Will physical classrooms soon be extinct? What is the role of electronic case-based learning in medical education? A review of the literature

Author: Dr. Sara Al-Khafaji

Background

The appearance of the unprecedented Coronavirus Disease 2019 pandemic (COVID-19) (Darras et al., 2021) has  created a sudden and noticeable shift towards the exclusive usage of online learning environment as the main source of medical education (Dost et al., 2020). 

Delivering CBL virtually to medical students is an exciting educational prospect. Although there is a plethora of literature on CBL within medical education, there is a paucity of literature within the contexts of electronic CBL(e-CBL), where the literature seems to be scant and unfocused. Therefore, the aim of this literature review is to evaluate the role and significance of e-CBL within medication education.  This will be used to inform medical schools of the value of using e-CBL to teach 21st century medical students.

Methods

OVID Medline and British Education Index databases were searched with a keyword search strategy (Table 1) which was utilised to limit searches to literature within the topic area. Each key word searched included alternatives to allow for their respective acronyms. Inclusion and exclusion criteria were used as shown below (Table 2).

Results

• Comparison with face-to-face CBL

Interestingly, Cook et al. (2021) found the increase in knowledge did not differ between the in-person and the e-CBL group. This is however, in contrast, to the results by Schlupeck et al. (2021) which suggests that e-CBL can be superior to traditional lectures when it comes to assessing wound care. This is further echoed by the findings of Holland and Pawlikowska (2019)’ study, which found that students prefer e-CBL over face-to-face discussions. However they do surprisingly note that more students(nearly twice) participated in the in-person discussions than completed the e-CBL, making such conclusions contradictory and questioning the overall superiority of an online environment as compared to a traditional face-to face- one.

Overall, there is still considerable uncertainty with how e-CBL compares to an- in person approach due to the lack of literature that discusses this. The majority of the papers which evaluate e-CBL also fail to attempt to directly compare it with a face-to face teaching.

• Improving test scores

Recently published papers Elsayes et al. (2021),  Cook et. al (2021) and Grover et. al (2020), assessed the effectiveness of delivering e-CBL to medical students using ‘’pre-session’’ and ‘’post-session’’ multiple-choice questions (MCQ) to evaluate for an increase in students’ knowledge. All three papers gathered data in a similar method (MCQs) and found a marked improvement of the test scores of medical students after delivering e-CBL sessions.

• Beyond MCQ scores

As the COVID-19 pandemic required the medical education systems to advance into a new era of digital learning over a short period of time (Fatani, 2020), unsurprisingly, most of the literature that evaluate the effectiveness of e-CBL is based on short studies and short trial modules. Below are some of the key studies and their findings.

 

Conclusions and moving forward

Overall, the delivery of e-CBL to medical students has generally shown to be effective way of facilitating learning, improving learning outcomes and increasing knowledge of medical students across different specialties. There is also a satisfactory agreement between papers that students find e-CBL to be an enjoyable and flexible way of learning, which is encouraging in emergency situations such as the COVID-19 pandemic that took place, where e-learning may be the only option.  Other key themes discussed in the literature review centred on the advantages and disadvantages of e-CBL and how it compares with other types of learning.

Further research is however necessary to assess the long-term benefits of using e-CBL looking to assess whether the increased knowledge retains over time. Additionally, the findings regarding the superiority of e-CBL when compared directly to other types of teaching, such as face-to-face teaching still remains unclear and require further experimental research.

Dr. Al-Khafaji

MBBS (Hons)

Post graduate Medical Education student (UCL)

Link to the paper’s poster

poster for conference

 

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