Unstructured Cases in Case-based Learning Benefit Students with Primary Care Career Preferences

doi:10.1016/S0002-9610(98)00076-2

The American Journal of Surgery

Volume 175, Issue 6, June 1998, Pages 503-507

https://doi.org/10.1016/S0002-9610(98)00076-2 Get rights and content

Abstract

Background: The impact of instructional method on students with opposing surgical career orientations was investigated in a prospective study.

Methods: Students were randomly assigned to structured or unstructured case-based discussions. Clinical reasoning (OSCE and a diagnosis exercise), subject knowledge (multiple choice test [MCT]), method preference, and pre-third year career preference were compared.

Results: Twenty-two students listed a surgical career high (Surgical) and 20 low (Primary). Surgical MCT scores were higher than Primary regardless of instructional method. Surgical diagnosis exercise scores were higher than Primary with the structured method (22.0 ± 2.3 versus 15.1 ± 3.0, P <0.08). Unstructured scores on this exercise were similar (19.7 ± 1.8 Surgical versus 20.3 ± 3.5 Primary). Analysis of variance suggested an interaction on the diagnosis exercise between method and career (P = 0.16). Students preferred the unstructured method.

Conclusions: The improved diagnosis exercise performance implies that unstructured cases positively influence surgical domain specific reasoning for nonsurgical career students. These method effects increase our understanding of case-based methods in surgical education.

Section snippets

Methods

This study was completed with informed consent of the participants and Institutional Review Board approval. The study was conducted with the class of 1997. Students were asked to complete a career preference survey that was administered during the week prior to the start of third-year clinical rotations. In the survey, students listed their top three and bottom three medical career choices from a list. On the first day of their surgical clerkship, students were prospectively randomized to

Results

The class of 1997 numbered 94, participants 87. Eight participants did not complete all of the study teaching sessions due to other clerkship duties. Seventy of the remaining 79 students completed the career preference survey. Twenty-two participants listed surgery as a strong preference (top three careers) and 20 indicated that surgery held little or no interest (bottom three careers). First or second career preferences for 19 of the 20 nonsurgery students were in fields commonly identified

Comments

A majority of medical school curriculum is currently centered on case-based or problem-based learning (CBL or PBL). First utilized extensively in the preclinical years, CBL has been adopted into clinical rotations. Despite the quick incorporation of this approach, its risks, benefits, outcomes, and optimal implementation have yet to be completely discerned. Preliminary outcomes were mixed, both for and against CBL.[2]Scores on basic and clinical examinations are sometimes higher and sometimes

References (7)

JP Sutyak et al.
Role of case structure and prior experience in a case-based surgical clerkship
Am J Surg
(1996)
RW Schwartz et al.
Problem-based learningan effective educational method for a surgery clerkship
J Surg Res
(1992)
HS Barrows et al.
Problem-Based Learning
(1980)

There are more references available in the full text version of this article.

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¹: Presented at the 17th Annual Meeting of the Association for Surgical Education, Philadelphia, Pennsylvania, April 10–12, 1997.

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Association for Surgical EducationsUnstructured Cases in Case-based Learning Benefit Students with Primary Care Career Preferences 1

Abstract

Section snippets

Methods

Results

Comments

Am J Surg

J Surg Res

Problem-Based Learning

Association for Surgical Educations
Unstructured Cases in Case-based Learning Benefit Students with Primary Care Career Preferences ¹