case study in pedagogy

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In This Article Expand or collapse the "in this article" section Case Study in Education Research

Introduction, general overview and foundational texts of the late 20th century.

• Conceptualisations and Definitions of Case Study
• Case Study and Theoretical Grounding
• Choosing Cases
• Methodology, Method, Genre, or Approach
• Case Study: Quality and Generalizability
• Multiple Case Studies
• Exemplary Case Studies and Example Case Studies
• Criticism, Defense, and Debate around Case Study

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Case Study in Education Research by Lorna Hamilton LAST REVIEWED: 27 June 2018 LAST MODIFIED: 27 June 2018 DOI: 10.1093/obo/9780199756810-0201

It is important to distinguish between case study as a teaching methodology and case study as an approach, genre, or method in educational research. The use of case study as teaching method highlights the ways in which the essential qualities of the case—richness of real-world data and lived experiences—can help learners gain insights into a different world and can bring learning to life. The use of case study in this way has been around for about a hundred years or more. Case study use in educational research, meanwhile, emerged particularly strongly in the 1970s and 1980s in the United Kingdom and the United States as a means of harnessing the richness and depth of understanding of individuals, groups, and institutions; their beliefs and perceptions; their interactions; and their challenges and issues. Writers, such as Lawrence Stenhouse, advocated the use of case study as a form that teacher-researchers could use as they focused on the richness and intensity of their own practices. In addition, academic writers and postgraduate students embraced case study as a means of providing structure and depth to educational projects. However, as educational research has developed, so has debate on the quality and usefulness of case study as well as the problems surrounding the lack of generalizability when dealing with single or even multiple cases. The question of how to define and support case study work has formed the basis for innumerable books and discursive articles, starting with Robert Yin’s original book on case study ( Yin 1984 , cited under General Overview and Foundational Texts of the Late 20th Century ) to the myriad authors who attempt to bring something new to the realm of case study in educational research in the 21st century.

This section briefly considers the ways in which case study research has developed over the last forty to fifty years in educational research usage and reflects on whether the field has finally come of age, respected by creators and consumers of research. Case study has its roots in anthropological studies in which a strong ethnographic approach to the study of peoples and culture encouraged researchers to identify and investigate key individuals and groups by trying to understand the lived world of such people from their points of view. Although ethnography has emphasized the role of researcher as immersive and engaged with the lived world of participants via participant observation, evolving approaches to case study in education has been about the richness and depth of understanding that can be gained through involvement in the case by drawing on diverse perspectives and diverse forms of data collection. Embracing case study as a means of entering these lived worlds in educational research projects, was encouraged in the 1970s and 1980s by researchers, such as Lawrence Stenhouse, who provided a helpful impetus for case study work in education ( Stenhouse 1980 ). Stenhouse wrestled with the use of case study as ethnography because ethnographers traditionally had been unfamiliar with the peoples they were investigating, whereas educational researchers often worked in situations that were inherently familiar. Stenhouse also emphasized the need for evidence of rigorous processes and decisions in order to encourage robust practice and accountability to the wider field by allowing others to judge the quality of work through transparency of processes. Yin 1984 , the first book focused wholly on case study in research, gave a brief and basic outline of case study and associated practices. Various authors followed this approach, striving to engage more deeply in the significance of case study in the social sciences. Key among these are Merriam 1988 and Stake 1995 , along with Yin 1984 , who established powerful groundings for case study work. Additionally, evidence of the increasing popularity of case study can be found in a broad range of generic research methods texts, but these often do not have much scope for the extensive discussion of case study found in case study–specific books. Yin’s books and numerous editions provide a developing or evolving notion of case study with more detailed accounts of the possible purposes of case study, followed by Merriam 1988 and Stake 1995 who wrestled with alternative ways of looking at purposes and the positioning of case study within potential disciplinary modes. The authors referenced in this section are often characterized as the foundational authors on this subject and may have published various editions of their work, cited elsewhere in this article, based on their shifting ideas or emphases.

Merriam, S. B. 1988. Case study research in education: A qualitative approach . San Francisco: Jossey-Bass.

This is Merriam’s initial text on case study and is eminently accessible. The author establishes and reinforces various key features of case study; demonstrates support for positioning the case within a subject domain, e.g., psychology, sociology, etc.; and further shapes the case according to its purpose or intent.

Stake, R. E. 1995. The art of case study research . Thousand Oaks, CA: SAGE.

Stake is a very readable author, accessible and yet engaging with complex topics. The author establishes his key forms of case study: intrinsic, instrumental, and collective. Stake brings the reader through the process of conceptualizing the case, carrying it out, and analyzing the data. The author uses authentic examples to help readers understand and appreciate the nuances of an interpretive approach to case study.

Stenhouse, L. 1980. The study of samples and the study of cases. British Educational Research Journal 6:1–6.

DOI: 10.1080/0141192800060101

A key article in which Stenhouse sets out his stand on case study work. Those interested in the evolution of case study use in educational research should consider this article and the insights given.

Yin, R. K. 1984. Case Study Research: Design and Methods . Beverley Hills, CA: SAGE.

This preliminary text from Yin was very basic. However, it may be of interest in comparison with later books because Yin shows the ways in which case study as an approach or method in research has evolved in relation to detailed discussions of purpose, as well as the practicalities of working through the research process.

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Making Learning Relevant With Case Studies

The open-ended problems presented in case studies give students work that feels connected to their lives.

To prepare students for jobs that haven’t been created yet, we need to teach them how to be great problem solvers so that they’ll be ready for anything. One way to do this is by teaching content and skills using real-world case studies, a learning model that’s focused on reflection during the problem-solving process. It’s similar to project-based learning, but PBL is more focused on students creating a product.

Case studies have been used for years by businesses, law and medical schools, physicians on rounds, and artists critiquing work. Like other forms of problem-based learning, case studies can be accessible for every age group, both in one subject and in interdisciplinary work.

You can get started with case studies by tackling relatable questions like these with your students:

• How can we limit food waste in the cafeteria?
• How can we get our school to recycle and compost waste? (Or, if you want to be more complex, how can our school reduce its carbon footprint?)
• How can we improve school attendance?
• How can we reduce the number of people who get sick at school during cold and flu season?

Addressing questions like these leads students to identify topics they need to learn more about. In researching the first question, for example, students may see that they need to research food chains and nutrition. Students often ask, reasonably, why they need to learn something, or when they’ll use their knowledge in the future. Learning is most successful for students when the content and skills they’re studying are relevant, and case studies offer one way to create that sense of relevance.

Teaching With Case Studies

Ultimately, a case study is simply an interesting problem with many correct answers. What does case study work look like in classrooms? Teachers generally start by having students read the case or watch a video that summarizes the case. Students then work in small groups or individually to solve the case study. Teachers set milestones defining what students should accomplish to help them manage their time.

During the case study learning process, student assessment of learning should be focused on reflection. Arthur L. Costa and Bena Kallick’s Learning and Leading With Habits of Mind gives several examples of what this reflection can look like in a classroom: 

Journaling: At the end of each work period, have students write an entry summarizing what they worked on, what worked well, what didn’t, and why. Sentence starters and clear rubrics or guidelines will help students be successful. At the end of a case study project, as Costa and Kallick write, it’s helpful to have students “select significant learnings, envision how they could apply these learnings to future situations, and commit to an action plan to consciously modify their behaviors.”

Interviews: While working on a case study, students can interview each other about their progress and learning. Teachers can interview students individually or in small groups to assess their learning process and their progress.

Student discussion: Discussions can be unstructured—students can talk about what they worked on that day in a think-pair-share or as a full class—or structured, using Socratic seminars or fishbowl discussions. If your class is tackling a case study in small groups, create a second set of small groups with a representative from each of the case study groups so that the groups can share their learning.

4 Tips for Setting Up a Case Study

1. Identify a problem to investigate: This should be something accessible and relevant to students’ lives. The problem should also be challenging and complex enough to yield multiple solutions with many layers.

2. Give context: Think of this step as a movie preview or book summary. Hook the learners to help them understand just enough about the problem to want to learn more.

3. Have a clear rubric: Giving structure to your definition of quality group work and products will lead to stronger end products. You may be able to have your learners help build these definitions.

4. Provide structures for presenting solutions: The amount of scaffolding you build in depends on your students’ skill level and development. A case study product can be something like several pieces of evidence of students collaborating to solve the case study, and ultimately presenting their solution with a detailed slide deck or an essay—you can scaffold this by providing specified headings for the sections of the essay.

Problem-Based Teaching Resources

There are many high-quality, peer-reviewed resources that are open source and easily accessible online.

• The National Center for Case Study Teaching in Science at the University at Buffalo built an online collection of more than 800 cases that cover topics ranging from biochemistry to economics. There are resources for middle and high school students.
• Models of Excellence , a project maintained by EL Education and the Harvard Graduate School of Education, has examples of great problem- and project-based tasks—and corresponding exemplary student work—for grades pre-K to 12.
• The Interdisciplinary Journal of Problem-Based Learning at Purdue University is an open-source journal that publishes examples of problem-based learning in K–12 and post-secondary classrooms.
• The Tech Edvocate has a list of websites and tools related to problem-based learning.

In their book Problems as Possibilities , Linda Torp and Sara Sage write that at the elementary school level, students particularly appreciate how they feel that they are taken seriously when solving case studies. At the middle school level, “researchers stress the importance of relating middle school curriculum to issues of student concern and interest.” And high schoolers, they write, find the case study method “beneficial in preparing them for their future.”

Center for Teaching

Case studies.

Print Version

Case studies are stories that are used as a teaching tool to show the application of a theory or concept to real situations. Dependent on the goal they are meant to fulfill, cases can be fact-driven and deductive where there is a correct answer, or they can be context driven where multiple solutions are possible. Various disciplines have employed case studies, including humanities, social sciences, sciences, engineering, law, business, and medicine. Good cases generally have the following features: they tell a good story, are recent, include dialogue, create empathy with the main characters, are relevant to the reader, serve a teaching function, require a dilemma to be solved, and have generality.

Instructors can create their own cases or can find cases that already exist. The following are some things to keep in mind when creating a case:

• What do you want students to learn from the discussion of the case?
• What do they already know that applies to the case?
• What are the issues that may be raised in discussion?
• How will the case and discussion be introduced?
• What preparation is expected of students? (Do they need to read the case ahead of time? Do research? Write anything?)
• What directions do you need to provide students regarding what they are supposed to do and accomplish?
• Do you need to divide students into groups or will they discuss as the whole class?
• Are you going to use role-playing or facilitators or record keepers? If so, how?
• What are the opening questions?
• How much time is needed for students to discuss the case?
• What concepts are to be applied/extracted during the discussion?
• How will you evaluate students?

To find other cases that already exist, try the following websites:

• The National Center for Case Study Teaching in Science , University of Buffalo. SUNY-Buffalo maintains this set of links to other case studies on the web in disciplines ranging from engineering and ethics to sociology and business
• A Journal of Teaching Cases in Public Administration and Public Policy , University of Washington

For more information:

• World Association for Case Method Research and Application

Book Review :  Teaching and the Case Method , 3rd ed., vols. 1 and 2, by Louis Barnes, C. Roland (Chris) Christensen, and Abby Hansen. Harvard Business School Press, 1994; 333 pp. (vol 1), 412 pp. (vol 2).

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Case-based learning.

Case-based learning (CBL) is an established approach used across disciplines where students apply their knowledge to real-world scenarios, promoting higher levels of cognition (see Bloom’s Taxonomy ). In CBL classrooms, students typically work in groups on case studies, stories involving one or more characters and/or scenarios.  The cases present a disciplinary problem or problems for which students devise solutions under the guidance of the instructor. CBL has a strong history of successful implementation in medical, law, and business schools, and is increasingly used within undergraduate education, particularly within pre-professional majors and the sciences (Herreid, 1994). This method involves guided inquiry and is grounded in constructivism whereby students form new meanings by interacting with their knowledge and the environment (Lee, 2012).

There are a number of benefits to using CBL in the classroom. In a review of the literature, Williams (2005) describes how CBL: utilizes collaborative learning, facilitates the integration of learning, develops students’ intrinsic and extrinsic motivation to learn, encourages learner self-reflection and critical reflection, allows for scientific inquiry, integrates knowledge and practice, and supports the development of a variety of learning skills.

CBL has several defining characteristics, including versatility, storytelling power, and efficient self-guided learning.  In a systematic analysis of 104 articles in health professions education, CBL was found to be utilized in courses with less than 50 to over 1000 students (Thistlethwaite et al., 2012). In these classrooms, group sizes ranged from 1 to 30, with most consisting of 2 to 15 students.  Instructors varied in the proportion of time they implemented CBL in the classroom, ranging from one case spanning two hours of classroom time, to year-long case-based courses. These findings demonstrate that instructors use CBL in a variety of ways in their classrooms.

The stories that comprise the framework of case studies are also a key component to CBL’s effectiveness. Jonassen and Hernandez-Serrano (2002, p.66) describe how storytelling:

Is a method of negotiating and renegotiating meanings that allows us to enter into other’s realms of meaning through messages they utter in their stories,

Helps us find our place in a culture,

Allows us to explicate and to interpret, and

Facilitates the attainment of vicarious experience by helping us to distinguish the positive models to emulate from the negative model.

Neurochemically, listening to stories can activate oxytocin, a hormone that increases one’s sensitivity to social cues, resulting in more empathy, generosity, compassion and trustworthiness (Zak, 2013; Kosfeld et al., 2005). The stories within case studies serve as a means by which learners form new understandings through characters and/or scenarios.

CBL is often described in conjunction or in comparison with problem-based learning (PBL). While the lines are often confusingly blurred within the literature, in the most conservative of definitions, the features distinguishing the two approaches include that PBL involves open rather than guided inquiry, is less structured, and the instructor plays a more passive role. In PBL multiple solutions to the problem may exit, but the problem is often initially not well-defined. PBL also has a stronger emphasis on developing self-directed learning. The choice between implementing CBL versus PBL is highly dependent on the goals and context of the instruction.  For example, in a comparison of PBL and CBL approaches during a curricular shift at two medical schools, students and faculty preferred CBL to PBL (Srinivasan et al., 2007). Students perceived CBL to be a more efficient process and more clinically applicable. However, in another context, PBL might be the favored approach.

In a review of the effectiveness of CBL in health profession education, Thistlethwaite et al. (2012), found several benefits:

Students enjoyed the method and thought it enhanced their learning,

Instructors liked how CBL engaged students in learning,

CBL seemed to facilitate small group learning, but the authors could not distinguish between whether it was the case itself or the small group learning that occurred as facilitated by the case.

Other studies have also reported on the effectiveness of CBL in achieving learning outcomes (Bonney, 2015; Breslin, 2008; Herreid, 2013; Krain, 2016). These findings suggest that CBL is a vehicle of engagement for instruction, and facilitates an environment whereby students can construct knowledge.

Science – Students are given a scenario to which they apply their basic science knowledge and problem-solving skills to help them solve the case. One example within the biological sciences is two brothers who have a family history of a genetic illness. They each have mutations within a particular sequence in their DNA. Students work through the case and draw conclusions about the biological impacts of these mutations using basic science. Sample cases: You are Not the Mother of Your Children ; Organic Chemisty and Your Cellphone: Organic Light-Emitting Diodes ;   A Light on Physics: F-Number and Exposure Time

Medicine – Medical or pre-health students read about a patient presenting with specific symptoms. Students decide which questions are important to ask the patient in their medical history, how long they have experienced such symptoms, etc. The case unfolds and students use clinical reasoning, propose relevant tests, develop a differential diagnoses and a plan of treatment. Sample cases: The Case of the Crying Baby: Surgical vs. Medical Management ; The Plan: Ethics and Physician Assisted Suicide ; The Haemophilus Vaccine: A Victory for Immunologic Engineering

Public Health – A case study describes a pandemic of a deadly infectious disease. Students work through the case to identify Patient Zero, the person who was the first to spread the disease, and how that individual became infected.  Sample cases: The Protective Parent ; The Elusive Tuberculosis Case: The CDC and Andrew Speaker ; Credible Voice: WHO-Beijing and the SARS Crisis

Law – A case study presents a legal dilemma for which students use problem solving to decide the best way to advise and defend a client. Students are presented information that changes during the case.  Sample cases: Mortgage Crisis Call (abstract) ; The Case of the Unpaid Interns (abstract) ; Police-Community Dialogue (abstract)

Business – Students work on a case study that presents the history of a business success or failure. They apply business principles learned in the classroom and assess why the venture was successful or not. Sample cases: SELCO-Determining a path forward ; Project Masiluleke: Texting and Testing to Fight HIV/AIDS in South Africa ; Mayo Clinic: Design Thinking in Healthcare

Humanities - Students consider a case that presents a theater facing financial and management difficulties. They apply business and theater principles learned in the classroom to the case, working together to create solutions for the theater. Sample cases: David Geffen School of Drama

Recommendations

Finding and Writing Cases

Consider utilizing or adapting open access cases - The availability of open resources and databases containing cases that instructors can download makes this approach even more accessible in the classroom. Two examples of open databases are the Case Center on Public Leadership and Harvard Kennedy School (HKS) Case Program , which focus on government, leadership and public policy case studies.

• Consider writing original cases - In the event that an instructor is unable to find open access cases relevant to their course learning objectives, they may choose to write their own. See the following resources on case writing: Cooking with Betty Crocker: A Recipe for Case Writing ; The Way of Flesch: The Art of Writing Readable Cases ;   Twixt Fact and Fiction: A Case Writer’s Dilemma ; And All That Jazz: An Essay Extolling the Virtues of Writing Case Teaching Notes .

Implementing Cases

Take baby steps if new to CBL - While entire courses and curricula may involve case-based learning, instructors who desire to implement on a smaller-scale can integrate a single case into their class, and increase the number of cases utilized over time as desired.

Use cases in classes that are small, medium or large - Cases can be scaled to any course size. In large classes with stadium seating, students can work with peers nearby, while in small classes with more flexible seating arrangements, teams can move their chairs closer together. CBL can introduce more noise (and energy) in the classroom to which an instructor often quickly becomes accustomed. Further, students can be asked to work on cases outside of class, and wrap up discussion during the next class meeting.

Encourage collaborative work - Cases present an opportunity for students to work together to solve cases which the historical literature supports as beneficial to student learning (Bruffee, 1993). Allow students to work in groups to answer case questions.

Form diverse teams as feasible - When students work within diverse teams they can be exposed to a variety of perspectives that can help them solve the case. Depending on the context of the course, priorities, and the background information gathered about the students enrolled in the class, instructors may choose to organize student groups to allow for diversity in factors such as current course grades, gender, race/ethnicity, personality, among other items.  

Use stable teams as appropriate - If CBL is a large component of the course, a research-supported practice is to keep teams together long enough to go through the stages of group development: forming, storming, norming, performing and adjourning (Tuckman, 1965).

Walk around to guide groups - In CBL instructors serve as facilitators of student learning. Walking around allows the instructor to monitor student progress as well as identify and support any groups that may be struggling. Teaching assistants can also play a valuable role in supporting groups.

Interrupt strategically - Only every so often, for conversation in large group discussion of the case, especially when students appear confused on key concepts. An effective practice to help students meet case learning goals is to guide them as a whole group when the class is ready. This may include selecting a few student groups to present answers to discussion questions to the entire class, asking the class a question relevant to the case using polling software, and/or performing a mini-lesson on an area that appears to be confusing among students.  

Assess student learning in multiple ways - Students can be assessed informally by asking groups to report back answers to various case questions. This practice also helps students stay on task, and keeps them accountable. Cases can also be included on exams using related scenarios where students are asked to apply their knowledge.

Barrows HS. (1996). Problem-based learning in medicine and beyond: a brief overview. New Directions for Teaching and Learning, 68, 3-12.  

Bonney KM. (2015). Case Study Teaching Method Improves Student Performance and Perceptions of Learning Gains. Journal of Microbiology and Biology Education, 16(1): 21-28.

Breslin M, Buchanan, R. (2008) On the Case Study Method of Research and Teaching in Design.  Design Issues, 24(1), 36-40.

Bruffee KS. (1993). Collaborative learning: Higher education, interdependence, and authority of knowledge. Johns Hopkins University Press, Baltimore, MD.

Herreid CF. (2013). Start with a Story: The Case Study Method of Teaching College Science, edited by Clyde Freeman Herreid. Originally published in 2006 by the National Science Teachers Association (NSTA); reprinted by the National Center for Case Study Teaching in Science (NCCSTS) in 2013.

Herreid CH. (1994). Case studies in science: A novel method of science education. Journal of Research in Science Teaching, 23(4), 221–229.

Jonassen DH and Hernandez-Serrano J. (2002). Case-based reasoning and instructional design: Using stories to support problem solving. Educational Technology, Research and Development, 50(2), 65-77.  

Kosfeld M, Heinrichs M, Zak PJ, Fischbacher U, Fehr E. (2005). Oxytocin increases trust in humans. Nature, 435, 673-676.

Krain M. (2016) Putting the learning in case learning? The effects of case-based approaches on student knowledge, attitudes, and engagement. Journal on Excellence in College Teaching, 27(2), 131-153.

Lee V. (2012). What is Inquiry-Guided Learning?  New Directions for Learning, 129:5-14.

Nkhoma M, Sriratanaviriyakul N. (2017). Using case method to enrich students’ learning outcomes. Active Learning in Higher Education, 18(1):37-50.

Srinivasan et al. (2007). Comparing problem-based learning with case-based learning: Effects of a major curricular shift at two institutions. Academic Medicine, 82(1): 74-82.

Thistlethwaite JE et al. (2012). The effectiveness of case-based learning in health professional education. A BEME systematic review: BEME Guide No. 23.  Medical Teacher, 34, e421-e444.

Tuckman B. (1965). Development sequence in small groups. Psychological Bulletin, 63(6), 384-99.

Williams B. (2005). Case-based learning - a review of the literature: is there scope for this educational paradigm in prehospital education? Emerg Med, 22, 577-581.

Zak, PJ (2013). How Stories Change the Brain. Retrieved from: https://greatergood.berkeley.edu/article/item/how_stories_change_brain

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What is the Case Method?

The core pedagogy of Harvard Business School since the early 20th century, the case method boasts a unique ability to make complex concepts accessible and develop students’ leadership skills, all while creating an engaging intellectual atmosphere.

A “case” is a short narrative document – a story – that presents a particular challenge facing an individual or organization. Each case reflects the information available to decision-makers at the time, and builds to a particular decision point, but without revealing what decision was actually made. For each class, students are asked to read the case and to put themselves in the shoes of the actual decision-makers to consider what they themselves would have done given the information available at the time.

To help situate the decision, each case also provides background history on the most relevant issues and events leading up to the decision point. For example, a case that focuses on a decision facing Martin Luther King Jr. during the campaign for black voting rights in 1965 also traces the broader civil rights movement, as well as the history of segregation and black disenfranchisement in the U.S. since the Civil War.

In the classroom, the instructor poses questions to guide student discussion. These carefully designed questions are the key to any successful case-method course. An experienced case-method teacher is often thinking several steps ahead, anticipating what points and questions might be raised and standing ready with follow-up questions to guide the group. Active participation in class is essential to the case method’s success, and the grading metrics reflect its importance. Students quickly learn to speak up, to challenge each other, and to build on each other’s ideas.

Any professor or teacher can teach by the case method. Content expertise beyond the case itself is helpful but not required. To assist both experienced and new case-method teachers, each case has its own teaching plan: a flexible road-map for the instructor that suggests specific questions, strategies for eliciting key insights, and ideas for organizing student responses visually on a blackboard. For some cases, more extensive supporting documents known as “teaching notes” are available to fully brief the instructor on the relevant history and the multiple levels of questions he or she might consider.

“ I’ve never had this experience as a teacher before, and it's explicitly due to the case method — it's a game changer. ”

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What the Case Study Method Really Teaches

• Nitin Nohria

Seven meta-skills that stick even if the cases fade from memory.

It’s been 100 years since Harvard Business School began using the case study method. Beyond teaching specific subject matter, the case study method excels in instilling meta-skills in students. This article explains the importance of seven such skills: preparation, discernment, bias recognition, judgement, collaboration, curiosity, and self-confidence.

During my decade as dean of Harvard Business School, I spent hundreds of hours talking with our alumni. To enliven these conversations, I relied on a favorite question: “What was the most important thing you learned from your time in our MBA program?”

• Nitin Nohria is the George F. Baker Jr. and Distinguished Service University Professor. He served as the 10th dean of Harvard Business School, from 2010 to 2020.

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Experiential and Case-Based Learning

Case-based teaching.

Case-based teaching strategies use real-life examples to offer a shared learning experience. It may be difficult for students to experience real-world situations together. These scenarios, provide a common “experience” so that students can solve problems, make decisions, and generally think critically together. Many case studies are stories, designed to engage students in research and analysis of a specific problem or set of problems. Case studies tend to work well in the online/hybrid learning environment.

Examples and Resources

• National Center for Case Study Teaching in Science, University of Buffalo  – A comprehensive site for all scientific disciplines, links to numerous articles on case study teaching in science plus an extensive collection of cases.
• Teaching with the Case Method from Carleton College   – Several examples of teaching with case studies.

Major, A., & Viswanathan, R. (2019). Create a case method group activity to engage students in critical thinking. In A. deNoyelles, A. Albrecht, S. Bauer, & S. Wyatt (Eds.),  Teaching Online Pedagogical Repository . Orlando, FL: University of Central Florida Center for Distributed Learning.  https://topr.online.ucf.edu/create-case-method-group-activity-engage-students-critical-thinking/ .

Experiential Learning

Experiential learning is an activity-oriented strategy rooted in experiences. Personalized reflection on experiences and the formulation of plans to apply learning to other contexts are critical factors. Experiential learning is effective in providing opportunities for students to engage and apply academic understanding through hands-on experience. There are many methods and tools that can be useful when employing experiential instruction such as simulations, field experience, games, storytelling, and surveys.

Field Experience

Field experience is an excellent way to bring real-world experiences back to a course. Students are often asked to document their experiences and observations and share reflections. For example, students majoring in art history frequently visit local museums to view examples of artwork presented in class.

Games/Simulations

Games and simulations allow learners to practice skills, acquire knowledge and learn concepts while having fun. Tools such as Kahoot can be used by faculty in order to conduct formative assessment in the form of an online, in-class game. In addition, technologies such as SimCity  provide virtual environments for students to explore, like  Center of the Cell and the many simulations found on  Phet  can offer students experiences that might be impossible in real life.

Role-playing gets students to explore acting out different scenarios or characters. For example, in a business class students may act as a buyer or seller of a specific product. In doing so, students develop a better understanding of the concepts they’ve learned by testing them out.

Ertmer, P. A., & Koehler, A. A. (2014). Online case-based discussions: Examining coverage of the afforded problem space.  Educational Technology Research and Development , 62( 5 ), 617-636.  https://doi.org/10.1007/s11423-014-9350-9

Kolb, D. (1984).  Experiential learning: Experience as the source of learning and development . Englewood Cliffs, NJ: Prentice Hall. Retrieved from  https://www.pearson.com/us/higher-education/program/Kolb-Experiential-Learning-Experience-as-the-Source-of-Learning-and-Development-2nd-Edition/PGM183903.html

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How to cite: Ożadowicz, A. Blended Learning and Flipped Classroom in Higher Engineering Education: Case Study and Students’ Perception in the Post-COVID-19 Period. Preprints 2024 , 2024052042. https://doi.org/10.20944/preprints202405.2042.v2 Ożadowicz, A. Blended Learning and Flipped Classroom in Higher Engineering Education: Case Study and Students’ Perception in the Post-COVID-19 Period. Preprints 2024, 2024052042. https://doi.org/10.20944/preprints202405.2042.v2 Copy

Ożadowicz, A. Blended Learning and Flipped Classroom in Higher Engineering Education: Case Study and Students’ Perception in the Post-COVID-19 Period. Preprints 2024 , 2024052042. https://doi.org/10.20944/preprints202405.2042.v2

Ożadowicz, A. (2024). Blended Learning and Flipped Classroom in Higher Engineering Education: Case Study and Students’ Perception in the Post-COVID-19 Period. Preprints. https://doi.org/10.20944/preprints202405.2042.v2

Ożadowicz, A. 2024 "Blended Learning and Flipped Classroom in Higher Engineering Education: Case Study and Students’ Perception in the Post-COVID-19 Period" Preprints. https://doi.org/10.20944/preprints202405.2042.v2

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Experiences of medical students and faculty regarding the use of long case as a formative assessment method at a tertiary care teaching hospital in a low resource setting: a qualitative study

• Jacob Kumakech 1 ,
• Ian Guyton Munabi 2 ,
• Aloysius Gonzaga Mubuuke 3 &
• Sarah Kiguli 4  

BMC Medical Education volume  24 , Article number:  621 ( 2024 ) Cite this article

Metrics details

Introduction

The long case is used to assess medical students’ proficiency in performing clinical tasks. As a formative assessment, the purpose is to offer feedback on performance, aiming to enhance and expedite clinical learning. The long case stands out as one of the primary formative assessment methods for clinical clerkship in low-resource settings but has received little attention in the literature.

To explore the experiences of medical students and faculty regarding the use of the Long Case Study as a formative assessment method at a tertiary care teaching hospital in a low-resource setting.

Methodology

A qualitative study design was used. The study was conducted at Makerere University, a low-resource setting. The study participants were third- and fifth-year medical students as well as lecturers. Purposive sampling was utilized to recruit participants. Data collection comprised six Focus Group Discussions with students and five Key Informant Interviews with lecturers. The qualitative data were analyzed by inductive thematic analysis.

Three themes emerged from the study: ward placement, case presentation, and case assessment and feedback. The findings revealed that students conduct their long cases at patients’ bedside within specific wards/units assigned for the entire clerkship. Effective supervision, feedback, and marks were highlighted as crucial practices that positively impact the learning process. However, challenges such as insufficient orientation to the long case, the super-specialization of the hospital wards, pressure to hunt for marks, and inadequate feedback practices were identified.

The long case offers students exposure to real patients in a clinical setting. However, in tertiary care teaching hospitals, it’s crucial to ensure proper design and implementation of this practice to enable students’ exposure to a variety of cases. Adequate and effective supervision and feedback create valuable opportunities for each learner to present cases and receive corrections.

Peer Review reports

The long case serves as an authentic assessment method for evaluating medical students’ competence in clinical tasks [ 1 ]. This form of assessment requires students to independently spend time with patients taking their medical history, conducting physical examinations, and formulating diagnosis and management plans. Subsequently, students present their findings to senior clinicians for discussion and questioning [ 2 , 3 ]. While developed countries increasingly adopt simulation-based assessments for formative evaluation, logistical challenges hinder the widespread use of such methods in developing countries [ 4 ]. Consequently, the low-resource countries heavily rely on real patient encounters for formative assessment. The long case is one such method predominantly used as a primary formative assessment method during clinical clerkship and offers a great opportunity for feedback [ 5 ]. The assessment grounds students’ learning into practice by providing them with rich opportunities to interact with patients and have the feel of medical practice. The long case thus bridges the gap between theory and practice, immersing students in the real tasks of a physician [ 1 ]. The complexity of clinical scenarios and the anxiety associated with patient encounters may not be well replicated in simulation-based assessments because diseases often have atypical presentations not found in textbooks. Assessment methods should thus utilize authentic learning experiences to provide learners with applications of learning that they would expect to encounter in real life [ 6 ]. This requires medical education and the curriculum to focus attention on assessment because it plays a significant role in driving learning [ 7 ]. The long case thus remains crucial in medical education as one of the best ways of preparing for practice. It exposes the student repeatedly to taking medical history, examining patients, making clinical judgments, deciding treatment plans, and collaborating with senior clinicians.

The long case, however, has faced significant criticism in the medical education literature due to perceived psychometric deficiencies [ 8 , 9 , 10 ]. Consequently, many universities have begun to adopt assessment methods that yield more reliable and easily defensible results [ 2 ] due to concerns over the low reliability, generalizability, and validity of the long case, coupled with rising litigations and student appeals [ 11 , 12 ]. Despite these shortcomings, the long case remains an educationally valuable assessment tool that provides diagnostic feedback essential for the learning process during clinical clerkship [ 13 ]. Teachers can utilize long-case results to pinpoint neglected areas or teaching deficiencies and align with course outcomes.

However, there is a paucity of research into the long case as a formative assessment tool. A few studies conducted in developed countries highlighted its role in promoting a holistic approach to patient care, fostering students’ clinical skills, and a driving force for students to spend time with patients [ 2 , 13 ], . There is a notable absence of literature on the use of long case as a formative assessment method in low-resource countries, and no published work is available at Makerere University where it has been used for decades. This underscores the importance of conducting research in this area to provide insight into the effectiveness, challenges, and potentials for improvement. Therefore, this study aimed to investigate the experiences of medical students and faculty regarding the utilization of the long case as a formative assessment method within the context of a tertiary care teaching hospital in a low-resource setting.

Study design

This was an exploratory qualitative study.

Study setting

The research was conducted at Makerere University within the Department of Internal Medicine. The Bachelor of Medicine and Bachelor of Surgery (MBChB) degree at Makerere University is a five-year program with the first two years for pre-clinical (biomedical Sciences) course and the last three years dedicated to clinical clerkship. Medical students do Internal Medicine clerkships in third- and fifth-year at the two tertiary teaching hospitals namely; Mulago and Kiruddu National Referral Hospitals. The students are introduced to the long case in third-year as Junior Clerks and later in the fifth-year as Senior Clerks. During clerkship, students are assigned to various medical wards, where they interact with patients, take medical history from them, perform physical examinations, and develop diagnosis and management plans. Subsequently, students present their long cases to lecturers or postgraduate students, often in the presence of their peers, followed by feedback and comprehensive case discussions. Students are afforded ample time to prepare and present their cases during ward rounds, at their discretion. The students are formatively assessed and a mark is awarded on a scale of one to ten in the student’s logbook. Each student is required to make a minimum of ten long cases over the seven weeks of clerkship.

Study participants

The study participants were third- and fifth-year medical students who had completed junior and senior clerkship respectively, as well as lecturers who possessed at least five years of experience with the long case. The participants were selected through purposive sampling. The sample size for the study was determined by data saturation.

Data collection

Data were collected through Focus Group Discussions (FGDs) and Key Informant Interviews (KIIs). A total of 36 medical students participated in FGDs, reflecting on their experiences with the long case. Five faculty members participated in individual KIIs. The students were mobilized by their class representative and a brief recruitment presentation was made at the study site while the lecturers were approached via email and telephone invitation.

Six FGDs were conducted, three for junior clerks and three for senior clerks. Each FGD comprised of 5–7 participants with balanced male and female gender representation. Data saturation was achieved by the fifth FGD, at which point no additional new information emerged. A research assistant proficient in qualitative research methods moderated the FGDs. The discussions lasted between 55 min and 1 h 10 min and were audio recorded. The Principal Investigator attended all the FGDs to document interactions and record his perspectives and non-verbal cues of participants.

Semi-structured KIIs were used to collect data from Internal Medicine faculty. Five KIIs were conducted, and data saturation was achieved by the fourth interview, at which point no new theme emerged. The Principal Investigator conducted the KIIs via Zoom. Each interview lasted between 25 and 50 min and all were audio recorded. A research assistant proficient in qualitative methods attended all the Zoom meetings. The data collected were securely stored on a hard drive and Google Drive with password protection to prevent unauthorized access.

Data analysis

Data analysis was done through inductive thematic analysis method. Following each FGD or KII session, the data collection team listened to the recordings to familiarize themselves with the data and develop general ideas regarding the participants’ perspectives. The data were transcribed verbatim by the researchers to generate text data. Two separate transcripts were generated by the Principal Investigator and a research assistant. The transcripts were then compared and manually reviewed by the research team to compare the accuracy with the audio recordings. After transcript harmonization, data cleaning was done for both FGDs and KIIs transcripts.

The transcribed data from both FGDs and KIIs underwent inductive thematic analysis as aggregated data. This involved initial line-by-line coding, followed by focused coding where the relationships between initial codes were explored and similar codes were grouped. Throughout the analysis, the principle of constant comparison was applied, where emerging codes were compared for similarities and differences.

Study results

Socio-demographics.

A total of 36 medical students participated in the FGDs, comprising 18 junior clerks and 19 senior clerks. The participants were aged between 21 and 25 years except two participants who were aged above 25 (30 and 36 years old). Among the third-year students, there were 10 male and 9 female participants while the fifth-year student comprised of 8 male and 10 female participants.

Five lecturers participated in the Key Informant Interviews, three of whom were females and two male participants. They were aged between 40 and 50 years, and all had over 10 years of experience with the long case. The faculty members included one consultant physician, one associate professor, two senior lecturers, and one lecturer.

Themes that emerged

Three themes emerged from the study: ward placement, case presentations, and case assessment and feedback.

Theme 1: Ward placement

The study findings disclosed that medical students are assigned to specific wards for the duration of their clerkship. The specialization of medical wards was found to significantly restrict students’ exposure to limited disease conditions found only in their allocated ward.

With the super-specialization of the units, there is some bias on what they do learn; if a particular group is rotating on the cardiology unit, they will obviously have a bias to learn the history and physical exam related to cardiovascular disease (KII 1).

The students, particularly junior clerks, expressed dissatisfaction with the lack of proper and standardized orientation to the long case on the wards. This deficiency led to wastage of time and a feeling of being unwelcome in the clerkship.

Some orient you when you reach the ward but others you reach and you are supposed to pick up on your own. I expect orientation, then taking data from us, what they expect us to do, and what we expect from them, taking us through the clerkship sessions (FGD 4 Participant 1).

Students’ exposure to cases in other wards poses significant challenges; the study found that as some lecturers facilitate visits to different wards for scheduled teaching sessions, others don’t, resulting in missed learning opportunities. Additionally, some lecturers leave the burden on students’ personal initiative to explore cases in other wards.

We actually encourage them to go through the different specialties because when you are faced with a patient, you will not have to choose which one to see and not to see (KII 4).

Imagine landing on a stroke patient when you have been in the infectious disease ward or getting a patient with renal condition when you have been in the endocrinology ward can create problems (FGD 6 Participant 3).

Theme 2 Case presentation

Medical students present their long case to lecturers and postgraduate students. However, participants revealed variations among lecturers regarding their preferences on how they want students to present their cases. While some prefer to listen to the entire history and examination, others prefer only a summary, and some prefer starting from the diagnosis.

The practice varies depending on the lecturer, as everyone does it their own way. There are some, who listen to your history, examination, and diagnosis, and then they go into basic discussion of the case; others want only a summary. Some lecturers come and tell you to start straight away from your diagnosis, and then they start treating you backward (FGD 6 Participant 3).

The students reported limited observation of their skills due a little emphasis placed by examiners on physical examination techniques, as well as not providing the students with the opportunity to propose treatment plans.

When we are doing these physical examinations on the ward no one is seeing you. You present your physical examination findings, but no one saw how you did it. You may think you are doing the right thing during the ward rotations, but actually your skills are bad (FGD 4 Participant 6).

They don’t give us time to propose management plans. The only time they ask for how you manage a patient is during the summative long case, yet during the ward rotation, they were not giving us the freedom to give our opinion on how we would manage the patient.(FGD 2Participant 6).

Supervision was reportedly dependent on the ward to which the student was allocated. Additionally, the participants believe that the large student-to-lecturer ratio negatively affects the opportunity to present.

My experience was different in years three and five. In year three, we had a specialist every day on the ward, but in year five, we would have a specialist every other day, sometimes even once a week. When I compare year five with year three, I think I was even a better doctor in year three than right now (FGD 1 Participant 1).

Clinical training is like nurturing somebody to behave or conduct themselves in a certain way. Therefore, if the numbers are large, the impacts per person decrease, and the quality decreases (KII 5).

Theme C: Case assessment and feedback

The study found that a student’s long case is assessed both during the case presentation on the ward and through the case write-up, with marks awarded accordingly.

They present to the supervisor and then also write it up, so at a later time you also mark the sheet where they have written up the cases; so they are assessed at presentation and write up (KII 2).

The mark awarded was reportedly a significant motivator for students to visit wards and clerk patients, but students also believe that the pressure to hunt for marks tends to override the goal of the formative assessment.

Your goal there is to learn, but most of us go with the goal of getting signatures; signature-based learning. The learning, you realize probably comes on later if you have the individual morale to go and learn (FGD 1 participant 1).

Feedback is an integral part of any formative assessment. While students receive feedback from lecturers, the participants were concerned about the absence of a formal channel for soliciting feedback from students.

Of course, teachers provide feedback to students because it is a normal part of teaching. However, it is not a common routine to solicit feedback about how teaching has gone. So maybe that is something that needs to be improved so that we know if we have been effective teachers (KII 3).

Whereas the feedback intrigues students to read more to compensate for their knowledge gap, they decried several encounters with demeaning, intimidating, insulting, demotivating, and embarrassing feedback from assessors.

Since we are given a specific target of case presentation we are supposed to make in my training , if I make the ten, I wouldn’t want to present again. Why would I receive other negative comments for nothing? They truly have a personality effect on the student, and students feel low self-esteem (FGD 1, Participant 4).

This study aimed to investigate the experiences of medical students and faculty regarding the use of the long case as a formative assessment method at a tertiary care teaching hospital in a low-resource setting. This qualitative research provides valuable insights into the current practices surrounding the long case as a formative assessment method in such a setting.

The study highlighted the patient bedside as the primary learning environment for medical students. Bedside teaching plays a crucial role in fostering the development of skills such as history-taking and physical examination, as well as modeling professional behaviors and directly observing learners [ 14 , 15 ]. However, the specialization of wards in tertiary hospitals means that students may not be exposed to certain conditions found in other wards. This lack of exposure can lead to issues of case specificity, which has been reported in various literature as a cause of low reliability and generalizability of the long case [ 16 , 17 ]. Participants in the study expressed feeling like pseudo-specialists based on their ward allocations. This is partly attributed to missing scheduled teachings and poor management of opportunities to clerk and present patients on other wards. Addressing these challenges is essential for enhancing the effectiveness of the long case as a formative assessment method in medical education.

Proper orientation at the beginning of a clerkship is crucial for clarifying the structure and organization, defining students’ roles, and providing insights into clinical supervisors’ perspectives [ 18 ]. However, the study revealed that orientation into the long case was unsatisfactory, resulting in time wastage and potentially hindering learning. Effective orientation requires dedicated time and should involve defining expectations and goals, as well as guiding students through the steps of history-taking and physical examination during the initial weeks of the rotation. Contrary to this ideal approach, the medical students reported being taken through systemic examinations when the clerkship was nearing its end, highlighting a significant gap in the orientation process. Proper orientation is very important since previous studies have also documented the positive impact of orientation on student performance [ 19 ]. Therefore, addressing the shortcomings in orientation practices identified in this study is essential for optimizing learning outcomes and ensuring that students are adequately prepared to engage in the long case.

There was reportedly a significant variation in the way students present their long cases, with some lecturers preferring only a case summary, while others expect a complete presentation or begin with a diagnosis. While this diversity in learning styles may expose students to both familiar and unfamiliar approaches, providing a balance of comfort and tension [ 20 ], it’s essential for students to first be exposed to familiar methods before transitioning to less familiar ones to expand their ability to use diverse learning styles. The variation observed in this context may be attributed to time constraints, as lecturers may aim to accommodate the large number of students within the available time. Additionally, a lack of standardized practices could also contribute to this variation. Therefore, there is a pressing need for standardized long-case practices to ensure a consistent experience for students and to meet the desired goals of the assessment. Standardizing the long case practice would not only provide a uniform experience for students but also enhance the reliability, validity, and perception of fairness of the assessment [ 9 , 21 ]. It would ensure that all students are evaluated using the same criteria, reducing potential biases and disparities in grading. Additionally, standardized practices facilitate better alignment with learning objectives and promote more effective feedback mechanisms [ 22 ].

Related to the above, students reported limited observation of skills and little emphasis placed on them to learn physical examination techniques. This finding resonates with the research conducted by Abdalla and Shorbagi in 2018, where many students reported a lack of observation during history-taking and physical examination [ 23 ]. The importance of observation is underscored by the fact that students often avoid conducting physical examinations, as highlighted in Pavlakis & Laurent’s study among postgraduate trainees in 2001 [ 24 ]. This study sheds more light on the critical role of observation in forcing medical students to master clinical assessment and practical skills. The study also uncovered that students are rarely given the opportunity to propose management plans during case presentations, which hampers their confidence and learning of clinical decision-making. These findings likely stem from the large student-to-lecturer ratio and little attention given to these aspects of the long case during the planning of the assessment method. The result is students not receiving the necessary guidance and support to develop their clinical and decision-making skills. Therefore, addressing these issues by putting more emphasis on observation of student-patient interaction, management plan, and having a smaller student group is vital to ensure that medical students receive comprehensive training and are adequately prepared for their future roles as physicians.

The study found that the marks awarded for the long case serve as the primary motivator for students. This finding aligns with previous research indicating that the knowledge that each long case is part of assessment drives students to perform their duties diligently [ 2 , 25 ]. It underscores the crucial role that assessment plays in driving learning processes. However, the pressures to obtain marks and signatures reportedly hinder students’ engagement in learning. This could be attributed to instances where some lecturers relax on supervision or are absent, leaving students to struggle to find someone to assess them. Inadequate supervision by attending physicians has been identified in prior studies as one of the causes of insufficient clinical experience [ 26 ], something that need to be dealt with diligently. While the marks awarded are a motivating factor, it is essential to understand other underlying motivations of medical students to engage in the long case and their impact on the learning process.

Feedback is crucial for the long case to fulfill its role as an assessment for learning. The study participants reported that feedback is provided promptly as students present their cases. This immediate feedback is essential for identifying errors and learning appropriate skills to enhance subsequent performance. However, the feedback process appears to be unilateral, with students receiving feedback from lecturers but lacking a structured mechanism for providing feedback themselves. One reason for the lack of student feedback may be a perceived intimidating approach from lecturers which discourages students from offering their input. It is thus important to establish a conducive environment where students feel comfortable providing feedback without fear of negative repercussions. The study underscores the significance of feedback from students in improving the learning process. This aligns with the findings of Hattie and Timperley (2007), who emphasized that feedback received from learners contributes significantly to improvements in student learning [ 27 ]. Therefore, it is essential to implement strategies to encourage and facilitate bidirectional feedback between students and lecturers in the context of the long case assessment. This could involve creating formal channels for students to provide feedback anonymously or in a structured format, fostering open communication, and addressing any perceived barriers to feedback exchange [ 28 ]. By promoting a culture of feedback reciprocity, educators can enhance the effectiveness of the long case as an assessment tool.

Conclusions

In conclusion, the long case remains a cornerstone of formative assessment during clerkship in many medical schools, particularly in low-resource countries. However, its effectiveness is challenged by limitations such as case specificity in tertiary care hospitals, which can affect the assessment’s reliability and generalizability. The practice of awarding marks in formative assessment serves as a strong motivator for students but also creates tension, especially when there is inadequate contact with lecturers. This can lead to a focus on hunting for marks at the expense of genuine learning. Thus adequate supervision and feedback practices are vital for ensuring the success of the long case as an assessment for learning.

Furthermore, there is a need to foster standardized long case practice to ensure that scheduled learning activities are completed and that all students clerk and present patients with different conditions from various wards. This will promote accountability among both lecturers and students and ensure a consistent and uniform experience with the long case as an assessment for learning, regardless of the ward a student is assigned.

Data availability

The data supporting the study results of this article can be accessed from the Makerere University repository, titled “Perceptions of Medical Students and Lecturers of the Long Case Practices as Formative Assessment in Internal Medicine Clerkship at Makerere University,” available on DSpace. The identifier is http://hdl.handle.net/10570/13032 . Additionally, the raw data are securely stored with the researchers in Google Drive.

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JK contributed to the conception and design of the study, as well as the acquisition, analysis, and interpretation of the data. He also drafted the initial version of the work and approved the submitted version. He agrees to be personally accountable for his contribution and to ensure that any questions related to the accuracy or integrity of any part of the work, even those in which he was not personally involved, are appropriately investigated and resolved, with the resolution documented in the literature.IMG contributed to the analysis and interpretation of the data. He also made major corrections to the first draft of the manuscript and approved the submitted version. He agrees to be personally accountable for his contribution and to ensure that any questions related to the accuracy or integrity of any part of the work, even those in which he was not personally involved, are appropriately investigated and resolved, with the resolution documented in the literature.MA contributed to the analysis and interpretation of the data. He made major corrections to the first draft of the manuscript and approved the submitted version. He agrees to be personally accountable for his contribution and to ensure that any questions related to the accuracy or integrity of any part of the work, even those in which he was not personally involved, are appropriately investigated and resolved, with the resolution documented in the literature.SK made major corrections to the first draft and the final corrections for the submitted version of the work. She agrees to be personally accountable for her contribution and to ensure that any questions related to the accuracy or integrity of any part of the work, even those in which she was not personally involved, are appropriately investigated and resolved, with the resolution documented in the literature.

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Kumakech, J., Munabi, I.G., Mubuuke, A.G. et al. Experiences of medical students and faculty regarding the use of long case as a formative assessment method at a tertiary care teaching hospital in a low resource setting: a qualitative study. BMC Med Educ 24 , 621 (2024). https://doi.org/10.1186/s12909-024-05589-7

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Case Study Analysis as an Effective Teaching Strategy: Perceptions of Undergraduate Nursing Students From a Middle Eastern Country

Vidya seshan.

1 Maternal and Child Health Department, College of Nursing, Sultan Qaboos University, P.O. Box 66 Al-Khoudh, Postal Code 123, Muscat, Oman

Gerald Amandu Matua

2 Fundamentals and Administration Department, College of Nursing, Sultan Qaboos University, P.O. Box 66 Al-Khoudh, Postal Code 123, Muscat, Oman

Divya Raghavan

Judie arulappan, iman al hashmi, erna judith roach, sheeba elizebath sunderraj, emi john prince.

3 Griffith University, Nathan Campus, Queensland 4111

Background: Case study analysis is an active, problem-based, student-centered, teacher-facilitated teaching strategy preferred in undergraduate programs as they help the students in developing critical thinking skills. Objective: It determined the effectiveness of case study analysis as an effective teacher-facilitated strategy in an undergraduate nursing program. Methodology: A descriptive qualitative research design using focus group discussion method guided the study. The sample included undergraduate nursing students enrolled in the Maternal Health Nursing Course during the Academic Years 2017 and 2018. The researcher used a purposive sampling technique and a total of 22 students participated in the study, through five (5) focus groups, with each focus group comprising between four to six nursing students. Results: In total, nine subthemes emerged from the three themes. The themes were “Knowledge development”, “Critical thinking and Problem solving”, and “Communication and Collaboration”. Regarding “Knowledge development”, the students perceived case study analysis method as contributing toward deeper understanding of the course content thereby helping to reduce the gap between theory and practice especially during clinical placement. The “Enhanced critical thinking ability” on the other hand implies that case study analysis increased student's ability to think critically and aroused problem-solving interest in the learners. The “Communication and Collaboration” theme implies that case study analysis allowed students to share their views, opinions, and experiences with others and this enabled them to communicate better with others and to respect other's ideas which further enhanced their team building capacities. Conclusion: This method is effective for imparting professional knowledge and skills in undergraduate nursing education and it results in deeper level of learning and helps in the application of theoretical knowledge into clinical practice. It also broadened students’ perspectives, improved their cooperation capacity and their communication with each other. Finally, it enhanced student's judgment and critical thinking skills which is key for their success.

Introduction/Background

Recently, educators started to advocate for teaching modalities that not only transfer knowledge ( Shirani Bidabadi et al., 2016 ), but also foster critical and higher-order thinking and student-centered learning ( Wang & Farmer, 2008 ; Onweh & Akpan, 2014). Therefore, educators need to utilize proven teaching strategies to produce positive outcomes for learners (Onweh & Akpan, 2014). Informed by this view point, a teaching strategy is considered effective if it results in purposeful learning ( Centra, 1993 ; Sajjad, 2010 ) and allows the teacher to create situations that promote appropriate learning (Braskamp & Ory, 1994) to achieve the desired outcome ( Hodges et al., 2020 ). Since teaching methods impact student learning significantly, educators need to continuously test the effectives of their teaching strategies to ensure desired learning outcomes for their students given today's dynamic learning environments ( Farashahi & Tajeddin, 2018 ).

In this study, the researchers sought to study the effectiveness of case study analysis as an active, problem-based, student-centered, teacher-facilitated strategy in a baccalaureate-nursing program. This choice of teaching method is supported by the fact that nowadays, active teaching-learning is preferred in undergraduate programs because, they not only make students more powerful actors in professional life ( Bean, 2011 ; Yang et al., 2013 ), but they actually help learners to develop critical thinking skills ( Clarke, 2010 ). In fact, students who undergo such teaching approaches usually become more resourceful in integrating theory with practice, especially as they solve their case scenarios ( Chen et al., 2019 ; Farashahi & Tajeddin, 2018 ; Savery, 2019 ).

Review of Literature

As a pedagogical strategy, case studies allow the learner to integrate theory with real-life situations as they devise solutions to the carefully designed scenarios ( Farashahi & Tajeddin, 2018 ; Hermens & Clarke, 2009). Another important known observation is that case-study-based teaching exposes students to different cases, decision contexts and the environment to experience teamwork and interpersonal relations as “they learn by doing” thus benefiting from possibilities that traditional lectures hardly create ( Farashahi & Tajeddin, 2018 ; Garrison & Kanuka, 2004 ).

Another merit associated with case study method of teaching is the fact that students can apply and test their perspectives and knowledge in line with the tenets of Kolb et al.'s (2014) “experiential learning model”. This model advocates for the use of practical experience as the source of one's learning and development. Proponents of case study-based teaching note that unlike passive lectures where student input is limited, case studies allow them to draw from their own experience leading to the development of higher-order thinking and retention of knowledge.

Case scenario-based teaching also encourages learners to engage in reflective practice as they cooperate with others to solve the cases and share views during case scenario analysis and presentation ( MsDade, 1995 ).

This method results in “idea marriage” as learners articulate their views about the case scenario. This “idea marriage” phenomenon occurs through knowledge transfer from one situation to another as learners analyze scenarios, compare notes with each other, and develop multiple perspectives of the case scenario. In fact, recent evidence shows that authentic case-scenarios help learners to acquire problem solving and collaborative capabilities, including the ability to express their own views firmly and respectfully, which is vital for future success in both professional and personal lives ( Eronen et al., 2019 ; Yajima & Takahashi, 2017 ). In recognition of this higher education trend toward student-focused learning, educators are now increasingly expected to incorporate different strategies in their teaching.

This study demonstrated that when well implemented, educators can use active learning strategies like case study analysis to aid critical thinking, problem-solving, and collaborative capabilities in undergraduate students. This study is significant because the findings will help educators in the country and in the region to incorporate active learning strategies such as case study analysis to aid critical thinking, problem-solving, and collaborative capabilities in undergraduate students. Besides, most studies on the case study method in nursing literature mostly employ quantitative methods. The shortage of published research on the case study method in the Arabian Gulf region and the scanty use of qualitative methods further justify why we adopted the focus group method for inquiry.

A descriptive qualitative research design using focus group discussion method guided the study. The authors chose this method because it is not only inexpensive, flexible, stimulating but it is also known to help with information recall and results in rich data ( Matua et al., 2014 ; Streubert & Carpenter, 2011 ). Furthermore, as evidenced in the literature, the focus group discussion method is often used when there is a need to gain an in-depth understanding of poorly understood phenomena as the case in our study. The choice of this method is further supported by the scarcity of published research related to the use of case study analysis as a teaching strategy in the Middle Eastern region, thereby further justifying the need for an exploratory research approach for our study.

As a recommended strategy, the researchers generated data from information-rich purposively selected group of baccalaureate nursing students who had experienced both traditional lectures and cased-based teaching approaches. The focus group interviews allowed the study participants to express their experiences and perspectives in their own words. In addition, the investigators integrated participants’ self-reported experiences with their own observations and this enhanced the study findings ( Morgan & Bottorff, 2010 ; Nyumba et al., 2018 ; Parker & Tritter, 2006 ).

Eligibility Criteria

In order to be eligible to participate in the study, the participants had to:

• be a baccalaureate nursing student in College of Nursing, Sultan Qaboos University
• register for Maternity Nursing Course in 2017 and 2018.
• attend all the Case Study Analysis sessions in the courses before the study.
• show a willingness to participate in the study voluntarily and share their views freely.

The population included the undergraduate nursing students enrolled in the Maternal Health Nursing Course during the Academic Years 2017 and 2018.

The researcher used a purposive sampling technique to choose participants who were capable of actively participating and discussing their views in the focus group interviews. This technique enabled the researchers to select participants who could provide rich information and insights about case study analysis method as an effective teaching strategy. The final study sample included baccalaureate nursing students who agreed to participate in the study by signing a written informed consent. In total, twenty-two (22) students participated in the study, through five focus groups, with each focus group comprising between four and six students. The number of participants was determined by the stage at which data saturation was reached. The point of data saturation is when no new information emerges from additional participants interviewed ( Saunders et al., 2018 ).Focus group interviews were stopped once data saturation was achieved. Qualitative research design with focus group discussion allowed the researchers to generate data from information-rich purposively selected group of baccalaureate nursing students who had experienced both traditional lectures and case-based teaching approaches. The focus group interviews allowed the study participants to express their perspectives in their own words. In addition, the investigators enhanced the study findings by integrating participants’ self-reported experiences with the researchers’ own observations and notes during the study.

The study took place at College of Nursing; Sultan Qaboos University, Oman's premier public university, in Muscat. This is the only setting chosen for the study. The participants are the students who were enrolled in Maternal Health Nursing course during 2017 and 2018. The interviews occurred in the teaching rooms after official class hours. Students who did not participate in the study learnt the course content using the traditional lecture based method.

Ethical Considerations

Permission to conduct the study was granted by the College Research and Ethics Committee (XXXX). Prior to the interviews, each participant was informed about the purpose, benefits as well as the risks associated with participating in the study and clarifications were made by the principal researcher. After completing this ethical requirement, each student who accepted to participate in the study proceeded to sign an informed consent form signifying that their participation in the focus group interview was entirely voluntary and based on free will.

The anonymity of study participants and confidentiality of their data was upheld throughout the focus group interviews and during data analysis. To enhance confidentiality and anonymity of the data, each participant was assigned a unique code number which was used throughout data analysis and reporting phases. To further assure the confidentiality of the research data and anonymity of the participants, all research-related data were kept safe, under lock and key and through digital password protection, with unhindered access only available to the research team.

Research Intervention

In Fall 2017 and Spring 2018 semesters, as a method of teaching Maternal Health Nursing course, all students participated in two group-based case study analysis exercises which were implemented in the 7 th and 13 th weeks. This was done after the students were introduced to the case study method using a sample case study prior to the study. The instructor explained to the students how to solve the sample problem, including how to accomplish the role-specific competencies in the courses through case study analysis. In both weeks, each group consisting of six to seven students was assigned to different case scenarios to analyze and work on, after which they presented their collective solution to the case scenarios to the larger class of 40 students. The case scenarios used in both weeks were peer-reviewed by the researchers prior to the study.

Pilot Study

A group of three students participated as a pilot group for the study. However, the students who participated in the pilot study were not included in the final study as is general the principle with qualitative inquiry because of possible prior exposure “contamination”. The purpose of piloting was to gather data to provide guidance for a substantive study focusing on testing the data collection procedure, the interview process including the sequence and number of questions and probes and recording equipment efficacy. After the pilot phase, the lessons learned from the pilot were incorporated to ensure smooth operations during the actual focus group interview ( Malmqvist et al., 2019 .

Data Collection

The focus group interviews took place after the target population was exposed to case study analysis method in Maternal Health Nursing course during the Fall 2017 and Spring 2018 semesters. Before data collection began, the research team pilot tested the focus group interview guide to ensure that all the guide questions were clear and well understood by study participants.

In total, five (5) focus groups participated in the study, with each group comprising between four and six students. The focus group interviews lasted between 60 and 90 min. In addition to the interview guide questions, participants’ responses to unanswered questions were elicited using prompts to facilitate information flow whenever required. As a best practice, all the interviews were audio-recorded in addition to extensive field notes taken by one of the researchers. The focus group interviews continued until data saturation occurred in all the five (5) focus groups.

Credibility

In this study, participant's descriptions were digitally audio recorded to ensure that no information was lost. In order to ensure that the results are accurate, verbatim transcriptions of the audio recordings were done supported by interview notes. Furthermore, interpretations of the researcher were verified and supported with existing literature with oversight from the research team.

Transferability

The researcher provided a detailed description about the study settings, participants, sampling technique, and the process of data collection and analyses. The researcher used verbatim quotes from various participants to aid the transferability of the results.

Dependability

The researcher ensured that the research process is clearly documented, traceable, and logical to achieve dependability of the research findings. Furthermore, the researcher transparently described the research steps, procedures and process from the start of the research project to the reporting of the findings.

Confirmability

In this study, confirmability of the study findings was achieved through the researcher's efforts to make the findings credible, dependable, and transferable.

Data Analysis

Data were analyzed manually after the lead researcher integrated the verbatim transcriptions with the extensive field notes to form the final data set. Data were analyzed thematically under three thematic areas of a) knowledge development; b) critical thinking and problem solving; and (c) communication and collaboration, which are linked to the study objectives. The researchers used the Six (6) steps approach to conduct a trustworthy thematic analysis: (1) familiarization with the research data, (2) generating initial codes, (3) searching for themes, (4) reviewing the themes, (5) defining and naming themes, (6) writing the report ( Nowell et al., 2017 ).

The analysis process started with each team member individually reading and re-reading the transcripts several times and then identifying meaning units linked to the three thematic areas. The co-authors then discussed in-depth the various meaning units linked to the thematic statements until consensus was reached and final themes emerged based on the study objectives.

A total of 22 undergraduate third-year baccalaureate nursing students who were enrolled in the Maternal Health Nursing Course during the Academic Years 2017 and 2018 participated in the study, through five focus groups, with each group comprising four to six students. Of these, 59% were females and 41% were males. In total, nine subthemes emerged from the three themes. Under knowledge development, emerged the subthemes, “ deepened understanding of content ; “ reduced gap between theory and practice” and “ improved test-taking ability ”. While under Critical thinking and problem solving, emerged the subthemes, “ enhanced critical thinking ability ” and “ heightened curiosity”. The third thematic area of communication and collaboration yielded, “ improved communication ability ”; “ enhanced team-building capacity ”; “ effective collaboration” and “ improved presentation skills ”, details of which are summarized in Table 1 .

Table 1.

Objective Linked Themes and Student Perceptions of Outcome Case Study Analysis.

Theme 1: Knowledge Development

In terms of knowledge development, students expressed delight at the inclusion of case study analysis as a method during their regular theory class. The first subtheme related to knowledge development that supports the adoption of the case study approach is its perceived benefit of ‘ deepened understanding of content ’ by the students as vividly described by this participant:

“ I was able to perform well in the in-course exams as this teaching method enhanced my understanding of the content rather than memorizing ” (FGD#3).

The second subtheme related to knowledge development was informed by participants’ observation that teaching them using case study analysis method ‘ reduced the gap between theory and practice’. This participant's claim stem from the realization that, a case study scenario his group analyzed in the previous week helped him and his colleagues to competently deal with a similar situation during clinical placement the following week, as articulated below:

“ You see when I was caring for mothers in antenatal unit, I could understand the condition better and could plan her care well because me and my group already analyzed a similar situation in class last week which the teacher gave us, this made our work easier in the ward”. (FGD#7).

Another student added that:

“ It was useful as what is taught in the theory class could be applied to the clinical cases.”

This ‘theory-practice’ connection was particularly useful in helping students to better understand how to manage patients with different health conditions. Interestingly, the students reported that they were more likely to link a correct nursing care plan to patients whose conditions were close to the case study scenarios they had already studied in class as herein affirmed:

“ …when in the hospital I felt I could perceive the treatment modality and plan for [a particular] nursing care well when I [had] discussed with my team members and referred the textbook resource while performing case study discussion”. (FGD#17).

In a similar way, another student added:

“…I could relate with the condition I have seen in the clinical area. So this has given me a chance to recall the condition and relate the theory to practice”. (FGD#2) .

The other subtheme closely related to case study scenarios as helping to deepen participant's understanding of the course content, is the notion that this teaching strategy also resulted in ‘ improved test taking-ability’ as this participant's verbatim statement confirms:

“ I could answer the questions related to the cases discussed [much] better during in-course exams. Also [the case scenarios] helped me a great deal to critically think and answer my exam papers” (FGD#11).

Theme 2: Critical Thinking and Problem Solving

In this subtheme, students found the case study analysis as an excellent method to learn disease conditions in the two courses. This perceived success with the case study approach is associated with the method's ability to ‘ enhance students’ critical thinking ability’ as this student declares:

“ This method of teaching increased my ability to think critically as the cases are the situations, where we need to think to solve the situation”. (FGD#5)

This enhanced critical thinking ability attributed to case study scenario analysis was also manifested during patient care where students felt it allowed them to experience a “ flow of patient care” leading to better patient management planning as would typically occur during case scenario analysis. In support of this finding, a participant mentioned that:

“ …I could easily connect the flow of patient care provided and hence was able to plan for [his] management as often required during case study discussion” (FGD#12)

Another subtheme linked with this theme is the “ heightened curiosity” associated with the case scenario discussions. It was clear from the findings that the cases aroused curiosity in the mind of the students. This heightened interest meant that during class discussion, baccalaureate nursing students became active learners, eager to discover the next set of action as herein affirmed:

“… from the beginning of discussion with the group, I was eager to find the answer to questions presented and wanted to learn the best way for patient management” (FGD#14)

Theme 3: Communication and Collaboration

In terms of its impact on student communication, the subtheme revealed that case study analysis resulted in “ improved communication ability” among the nursing students . This enhanced ability of students to exchange ideas with each other may be attributed to the close interaction required to discuss and solve their assigned case scenarios as described by the participant below:

“ as [case study analysis] was done in the way of group discussion, I felt me and my friends communicated more within the group as we discussed our condition. We also learnt from each other, and we became better with time.” (FGD#21).

The next subtheme further augments the notion that case study analysis activities helped to “ enhance team-building capacity” of students as this participant affirmatively narrates:

“ students have the opportunity to meet face to face to share their views, opinion, and their experience, as this build on the way they can communicate with each other and respect each other's opinions and enhance team-building”. (FGD#19).

Another subtheme revealed from the findings show that the small groups in which the case analysis occurs allowed the learners to have deeper and more focused conversations with one another, resulting in “ an effective collaboration between students” as herein declared:

“ We could collaborate effectively as we further went into a deep conversation on the case to solve”. (FGD#16).

Similarly, another student noted that:

“ …discussion of case scenarios helped us to prepare better for clinical postings and simulation lab experience” (FGD#5) .

A fourth subtheme related to communication found that students also identified that case study analysis resulted in “ improved presentation skills”. This is attributed in part to the preparation students have to go through as part of their routine case study discussion activities, which include organizing their presentations and justifying and integrating their ideas. Besides readying themselves for case presentations, the advice, motivation, and encouragement such students receive from their faculty members and colleagues makes them better presenters as confirmed below:

“ …teachers gave us enough time to prepare, hence I was able to present in front of the class regarding the finding from our group.” (FGD#16).

In this study, the researches explored learner's perspectives on how one of the active teaching strategies, case study analysis method impacted their knowledge development, critical thinking, and problem solving as well as communication and collaboration ability.

Knowledge Development

In terms of knowledge development, the nursing students perceived case study analysis as contributing toward: (a) deeper understanding of content, (b) reducing gap between theory and practice, and (c) improving test-taking ability. Deeper learning” implies better grasping and retention of course content. It may also imply a deeper understanding of course content combined with learner's ability to apply that understanding to new problems including grasping core competencies expected in future practice situations (Rickles et al., 2019; Rittle-Johnson et al., 2020 ). Deeper learning therefore occurs due to the disequilibrium created by the case scenario, which is usually different from what the learner already knows ( Hattie, 2017 ). Hence, by “forcing” students to compare and discuss various options in the quest to solve the “imbalance” embedded in case scenarios, students dig deeper in their current understanding of a given content including its application to the broader context ( Manalo, 2019 ). This movement to a deeper level of understanding arises from carefully crafted case scenarios that instructors use to stimulate learning in the desired area (Nottingham, 2017; Rittle-Johnson et al., 2020 ). The present study demonstrated that indeed such carefully crafted case study scenarios did encourage students to engage more deeply with course content. This finding supports the call by educators to adopt case study as an effective strategy.

Another finding that case study analysis method helps in “ reducing the gap between theory and practice ” implies that the method helps students to maintain a proper balance between theory and practice, where they can see how theoretical knowledge has direct practical application in the clinical area. Ajani and Moez (2011) argue that to enable students to link theory and practice effectively, nurse educators should introduce them to different aspects of knowledge and practice as with case study analysis. This dual exposure ensures that students are proficient in theory and clinical skills. This finding further amplifies the call for educators to adequately prepare students to match the demands and realities of modern clinical environments ( Hickey, 2010 ). This expectation can be met by ensuring that student's knowledge and skills that are congruent with hospital requirements ( Factor et al., 2017 ) through adoption of case study analysis method which allows integration of clinical knowledge in classroom discussion on regular basis.

The third finding, related to “improved test taking ability”, implies that case study analysis helped them to perform better in their examination, noting that their experience of going through case scenario analysis helped them to answer similar cases discussed in class much better during examinations. Martinez-Rodrigo et al. (2017) report similar findings in a study conducted among Spanish electrical engineering students who were introduced to problem-based cooperative learning strategies, which is similar to case study analysis method. Analysis of student's results showed that their grades and pass rates increased considerably compared to previous years where traditional lecture-based method was used. Similar results were reported by Bonney (2015) in an even earlier study conducted among biology students in Kings Borough community college students, in New York, United States. When student's performance in examination questions covered by case studies was compared with class-room discussions, and text-book reading, case study analysis approach was significantly more effective compared to traditional methods in aiding students’ performance in their examinations. This finding therefore further demonstrates that case study analysis method indeed improves student's test taking ability.

Critical Thinking and Problem Solving

In terms of critical thinking and problem-solving ability, the use of case study analysis resulted in two subthemes: (a) enhanced critical thinking ability and (b) heightened learner curiosity. The “ enhanced critical thinking ability” implies that case analysis increased student's ability to think critically as they navigated through the case scenarios. This observation agrees with the findings of an earlier questionnaire-based study conducted among 145 undergraduate business administration students at Chittagong University, Bangladesh, that showed 81% of respondents agree that case study analysis develops critical thinking ability and enables students to do better problem analysis ( Muhiuddin & Jahan, 2006 ). This observation agrees with the findings of an earlier study conducted among 145 undergraduate business administration students at Chittagong University, Bangladesh. The study showed that 81% of respondents agreed that case study analysis facilitated the development of critical thinking ability in the learners and enabled the students to perform better with problem analysis ( Muhiuddin & Jahan, 2006 ).

More recently, Suwono et al. (2017) found similar results in a quasi-experimental research conducted at a Malaysian university. The research findings showed that there was a significant difference in biological literacy and critical thinking skills between the students taught using socio-biological case-based learning and those taught using traditional lecture-based learning. The researchers concluded that case-based learning enhanced the biological literacy and critical thinking skills of the students. The current study adds to the existing pedagogical knowledge base that case study methodology can indeed help to deepen learner's critical thinking and problem solving ability.

The second subtheme related to “ heightened learner curiosity” seems to suggest that the case studies aroused problem-solving interest in learners. This observation agrees with two earlier studies by Tiwari et al. (2006) and Flanagan and McCausland (2007) who both reported that most students enjoyed case-based teaching. The authors add that the case study method also improved student's clinical reasoning, diagnostic interpretation of patient information as well as their ability to think logically when presented a challenge in the classroom and in the clinical area. Jackson and Ward (2012) similarly reported that first year engineering undergraduates experienced enhanced student motivation. The findings also revealed that the students venturing self-efficacy increased much like their awareness of the importance of key aspects of the course for their future careers. The authors conclude that the case-based method appears to motivate students to autonomously gather, analyze and present data to solve a given case. The researchers observed enhanced personal and collaborative efforts among the learners, including improved communication ability. Further still, learners were more willing to challenge conventional wisdom, and showed higher “softer” skills after exposure to case analysis based teaching method. These findings like that of the current study indicate that teaching using case based analysis approach indeed motivates students to engage more in their learning, there by resulting in deeper learning.

Communication and Collaboration

Case study analysis is also perceived to result in: (a) improved communication ability; (b) enhanced team -building capacity, (c) effective collaboration ability, and (d) enhanced presentation skills. The “ improved communication ability ” manifested in learners being better able to exchange ideas with peers, communicating their views more clearly and collaborating more effectively with their colleagues to address any challenges that arise. Fini et al. (2018) report comparable results in a study involving engineering students who were subjected to case scenario brainstorming activities about sustainability concepts and their implications in transportation engineering in selected courses. The results show that this intervention significantly improved student's communication skills besides their higher-order cognitive, self-efficacy and teamwork skills. The researchers concluded that involving students in brainstorming activities related to problem identification including their practical implications, is an effective teaching strategy. Similarly, a Korean study by Park and Choi (2018) that sought to analyze the effects of case-based communication training involving 112 sophomore nursing students concluded that case-based training program improved the students’ critical thinking ability and communication competence. This finding seems to support further the use of case based teaching as an effective teaching-learning strategy.

The “ enhanced team-building capacity” arose from the opportunity students had in sharing their views, opinions, and experiences where they learned to communicate with each other and respect each other's ideas which further enhance team building. Fini et al. (2018) similarly noted that increased teamwork levels were seen among their study respondents when the researchers subjected engineering students to case scenario based-brainstorming activities as occurs with case study analysis teaching. Likewise, Lairamore et al. (2013) report similar results in their study that showed that case study analysis method increased team work ability and readiness among students from five health disciplines in a US-based study.

The finding that case study analysis teaching method resulted in “ effective collaboration ability” among students manifested as students entered into deep conversation as they solved the case scenarios. Rezaee and Mosalanejad (2015) assert that such innovative learning strategies result in noticeable educational outcomes, such as greater satisfaction with and enjoyment of the learning process ( Wellmon et al., 2012 ). Further, positive attitudes toward learning and collaboration have been noted leading to deeper learning as students prepare for case discussions ( Rezaee & Mosalanejad, 2015 ). This results show that case study analysis can be utilized by educators to foster professional collaboration among their learners, which is one of the key expectations of new graduates today.

The finding associated with “improved presentation skills” is consistent with the results of a descriptive study in Saudi Arabia that compared case study and traditional lectures in the teaching of physiology course to undergraduate nursing students. The researchers found that case-based teaching improved student’ overall knowledge and performance in the course including facilitating the acquisition of skills compared to traditional lectures ( Majeed, 2014 ). Noblitt et al. (2010) report similar findings in their study that compares traditional presentation approach with the case study method for developing and improving student's oral communication skills. This finding extends our understanding that case study method improves learners’ presentation skills.

The study was limited to level third year nursing students belonging to only one college and the sample size, which might limit the transferability of the study findings to other settings.

Implications for Practice

These study findings add to the existing body of knowledge that places case study based teaching as a tested method that promotes perception learning where students’ senses are engaged as a result of the real-life and authentic clinical scenarios ( Malesela, 2009 ), resulting in deeper learning and achievement of long-lasting knowledge ( Fiscus, 2018 ). The students reported that case scenario discussions broadened their perspectives, improved their cooperation capacity and communication with each other. This teaching method, in turn, offers students an opportunity to enhance their judgment and critical thinking skills by applying theory into practice.

These skills are critically important because nurses need to have the necessary knowledge and skills to plan high quality care for their patients to achieve a speedy recovery. In order to attain this educational goal, nurse educators have to prepare students through different student- centered strategies. The findings of our study appear to show that when appropriately used, case-based teaching results in acquisition of disciplinary knowledge manifested by deepened understanding of course content, as well as reducing the gap between theory and practice and enhancing learner's test-taking-ability. The study also showed that cased based teaching enhanced learner's critical thinking ability and curiosity to seek and acquire a deeper knowledge. Finally, the study results indicate that case study analysis results in improved communication and enhanced team-building capacity, collaborative ability and improved oral communication and presentation skills. The study findings and related evidence from literature show that case study analysis is well- suited approach for imparting knowledge and skills in baccalaureate nursing education.

This study evaluated the usefulness of Case Study Analysis as a teaching strategy. We found that this method of teaching helps encourages deeper learning among students. For instructors, it provides the opportunity to tailor learning experiences for students to undertake in depth study in order to stimulate deeper understanding of the desired content. The researchers conclude that if the cases are carefully selected according to the level of the students, and are written realistically and creatively and the group discussions keep students well engaged, case study analysis method is more effective than other traditional lecture methods in facilitating deeper and transferable learning/skills acquisition in undergraduate courses.

Conflict of Interest: The authors declare no conflict of interest.

ORCID iD: Judie Arulappan https://orcid.org/0000-0003-2788-2755

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A Study on the Impact of Case Study-Based Teaching Pedagogy in Marketing Education: An Analytic Hierarchy Process Approach

• First Online: 11 January 2022

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• Subhajit Bhattacharya 4 &
• Rohit Vishal Kumar 5  

Part of the book series: Palgrave Studies in Democracy, Innovation, and Entrepreneurship for Growth ((DIG))

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Management education can be seen as an integrated learning arena where the students acquire a set of skills consisting of knowledge, information, analytical abilities, decision-making abilities and ethics that help them take complex business decisions in real life. The business schools—engaged in imparting such education are constantly trying new and innovative methods of transferring the bookish knowledge to practical usages for the students. It is believed that proper use of case study can lead to transference of decision-making skills, business foresight, and managerial efficiency to the students of business management. This research, conducted on samples of cases on educators and students taken from 9 premiere business schools in India, uses the Analytical Hierarchical Process (AHP) methodology to understand the importance of case teaching methodology and its importance in transferring the said skills to the students. The findings suggest that there are three main dimensions of case teaching, viz. Decision-making skill, managerial efficiency, and business foresight which are related to sharpening analytical ability, self-efficacy, problem-solving, creativity, attitude building and industry readiness.

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Bhattacharya, S., Kumar, R.V. (2022). A Study on the Impact of Case Study-Based Teaching Pedagogy in Marketing Education: An Analytic Hierarchy Process Approach. In: Rajagopal, Behl, R. (eds) Managing Disruptions in Business. Palgrave Studies in Democracy, Innovation, and Entrepreneurship for Growth. Palgrave Macmillan, Cham. https://doi.org/10.1007/978-3-030-79709-6_13

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