (Dolmans & Snellen-Balendong, 1997). Research in professional education has been largely influenced by “authentic or situated learning” which claims to enable cumulative learning (Maton, 2009, p. 47).
Authentic learning is often related to case-based, problem-based and project-based pedagogies providing students with examples of real-life practices, building on prior experience and preparing them for the world of work. Case-based teaching at UKZN mimic cases students would be faced with in the work environment, involving complex, unstructured problems (Suleman, 2012).