What is Case Based Learning (CBL), Problem Based Learning (PBL), & Scenario Based Learning (SBL)?

What are they, why use them and suggestions on how to implement.

Yesterday was a fairly quiet at the School, so I got a chance to research and write up something on case vs problem vs scenario based learning.  These are my current notes and are likely to feed into a TEL briefing, staff development session, conference or journal article.

Abstract

The School is interested in developing a pedagogy that will fare well with increased student numbers and the expansion into online provision.  There is an implicit assumption that an ‘active learning’ and/or ‘student centred’ pedagogy may be most appropriate.  These approaches often use problem, scenario, or case base learning (PBL, SBL, CBL), and thus this post summarises what we know, why they may be effective, and suggests ‘good practice’ for implementation.

What:

Case Based Learning (CBL), Problem (PBL), & Scenario (SBL) are pedagogies that outline a case, problem, or scenario, and then ask the learners to consider the scenario in the context of learning outcomes to reinforce existing knowledge and perhaps find new information that is relevant. Typically, the approach uses small groups supervised by an expert (in content & teaching) who nudges learners towards the learning outcomes. Barrows (1986) outlines a PBL spectrum with two main variables – the amount of briefing (minimal to comprehensive), and expert input (minimal to ‘directed’), and concludes: ‘The term problem-based learning must be considered a genus for which there are many species and subspecies’ (ibid, 1986:485).  Currently, PBL approaches suggest minimal briefing and guidance, allowing learners to “explore tangents” (Srinivasan, 2007:74) whilst a CBL approach suggests increased guidance, avoiding “tangents” with guided questioning (ibid).

Kirschner, Sweller & Clark, (2006:75, my bolds) identify some PBL approaches:

 “…discovery learning (Anthony, 1973; Bruner, 1961); problem-based learning (PBL; Barrows & Tamblyn, 1980; Schmidt, 1983), inquiry learning (Papert, 1980; Rutherford, 1964), experiential learning (Boud, Keogh,  &  Walker,  1985;  Kolb  &  Fry,  1975),  and constructivist learning (Jonassen, 1991; Steffe & Gale, 1995).”

Scenario based learning is less well defined – a scan of contemporary literature reveals a paucity of description of the technique (Domingos & Lee, 2015; Ozogul, 2018; Khatiban et al, 2018).

Currently, I suggest that many implementations of PBL are more like CBL, and that at the School we tend to mean CBL when we mention these approaches.

Why:

The School favours CBL because it produces a deeper learning experience where a real understanding of the issues and techniques are developed and is preferred by students and staff (Hassoulas et al., 2017; Wilkes & Srinivasan, 2017; Srinivasan, 2007).  The approach and its inherent critique of didactic approaches is perhaps best encapsulated in the phrase:

“Tell Me and I Will Forget; Show Me and I May Remember; Involve Me and I Will Understand”

… often cited as Confucius (450BC).

However, there are tensions when introducing PBL to medical education as it takes significantly longer to cover the same curriculum items vs the traditional didactic method (Wilkes & Srinivasan, 2017).  It is also resource intensive in terms of space and experts’ time (Hassoulas, et al., 2017).  Kirschner, Sweller & Clark (2006) are also critical of a PBL approach, citing Albanese and Mitchell’s (1993) study of PBL vs conventional methods that concludes that “…although PBL students receive better scores for their clinical performance…” (ibid:82), they also find:

• Lower exam scores;
• No differences in residency selections;
• More study hours each day;
• Inefficient use of tests (significantly more tests & less benefit);

How:

For the School, I suggest:

• A social constructivist approach via group work (6-10 members);
• Scenarios should be written, perhaps augmented by audio / video segments;
• Scenarios may develop as a session progresses (e.g., emergency real time role-play);
• An expert supervises the session – perhaps one expert for 6-8 groups;
• Experts listen in and guide learners towards learning outcomes, with guided questioning or more direct intervention to reduce ‘off piste’ exploration.

Face to face:

Problems may arise supervising groups as they may not easily corral themselves to areas convenient for supervision.  Space for these sessions will be significantly more than that required by a traditional ‘lecture’ – ideally a large space with a handful of tables set far enough apart to allow group discussion and close enough to allow expert monitoring and facilitation.

Online:

This may be an easier implementation due to moving from virtual room to room via a click (for synchronous sessions) or being able to monitor all interactions on an asynchronous discussion board.  However, more supervision and guidance will demand more attention from experts.

References 

Barrows, H. S. (1986). A taxonomy of problem-based learning methods. Medical Education, 20, 481–486.

Domingos, E., & Lee, J. (2015). The evolution of scenario-based learning. In Games+ Learning+ Society Conference. Madison, Wisconsin. Retrieved from http://www.academia.edu/download/38390582/The_Evolution_of_Scenario-Based_Learning.docx 

Hassoulas, A., Forty, E., Hoskins, M., Walters, J., & Riley, S. (2017). A case-based medical curriculum for the 21st century: The use of innovative approaches in designing and developing a case on mental health. Medical Teacher. https://doi.org/10.1080/0142159X.2017.1296564 

Khatiban, M., Amini, R., & Farahanchi, A. (n.d.). Lecture-based versus problem- based learning in ethics education among nursing students. https://doi.org/10.1177/0969733018767246 

Kirschner, P. A., Sweller, J., & Clark, R. E. (2006). Why Minimal Guidance During Instruction Does Not Work. Educational Psychologist, 41(March 2015), 87–98. https://doi.org/10.1207/s15326985ep4102 

Ozogul, G. (2018). Best Practices in Engaging Online Learners Through Active and Experiential Learning Strategies. Interdisciplinary Journal of Problem-Based Learning, 12(1). https://doi.org/10.7771/1541-5015.1764 

Srinivasan, M., Wilkes, M., Stevenson, F., Nguyen, T., & Slavin, S. (2007). Comparing problem-based learning with case-based learning: Effects of a major curricular shift at two institutions. Academic Medicine. https://doi.org/10.1097/01.ACM.0000249963.93776.aa 

Wilkes, M. S., & Srinivasan, M. (2017). Problem Based Learning. In J. A. Dent, R. M. Harden, & D. Hunt (Eds.), A practical guide for medical teachers (Fifth, pp. 134–142). Edinburgh: Elsevier Churchill Livingstone. Retrieved from https://liverpool.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=cat00003a&AN=lvp.b5165252&site=eds-live&scope=site

Using web conferencing for presentations

 … and how to avoid students saying 'Less Skype lectures please!'

Often, LSTM staff and visiting lectures are many thousands of miles away. Hence we sometimes use web conferencing to bring those presenters on site - into our teaching rooms.  However, sometimes the most excellent presenter and content will be undermined by poor internet connectivity – resulting in one of our student reps saying: “Less Skype lectures please!”

I found this phrase troubling – I was concerned that an excellent opportunity to hear from those at the top of their field, to pass their knowledge and experience on to our students, was being lost. Unpacking a little, I discovered the issue was poor internet connections being used to web conference a lecture - hence the student comment.

So, I came up with some advice for staff using conferencing technology themselves or using it to bring others into their lectures. A prerequisite is that staff realise that web conferencing systems will struggle over poor internet connections - relevant to LSTM as many of the geographic areas we work in have poor connectivity.  Once understood:

1. For content - ask the presenter to forward (well in advance) learning materials so that the students can do much of the ‘learning’ before the session - perhaps a reading list, annotated notes, or a video of the presenter delivering the ‘content’;
2. Ask the students to prepare two or three questions each, and have these emailed to the presenter so that they can address those questions - though avoid a didactic experience by the back door!?
3. During the webinar (Skype or whatever), encourage interaction - use the tools - generate a dialogue - use the prepared questions as a starting point.
4. Prioritise voice over video - still images may be fine, but video might be too challenging;

 

Plan B

So, what if the web conference software fails? Try some alternatives such as:

•     Zoom
•     Appear.in

… though perhaps you should test one of these before you need to use it!

The current Zoom and Appear.in terms allow free 1-2-1 use - suitable for the above scenario.

And if it really falls apart I’d advise using a discussion board to explore the questions - the board will wait until the network catches up.

Plan A - LSTM’s virtual classroom:

A better alternative to Skype etc might be our dedicated virtual classroom - YouSeeU - but that’s a whole other post. In the meantime, here’s a video that’ll show what YouSeeU looks like: https://youtu.be/6egwpi44R-I

Whatever option you use, or if you want to discuss the alternatives, TEL@lstmed.ac.uk would be pleased to help - so email, call x3747, or just pop in!

Kindest regards to all,
David 

Picture credits: ulrichw on pixabay.com and @D2L.