The Case for Case Studies

Active learning.  That’s all the rage in education circles there days.  The idea that a student learns best by being involved in his or her own learning.  Don’t get me wrong – I know it’s a not a new concept.  Confucius himself is credited with the quote:

“I hear and I forget, I see and I remember, I do and I understand”

Clearly this idea has been around for some time.  I just can’t recall that being part of my own education – so I’m guessing that at some point in the 90s, someone forgot about it and didn’t include it as part of their classroom pedagogy…

Students working on a case study

… But active learning is making a comeback, despite pushback from some of the “old guard” professors.  I once showed up to a job interview where the job ad specifically said “seeking an active education specialist”.  Now, when an instructor applies for a job there are typically two components: a sample class and an interview.  I prepared a classroom with many learning activities, student interactions, problem solving.  It’s always a little unnerving to prepare these because your audience is typically not students but other faculty (so the interactions are *much* different).  I was rather proud of myself – at the breadth of active learning activities I had prepared – until I actually sat down for the interview.  I was asked, point blank, why I didn’t choose to lecture for my sample class.  “Dahhhh – Really?  You’re serious?  Remember your job ad?  It said “active learning”, which by definition means “don’t lecture”!”  Ok, so apparently, some people are still only paying lip service to this one without actually knowing what it means.

I wasn’t always a lover of all things active learning.  In fact, if you had asked me about 10 years ago, I would have told you that my own education, which included zero active learning, was just fine.  It clearly worked as a pedagogical tool – here I was with a degree certifying that I was one of the best graduates in my field.  Clearly I had learned…. Something…  Didn’t I?

Then, I undertook some studies in adult education…  For the first time in my life, I was asked to guide my education, to problem solve, to reflect on the value of what I was learning for my own practice.  The instructors who taught this diploma program did not only promote the value of active learning: they practiced it!  And I became a convert… Sure, the instructors could have spent all their time telling me how great active learning is – but instead, they asked me to reflect on its value.  In the end, that was the critical element that made me see its value.  I had to discover it for myself.

I won’t lie to you – active learning activities are difficult to design.  Lecturing is so much easier.  So much safer.  Comforting in it’s acceptance in the academic world.  (oh ya, and I admit that I love to lecture, too! ).  But if you seek it, it will come.  Pretty soon, I was teaching in Problem-Based Learning format.  This is the pedagogy pioneered by our own Canadian university McMaster, and it is rapidly taking over medical schools all over North America.  In this model, students aren’t told about anatomy, physiology, biochemistry – they are presented with a case study.  This is a story of a patient who comes to see them, presenting certain symptoms.  At this point, the students are naïve.  They don’t have any information to make a diagnostic.  However, they do have a brain, and they are about to use it.  Working in small groups, they determine what knowledge they would need to know in order to be able to address the patient’s complaints.  They go research it, pull their heads together, research more if that’s needed, and then solve the case.  You might argue that this is a slow process and that you cannot cover as many medical conditions in this fashion as if you were lecturing, and I would have to agree with you.  However, what you do have is a student (and eventually a clinician) who knows how to research a diagnostic.  Personally, I would rather have a doctor who thinks through every case rather than one who dispenses answers from his school days 50 years ago.  And besides, isn’t it plausible that doctors are sometimes presented with conditions they have never encountered before?  Wouldn’t you rather have a doctor who knows how to look up what bizarre and rare ailment is afflicting you (and how to treat it) than one who shrugs and says “sorry – never seen that before… Take two aspirins and call me in the morning”? Active learning encourages life long learning, because there is an emphasis on learning how to learn.

I just finished designing and teaching a molecular biology course, taught entirely on the case discussion method that I learned about at the Case Study in Science Workshop at the University at Buffalo, State University of New York (SUNY) last summer.  It was SCARY to show up to class on the first day with only a few case studies in hand.  What if the cases didn’t cover the materials appropriately?  What if the students hated it?  What if I couldn’t lead a discussion for 3 hrs every day (double yikes)?  To my amazement and delight, this turned out to be the best course I have ever taught.  Ok, Ok, I’ll give credit to my students, who were amazing.  But what really rattled me, on the very first day of class, is that I saw students THINK through a problem.  In biology, which is my field of expertise, this is a rather rare event.  Biology is typically taught as a collection of facts.  However, the cases present students with some problem or some fact and ask: “what’s the next step?  What would you do to investigate this?  Design an experiment.  What do you expect to find at the end?”  They devise their answers in small groups and then present their answers to the class.  I provide feedback on their thought process. 

Isn’t that kind of exercise exactly what biologists do?  I mean, here I am with a PhD in biochemistry, and each time I have to do something with the Kreb Cycle (my archnemesis – it taxes my memory), I look it up in a text book.  So I don’t really care that students know it by heart – I don’t claim to myself.  But what I would like to provide guidance on, which is something they cannot get from reading a book, is the thought process used in solving biological problems and designing experiments.  This course was extremely rewarding because at the end of every day, I felt that the students’ minds had grown a bit.  I hadn’t stuffed their brain with facts – although some facts are bound to have made their way in there – rather, I helped them develop their thinking skills and look at the world like a biologist. 

And that, to me, makes the case for using case studies in the classroom.

Annie