SUMMARY


Journal of Rawalpindi Medical College (JRMC); 2017;21(3): 303-305 

 303 

Original Article 
 

Perception of Medical Students Regarding Case Based 
Learning 

Tabassum Naveed 1, Naveed Mazhar Bhatti2 , Romana Malik 3 
 

1.Department of  Medical Education, HITEC Institute of Medical Sciences, ,Taxila;2.Department of Orthodontics, HITEC- 
Institute of Medical Sciences,Taxila Cantt;3 Department of Forensic Medicine & Toxicology,HITEC- Institute of Medical 

Sciences,  Taxila. 

 
 

Abstract 

Background: To determine perception of first year 
medical students about Case Based Learning (CBL) 
in a modular curriculum. 

Methods: In this cross sectional quantitative study 
convenient method of sampling was used to collect 
data from seventy-nine participants on a reliable 
survey tool (Cronbach alpha reliability=.87). Ethical 
approval was obtained and consent for the study was 
taken from study participants. The data was 
analyzed on SPSS version 22. 

Results: The eight questions asked in the survey 
yielded a statistically significant result with 
Friedman’s chi square=85.84 (df=7) p=.000<0.5, for 
perception of students in CBL session. We accepted 
the alternate hypothesis. 

Conclusion: Most of the students agree that CBL is 
useful. It promotes group discussions, interpersonal 
skills, feedback by students and teachers and helps 
them to correlate clinical data. 

Key Words: Case based learning, Interpersonal 
skills, Group discussions, Critical thinking. 

Introduction 
Case based learning (CBL) is a method of learning on a 
continuum of Problem Based Learning. It is assumed 
to promote critical thinking and problem solving. The 
method is traditionally used in clinical years of 
undergraduate teaching and learning. In a traditional 
discipline based curriculum, the students learn the 
subjects of anatomy, physiology and biochemistry in a 
lecture based teaching and are assumed to apply the 
knowledge learned in preclinical years to solve patient 
problems when they enter the clinical years. In a 
discipline based curriculum students are unable to 
understand how the different parts of human body 
function together in normal and diseased state to solve 
a patient’s clinical problem. In contrast, an integrated 
curriculum allows the student to take a holistic view of 
patients and their problem. Literature review showed 
that case based learning in basic science subjects of 

Anatomy, Physiology and Biochemistry promotes 
development of clinical competence in preclinical 
years.  CBL promotes vertical and horizontal 
integration of preclinical with clinical subjects.   Case 
based discussions are primarily used in post graduate 
clinical training where teacher selects a patient record 
and explores it with the learner.   The teacher evaluates 
the application of basic, clinical knowledge and 
decision making on dimensions such as patient 
presentation, investigations and management options.  

 Application of case based learning exposes the 
student to clinical thinking and decision making 
without patient exposure in a safe environment.  It 
provides a venue for students to apply basic science 
knowledge within clinical context.   
Purpose of this study was to determine perception of 
first year MBBS students to learning in case based 
learning sessions in the subjects of anatomy, 
physiology, biochemistry taking into account the 
independent factors of usefulness of CBL, clinical 
cases, correlation of clinical cases with learning 
objectives, group discussions, interpersonal skills, 
feedback by students, feedback by teachers and overall 
impression. We hypothesized that there will be a 
statistically significant difference between the means 
of six levels of the eight within people (subject) factors 
(independent variable) and the perception about CBL 
(dependent variable). 

 

Subjects and Methods 
A cross sectional study was conducted to collect data 
from students regarding case based learning. A 
convenient method of sampling was used.The study 
was conducted at Heavy Industries Taxila Education 
City-Institute of Medical Sciences (HITEC-IMS).The 
institute follows a modular curriculum approved by 
NUMS academic council. Each basic science 
department of first year conducts one CBL in a week. 
Survey form comprised of eight questions on a Likert 
scale (Table 1). Each question was rated as 1=Strongly 
disagree, 2= Disagree, 3= Slightly disagree, 4= slightly 



Journal of Rawalpindi Medical College (JRMC); 2017;21(3): 303-305 

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agree, 5= Strongly agree, 6= strongly agree. These six 
were taken as levels of a within subject factor also 
called the independent variables. The subjects or 
participants were the cases exposed to the six 
independent variables or questions and the same 
dependent variable i.e., perception bout CBL. 
Minimum possible score on the scale was eight, 
maximum was forty-eight. The reliability of the survey 
tool was determined and was found to be good at 0.87. 
Completely filled survey forms with consent were 
received from seventy-nine study participants. A non-
parametric test was done by Friedman chi square. 
Dependent variable perception about CBL was not 
normally distributed violating the assumption for 
using repeated measures ANOVA, histograms of all 
the independent variables or factors which are the 
eight questions of the survey form also showed that 
the data was not normally distributed hence non-
parametric counterpart of repeated measures 
ANOVA, Friedman test was carried out. 

Results 
Maximum mean score 4.38±1.34 (Table 1) was 
obtained on “CBL session promoted development of 
interpersonal skills” for which 34.2% participants 
“agreed” (Table 2). Lowest mean score 3.49±1.48 was 
obtained on, “CBL  session was useful” for which 
30.4% participants agreed(Table 1&2). 

Table 1: Descriptive Statistics for Perception 
about CBL 

Questions about 
perception of CBL 

Mean 
 

Standard 
Error 

Standard 
Deviation 

1.CBL session was 
useful 3.49 .16 1.48 

2.Clinical case given in 
CBL session was useful 

4.46 .13 1.17 

3.I was able to correlate 
clinical data in the case 
with learning objectives 

3.98 .16 1.44 

4.Group discussion 
during CBL session was 
useful 

4.30 .15 1.34 

5.CBL session promoted 
development of 
interpersonal skills 

4.38 .15 1.34 

6.Feedback provided by 
students was useful 3.65 .17 1.48 

7.Feedback provided by 
teacher was useful 4.64 .14 1.24 

8.Your overall 
impression of Cbl 
session 

3.67 .16 1.43 

The mean of eight questions survey was 32.61±7.93 
standard deviation (Table 3).A statistically significant 

result was obtained with Friedman’s chi square=85.84 
(df=7)p=.000<0.5, for perception of students in CBL 
session when asked from seventy-nine participants 
(Table 4).Hence, we accept the alternate hypothesis 
that there is a statistically significant difference 
between the means of six levels of the eight within 
people (subject) factors (independent variable) and the 
perception about CBL (dependent variable). 

Table 2:Student response on Survey 
Response 
(Levels) 

Q1 Q2 Q3 Q4 Q5 Q6 Q7 Q8 

Strongly 
disagree 

15.2 1.3 7.6 6.3 3.8 12.7 3.8 11.4 

Disagree 11.4 6.3 10.1 6.3 8.9 12.7 5.1 12.7 

Slightly 
disagree 

17.7 10.1 12.7 6.3 7.6 11.4 3.8 12.7 

Slightly 
agree 

22.8 27.8 30.4 27.8 25.3 29.1 20.3 29.1 

Agree 30.4 35.4 24.1 38 34.2 27.8 44.3 29.1 

Strongly 
agree 

2.5 19 15.2 15.2 20 6.3 22.8 5.1 

Table 3: Overall Survey Statistics 
Mean Variance Std. Deviation N of Items 

32.61 62.83 7.93 8 

Table 4: Friedman's Test 

 

Sum 
 of 
Squares Df 

Mean 
Square 

Fried
man's 
Chi-
Square Sig 

Between People 612.604 78 7.854   

Within 
People 
(subjects) 

Between 
questions 

103.342a 7 14.763 85.84 .000 

Residual 562.408 546 1.030   

Total 665.750 553 1.204   

Total 1278.35 631 2.026   

Grand Mean = 4.0759 

a. Kendall's coefficient of concordance W = .081. 

 
Discussion 

Students had a positive perception about CBL, 
reflected in above average mean score.   The results of 
the study are statistically significant and show that 
perception of students regarding cased based learning 
is affected by usefulness of the session, usefulness of 
clinical cases, their ability to correlate clinical cases, 
group discussion, interpersonal skills, feedback by 
students, teachers and their overall impression. 
Present  study is supported by a study conducted in 
United States of America where thirty-one medical 
schools reported that CBL was integrated in 75% of 
courses and more than half agreed that it promotes 
critical thinking a necessary condition for clinical 



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decision making and problem solving.  ,  ,   Another 
study proposes that perceived clinical relevance as 
provided by CBL should be used in curriculum as it 
promotes retention of basic science knowledge in 
clinical context and continued throughout the medical 
courses.   ,    A study utilizing thematic analysis of a 
focus group discussion study of CBL learning 
identified the following themes; clinical situation, 
patient data and informing decisions, clinical 
knowledge, multiple ways of thinking, professional 
care and professional self-concept. A study conducted 
in Pakistan regarding perception of medical students 
regarding case based learning and tutorial format 
concluded that Case based method was significantly 
more favored by students compared to traditional 
tutorial format regarding group dynamics and 
behavioral influences of facilitators, learning process 
and environment.  However, another study conducted 
in Pakistan to compare students’ perception of the 
effectiveness of teaching methodologies concluded 
that students in structured interactive sessions applied 
clinical reasoning and group discussion better 
compared to case based learning and interactive 
lectures.  Feedback is an important component of the 
process of CBL. 44.4% students agreed that feedback 
provided by teachers was useful. Studies have shown 
that students received feedback positively when it was 
directed towards learning. Teachers conducting CBL 
were trained in the process of conducting it. They were 
also trained in critical thinking and feedback and this 
may be the reason for the perception of students as is 
also proved by a previous study.   CBL provides early 
clinical exposure and develops relationship between 
basic and clinical sciences resolving an important issue 
of sequencing of basic and clinical subjects. It 
facilitates transition of students to clinical 
environment.21 

Conclusion 
Students have a positive perception about CBL in the 
subjects of anatomy, physiology and biochemistry 
when introduced in a modular curriculum. It provides 
opportunity for good quality group discussions, 
development of interpersonal skills, critical thinking 
and hence the ability to solve clinical cases in a safe 
environment without actual patient exposure. 
 

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