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Piloting Case-based Instruction in a Didactic Clinical Immunology Course

OBJECTIVES: To assess 1) the effect of case-based instructional modules on student critical thinking, class attendance, and satisfaction and 2) student opinion of case formats. DESIGN/SETTING/PARTICIPANTS: University-based upper division course in clinical immunology and serology. The course was taught by the same instructor for two consecutive semesters with the intervention introduced in the second semester. Sixty-seven students experienced the intervention and 56 students were in the baseline cohort. INTERVENTION: Nine cases were interspersed between lectures during the semester. Each case took one 50-minute class in which students worked in groups of five or six. MAIN OUTCOME MEASURES: Student performance on five critical thinking multiple-choice examination questions and percent student attendance on case days versus lecture days were analyzed using the Mann-Whitney test. Student ratings on course evaluations were analyzed using t-test comparing semesters with and without intervention. Student opinion of cases was obtained through surveys and a focus group. RESULTS: Student performance on critical thinking exam questions was similar in the two groups. Student attendance was significantly higher on case days (95.6%) versus lecture days (80.3%; p <0.0001). Only composite ratings for instructor involvement, student-instructor interaction, and course organization were significantly improved in the semester with cases compared to the semester with lecture only (p <0.0001 for all indices). CONCLUSIONS: Although case studies did not significantly improve student performance on critical thinking questions, they still proved to be a valuable instructional method. Student attendance, student-instructor interaction, and instructor involvement in the course were all positively affected by incorporation of case studies. Discussion of cases also helped to uncover student misconceptions of course material. ABBREVIATIONS: CL = cooperative learning; CLS = clinical laboratory science; Ig = immunoglobulin; PBL = problem-based learning; SIRS = Student Instructional Rating System.