Impact of case-based lectures on students' performance in vascular physiology module.

LECTURE-BASED TEACHING (LBT) remains the predominant form of teaching in healthcare profession education (6, 14). It is excellent in providing an overview of a particular topic to a large number of students. However, the concern, which has been highlighted time and again, is the monotony and passive nature of this form of information transmission, which may alienate students away from the learning process (11, 18). It has also been blamed for causing stress and information overload and producing doctors with poor critical thinking and problem-solving skills (8). Case-based teaching (CBT) is a teaching technique that exhibits a teacher-dependent approach to large groups of students (23). In contrast to LBT, CBT is interactive, provides increased motivation for learning by using clinical scenarios, and develops an effective clinical reasoning process (10). We have been fortunate enough at the Department of Physiology, College of Medicine, University of Dammam, a budding institution of the Kingdom of Saudi Arabia (KSA), to introduce a number of innovative teaching techniques emphasizing the interactive form of learning to understand physiological aspects in a better and interesting manner. This is possible only because faculty members have a commitment to development, are willing to step out of their conventional roles and try new approaches, and take risks. One of the techniques was to replace LBT with CBT while retaining large groups of students. The rationale for the use of cases in the lecture was fourfold: 1) to act as a tool to achieve the required knowledge of basic physiological concepts, 2) to provide a scaffold for the organization of facts, 3) to provide exposure to methods of clinical reasoning, and 4) to promote communication skills by fostering active discussion and participation. The majority of studies documenting students’ better performance in CBT (12, 20, 22) have been done in the United States, Europe, and Australia, whose entry level to a medical education program is graduation, in contrast to the KSA, where entry is at the undergraduate level. Hence, their results cannot be applied to the KSA (as students’ maturity may be a factor in the effectiveness of CBT), and it would be a major leap of faith to assume that most medical school entrants in KSA universities will be as mature as medical school entrants in the above-mentioned countries. In the KSA, a recent study (12a) has compared traditional lecturing with problem-based learning (PBL) and shown significant improvement in results. However, due to differences in the PBL technique used in that study (student-centered self-directed learning in small groups facilitated by facilitators with no lectures at all) with those of CBT (teacher-centered lecturing in larger groups with incorporation of clinical cases among the lectures), these results cannot be applied to CBT. Therefore, we designed the present study to compare the performance of students in two curriculums, i.e., “old” (traditional) versus “new” (CBT). It is the need of the hour. Multiplicity in the medical teaching approach is to be embraced, but only if it will produce better doctors than do traditional curriculums by comparing the doctors produced by new and traditional curriculums. However, by that time, any damage caused by a patchy knowledge base, if at all, would have already occurred (3). This compelled us to conclude that the comparison should begin without delay and should follow doctors as they progress through their career.