A guide to using case-based learning in biochemistry education

Enhancing teaching effectiveness in biochemistry labs: Author reflections and improvement strategies

This article details the outcome of a joint reflective approach undertaken by the authors to identify common difficulties experienced by 2nd-year undergraduate Biochemistry students in laboratory classes. Difficulties experienced in laboratories can affect the development of hand skills, an understanding of how to correctly operate laboratory equipment and the linkage between didactic content and their experimental demonstration. These difficulties covered were identified based on their common appearance across multiple cohorts and are grouped into five broad areas. The context of the laboratory exercises is detailed and the common difficulties experienced by students are outlined. The potential causes of these difficulties are then discussed along with the approaches and strategies that were implemented to help resolve future occurrences. The approach and resources developed to address these difficulties may help other Biochemistry educators who are facing similar experiences with their undergraduate students.

Integrated Case-Based Learning Session for Breast and Upper Limb Anatomy

Introduction

Medical students are frequently introduced to medical school curricula through anatomy coursework, which often includes histology and embryology content. As medical education has increasingly emphasized integration of content areas, use of activities such as case-based learning (CBL) sessions has grown. Little published work has demonstrated the effectiveness of CBL sessions in integrating anatomy, embryology, and histology on first-year medical students' ability to improve content mastery and adapt their study techniques.

Methods

We developed a CBL session that included anatomy, embryology, and histology content covering the upper extremity and breast pathology that was taught to incoming first-year medical students (N = 51) during a prematriculation program in the summers of 2022 and 2023. The session involved completion of an individual pre- and postsession quiz; group completion of clinical cases involving image interpretation, matching exercises, and construction of diagrams, flowcharts, or tables; and a postsession survey with Likert-style and free-response questions about preparation and session effectiveness.

Results

Postsession quiz scores significantly improved (p < .001). On the postsession survey (response rate: 59%), students commented that they enjoyed the real-life application and integration of the cases and that the sessions improved their understanding of the connections between content areas. Other comments demonstrated that students were evaluating and adapting their study approach in preparation for the sessions, often using techniques introduced and practiced in the sessions.

Discussion

CBL sessions can provide opportunities to incoming first-year medical students to practice, adapt, and evaluate study techniques while delivering integrated content.

Measuring the Impact of Incorporating Case Study Presentations Into Applied Biomedical Science Placement Workshops for Trainee Biomedical Scientists

Introduction: Successfully completing the Institute of Biomedical Science (IBMS) registration portfolio is essential to becoming a Health and Care Professions Council (HCPC) registered Biomedical Scientist. In the West Midlands, a unique collaboration between four universities (Aston, Wolverhampton, Coventry, and Keele) and local NHS Trusts supports student placements and portfolio development. The universities support Training Officers in delivering components of the registration portfolio through the delivery of eight combined placement workshops. These have been designed to align to the IBMS registration portfolio and help students meet the HCPC Standards of Proficiency. This study aimed to evaluate the effectiveness of a redesigned workshop where students generated and presented medical case studies to peers, academics, and training leads. Materials and Methods: The three phases of the case study intervention included a pre-intervention survey, academic-led sessions focussing on medical case presentations and delivery of the presentation followed by a post-intervention survey. Results: Analysing survey responses pre- and post-intervention, students demonstrated enhanced confidence in their understanding of clinical conditions (p<0.0001), connecting lab findings to diseases, and in delivering a case presentation to their peers (p<0.001). Students reported an increased confidence in structuring case presentations and their critical thinking ability (p<0.0001). All students agreed engaging with the case study workshop improved their ability to communicate knowledge of scientific concepts orally. Thematic analysis revealed that the case presentation deepened students' understanding of multidisciplinary teams. 98% of respondents agreed patient communication should be integrated into Biomedical Sciences courses and 85% would like to see case study presentations embedded into the curriculum. Discussion: Combined placement workshops are an integral part of the Applied Biomedical Science placement journey. Case study presentations are clearly a valuable teaching and learning tool to nurture and develop key transferable skills and competencies in conjunction with Biomedical Science expertise. The collaborative approach in the West Midlands effectively prepares graduates with essential pathology knowledge, skills, and a completed IBMS registration portfolio. This study highlights a successful framework for a collaborative partnership with local NHS trusts that has allowed the completion of numerous pathology placements and could be adopted by other universities delivering accredited Biomedical Science courses.

A cord of four strands: Perspective of pre-medical and medical students on combined teaching modalities in undergraduate biochemistry

Despite being a traditional coursework for pre-medical and medical students around the globe, biochemistry education suffers from a lack of positive appreciation due to the nature of the subject combined with deficiency of teaching modalities. A first semester biochemistry course was designed to include four different teaching modalities: lectures, recitations, case studies, and student presentations. A multi-item, anonymous, and voluntary questionnaire was distributed to students who had just completed the course and to those who had taken it the previous year. The questionnaire asked students to evaluate the course and how the different modalities affected their learning. These questionnaires took place in a two-year period between 2020 and 2021. Eighty-six (46%) of 186 total students responded. The vast majority of respondents agreed with the use of multimodal teaching techniques with respect to its impact on overall preparedness for future coursework, understanding, and enjoyability. Lectures and recitations were found to be the most useful in information retention and learning, although the same were found to be less enjoyable than other modalities. Although case studies and presentations were found to be enjoyable, most students ranked them low in terms of information retention and were the most voted to be removed from the course. There was general agreement between premedical and medical students' perception on the usefulness of the multimodal teaching techniques with respect to medical biochemistry modules and standardized exams. The agreement between cohorts suggests the premedical students accurately evaluated the usefulness of the course for the following year and validates the usefulness of the premedical student surveys. Use of multiple modalities in biochemistry education can be of substantial benefit in engaging and preparing students for further education.

Using student-designed cases to foster creative and critical thinking skills in biochemistry

BACKGROUND

In this novel intervention, we have tried to incorporate case-based learning with creative and critical thinking. Creative thinking indulges students to generate and apply new concepts in specific situations, seeing current situations in a new light, identifying alternative theories, and exploring new links that help generate a positive outcome. This may involve combining various hypotheses to form something original, sifting and refining ideas to discover possibilities, constructing new theories, and acting on intuition.

MATERIALS AND METHODS

This is a quasi-experimental study on educational intervention. First Bachelor of Medicine and Bachelor of Surgery (MBBS) students (N = 80) in their First MBBS students were randomly divided into control (n = 40) and study (n = 40) groups after they had undergone case-based learning in their first semester. The study group was asked to prepare three cases each on type II diabetes mellitus (DM), Fe deficiency anemia, and obstructive jaundice by discussion. Each case was prepared with a) an introduction consisting of presenting complaints, b) body comprising laboratory findings, and c) five questions related to the case. The cases were reviewed by a facilitator and presented to the other groups for discussion. Pretest and posttest questionnaires were collected and analyzed.

RESULTS

Based on the pretest scores, students were grouped as low, average, and high performers. Wilcoxon signed rank test was performed, which revealed significant improvement in the posttest scores of all students in the study group.

CONCLUSION

By designing new case histories themselves, students were able to understand the biochemical concepts of common diseases and apply these concepts in causation of diseases. Thus, case-based learning in this setting helped to foster creative and critical thinking skills of first MBBS students.

Problem-based or lecture-based learning, old topic in the new field: a meta-analysis on the effects of PBL teaching method in Chinese standardized residency training

BACKGROUND

Standardized residency training (SRT) is crucial for graduate medical education and the training of high-quality doctors. Nevertheless, China started SRT nationwide only in the recent decade. During these years, researchers have been searching for suitable teaching methods to improve the abilities of residents. Although the problem-based learning (PBL) teaching mode has been applied in undergraduate teaching for many years, the teaching effect of PBL has not been unified in Chinese SRT according to the core competences of the residents.

METHODS

Studies that compared the teaching effect of PBL and lecture-based learning (LBL) on SRT in China from January 2010 to April 2020 in the Chinese databases, such as China National Knowledge Infrastructure (CNKI), WanFang, WeiPu, Chinese BioMedical Literature (CBM), and English-language online databases, such as PubMed, Embase, and Cochrane Library were systematically reviewed. Data were analyzed using the Stata version 12.0 software.

RESULTS

A total of 75 articles (76 studies) were included in this meta-analysis. Compared with LBL group, PBL-based methods are more effective in the mastery of medical theory knowledge (WMD = 7.14, 95% CI: 5.93-8.34), operational skills (WMD = 6.54, 95% CI: 4.55-8.53), analysis and diagnosis of cases (WMD = 8.52, 95% CI: 7.50-9.53), and overall capacity (WMD = 8.70, 95% CI: 6.87-10.53), but showed no advantage on operational skills in diagnostic imaging (WMD = 1.30, 95% CI: -0.11-2.71). The questionnaire surveys analyzed in this meta-analysis indicated the positive effects of PBL on the mastery of theoretical knowledge, clinical diagnostic thinking, teamwork ability, ability to analyze and solve problems, ability to consult documents, learning interest and learning efficiency, but that there were no advantages in improving self-directed learning ability, communication ability and hands-on ability. The questionnaire result analyzed in this meta-analysis also showed the residents' satisfaction with PBL-based strategies.

CONCLUSIONS

Taken together, the current meta-analysis provides a systematic and comprehensive analysis on PBL teaching mode in Chinese SRT and outlines a path for further research on the detailed design of suitable teaching methods for different specialties and abilities.

A case-based learning approach to online biochemistry labs during COVID-19

With biochemistry forced to transition to remote-teaching online, the cooperative active learning and problem-solving normally in labs have been limited. With little ability to perform experiments with laboratory equipment, determining how to mimic the qualities integral to these labs in an online environment is necessary. We propose one possible solution to provide online labs: short case-based learning activities.

Value of Case-Based Learning within STEM Courses: Is It the Method or Is It the Student?

Undergraduate attrition from science, technology, engineering, and mathematics is well documented and generally intensifies during intermediate years of college. Many contributing factors exist; however, a mismatch between timing of certain pedagogical approaches, such as case-based learning, and the level of students' cognitive abilities plays a crucial role. Using cognitive load theory as a foundation, we examined relationships between case-based learning versus a traditional lecture and learning gains of undergraduates within an intermediate physiology course. We hypothesized instruction via a case study would provide greater learning benefits over a traditional lecture, with gains possibly tempered by student characteristics like academic preparation, as measured by ACT scores, and academic age, as measured by credit hours completed. Results were surprising. Case-based learning did not guarantee improved learning gains compared with a traditional lecture for all equally. Students with lower ACT scores or fewer credit hours completed had lower learning gains with a case study compared with a traditional lecture. As suggested by cognitive load theory, the amount of extraneous load potentially presented by case-based learning might overwhelm the cognitive abilities of inexperienced students.

iCBLS: An interactive case-based learning system for medical education

Medical students should be able to actively apply clinical reasoning skills to further their interpretative, diagnostic, and treatment skills in a non-obtrusive and scalable way. Case-Based Learning (CBL) approach has been receiving attention in medical education as it is a student-centered teaching methodology that exposes students to real-world scenarios that need to be solved using their reasoning skills and existing theoretical knowledge. In this paper, we propose an interactive CBL System, called iCBLS, which supports the development of collaborative clinical reasoning skills for medical students in an online environment. The iCBLS consists of three modules: (i) system administration (SA), (ii) clinical case creation (CCC) with an innovative semi-automatic approach, and (iii) case formulation (CF) through intervention of medical students' and teachers' knowledge. Two evaluations under the umbrella of the context/input/process/product (CIPP) model have been performed with a Glycemia study. The first focused on the system satisfaction, evaluated by 54 students. The latter aimed to evaluate the system effectiveness, simulated by 155 students. The results show a high success rate of 70% for students' interaction, 76.4% for group learning, 72.8% for solo learning, and 74.6% for improved clinical skills.

Digital case-based learning system in school

With the continuing growth of multi-media learning resources, it is important to offer methods helping learners to explore and acquire relevant learning information effectively. As services that organize multi-media learning materials together to support programming learning, the digital case-based learning system is needed. In order to create a case-oriented e-learning system, this paper concentrates on the digital case study of multi-media resources and learning processes with an integrated framework. An integration of multi-media resources, testing and learning strategies recommendation as the learning unit is proposed in the digital case-based learning framework. The learning mechanism of learning guidance, multi-media materials learning and testing feedback is supported in our project. An improved personalized genetic algorithm which incorporates preference information and usage degree into the crossover and mutation process is proposed to assemble the personalized test sheet for each learner. A learning strategies recommendation solution is proposed to recommend learning strategies for learners to help them to learn. The experiments are conducted to prove that the proposed approaches are capable of constructing personalized sheets and the effectiveness of the framework.

Creation and pilot testing of cases for case-based learning: A pedagogical approach for pathology cancer diagnosis

Background

Case-based learning (CBL) is an established pedagogical active learning method used in various disciplines and defined based on the field of study and type of case. The utility of CBL for teaching specific aspects of cancer diagnosis to practising pathologists has not been previously studied in sub-Saharan Africa.

Objectives

We aimed to pilot test standardised cancer cases on a group of practising pathologists in sub-Saharan Africa to evaluate case content, clarity of questions and delivery of content.

Methods

Expert faculty created cases for the four most commonly diagnosed cancers. The format included mini-cases and bullet cases which were all open-ended. The questions dealt with interpretation of clinical information, gross specimen examination, morphologic characteristics of tumours, ancillary testing, reporting and appropriate communication to clinicians.

Results

Cases on breast, cervical, prostate and colorectal cancers were tested on seven practising pathologists. Each case took an average of 45–90 min to complete.

Questions that were particularly challenging to testers were on:

Specimens they should have been but for some reason were not exposed to in routine practice.

Ancillary testing and appropriate tumour staging.

New knowledge gained included tumour grading and assessment of radial margins. Revisions to cases were made based on testers’ feedback, which included rewording of questions to reduce ambiguity and adding of tables to clarify concepts.

Conclusion

Cases were created for CBL in Kenya, but these are applicable elsewhere in Africa and beyond to teach cancer diagnosis. The pilot testing of cases prepared faculty for the actual CBL course and feedback provided by the testers assisted in improving the questions and impact on day-to-day practice.

Course constructions: A case-base of forensic toxicology

Forensic toxicology education in China is limited by insufficient teaching methods and resources, resulting in students with adequate theoretical principles but lacking practice experience. Typical cases used as teaching materials vividly represent intoxication and provide students with an opportunity to practice and hone resolving skills. In 2013, the Department of Forensic Pathology at Zhongshan School of Medicine began to construct top-quality courses in forensic toxicology, with its first step, creating a base containing typical cases of intoxication. This essay reviews the construction process of said cases-base, which is intended to set an example of forensic toxicology education.

Structural biology of tumor necrosis factor demonstrated for undergraduates instruction by computer simulation

This work presents a three-dimensional (3D) modeling exercise for undergraduate students in chemistry and health sciences disciplines, focusing on a protein-group linked to immune system regulation. Specifically, the exercise involves molecular modeling and structural analysis of tumor necrosis factor (TNF) proteins, both wild type and mutant. The structure of the tumor necrosis factor type 1 receptor (TNF-R1) is also briefly explored. TNF and TNF-R1 play major roles in maintaining human immune-system homeostasis. Upon binding with TNFR-1, the TNF can activate the nuclear factor kappa B (NF-κB), eventually resulting in apoptosis or cell death. These essential features of the clinically relevant TNF family is explored within the frame work of a readily adaptable tutorial. © 2015 by The International Union of Biochemistry and Molecular Biology, 44:246-255, 2016.

Evidence-informed strategies for undergraduate nutrition education: a review

This review focuses on evidence-informed strategies to enhance learning in undergraduate nutrition education. Here, we describe the general shift in undergraduate education from a teacher-centered model of teaching to a student-centered model and present approaches that have been proposed to address the challenges associated with this shift. We further discuss case-based, project-based, and community-based learning, patient simulation, and virtual clinical trials as educational strategies to improve students' critical thinking and problem-solving skills; these strategies are well suited to the teaching of undergraduate nutrition. The strategies are defined, and we discuss the potential benefits to students and how they can be applied specifically to the teaching of undergraduate nutrition. Finally, we provide a critical analysis of the limitations associated with these techniques and propose several directions for future research, including research methodologies that may best evaluate teaching strategies in terms of both teaching and learning outcomes. Consideration of these evidence-informed strategies is warranted, given their ability to encourage students to develop relevant skills that will facilitate their transition beyond the university classroom.