Improving Case-Based Learning with Learning Actions Research

One of the most common challenges we get from partners who are integrating our natural learning actions research into their educational plans is whether the model is applicable (or necessary) in case-based or problem-based initiatives.

Before we explore the answer to this question I thought it is worth the time to reflect on one of the key findings of our research to date – clinician learners need structure to support their lifelong learning. The model of planning, developing, packaging, and delivering content is insufficient to have the impact we intend (and need) our programs to achieve. We are learning that despite the fact that clinicians have spent much of their career engaging in continuing education, they very much still struggle with how to absorb and integrate new information into practice (knowledge translation). By providing structure that supports the natural learning actions we can make learning more effective and more efficient.

Now back to the original challenge, “Is the natural learning actions model applicable (or necessary) in case-based or problem-based lessons?”  With a bit of probing it seems that this question is typically rooted in the belief that case-based learning is in-and-of-itself a sufficient model to support knowledge translation and skills development; that since the design is typically more interactive, it is fully-formed. The reality is that, while data do suggest that case-based learning is often a more effective model, there is no data suggesting that it is absent of the same issues that undermine other modes of teaching (ie. live lecture, print-based education, etc.).

Lets use the schematics below to understand how learning actions research may be applied in a common form of case-based education:

In the typical case model (illustrated to the left above) the clinical scenario presents a series of actionable moments in which the learner is expected to make a decision. Once the clinical choice is made new information is presented within the context of feedback. In this way choices/actions are intertwined with information exchange – and as we learned within the learning actions research: providing a structure for information exchange is critical to supporting lifelong learning. To simplify this (illustrated to the right above) each of the learning moments within a typical case model is a critical moment for the application of the learning actions research. Said another way, each learning moment will be an opportunity for note-taking, reminders being set, searching related context, and if possible, social learning.

Surely the more practical nature of case-based learning is an essential reason why, in many settings, it outperforms other educational models, but that does not (in any way) make it fully-formed. The reality is that each of the actionable moments within a case can be used to enable information exchange and knowledge transfer. Mind you that this is just as true for tumor boards and M&M conferences as it is for case-based lectures or even simulations.

What is the takeaway? There is little value in case-based education that is devoid of actual information exchange, and whenever/however there is new information being exchanged we, as educators, must begin to recognize that we have been missing a clear opportunity to support the natural learning actions described in our natural learning actions research.

But wait, there’s more…the flip side of this is that when the learner is actively engaged in case-based learning, they are even more likely to be nudged using the triggers that we believe are essential to effectively leveraging the learning actions, AND the case-based, interactive model itself makes it far simpler to engineer the appropriate nudges and triggers.

So the answer the original challenge, “Is the natural learning actions model applicable (or necessary) in case-based or problem-based lessons?”  Not only is it applicable, it is every bit as essential and in more ways even easier to apply!