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May 31, 2007

Profs share insights on case-based learning

A move toward active learning methods that engage students has been changing the ambience of today’s college classrooms. In a wide range of classes, students are exposed to more than just a lecture-based method of learning.

Case-based learning is one such active learning method. The practice aims to help students craft their analytical skills by presenting them with real-world situations, or cases, to which they can apply their experience and classroom knowledge.

An added bonus is that students may strengthen their collaboration skills, because most case-based learning is done as a group or team.

“They’re using a kind of skill that we want to see them have,” said Joanne Nicoll, associate director of the Center for Instructional Development and Distance Education (CIDDE), adding that students will need these case-based skills not only as they continue their education, but in the workplace as well.

Nicoll said cases can range from a simple example seeking a “What would you do?” response to complex problem-solving exercises that force students to identify the salient issues and choose from many possible answers. Some even involve role-playing as part of the learning experience.

Common elements of cases include that they outline a real-world scenario, preferably a recent one, and they tell a good story.

“People like stories, whether it’s undergraduate or graduate professional school,” Nicoll said.

Cases also should include dialogue, relate to the student, enable him or her to empathize with the main characters and be generalizable. In addition, they should serve a teaching function and require problem solving, Nicoll said.

Among the advantages to case-based learning: Cases provide real-world context, encourage viewing a situation from multiple perspectives, promote critical thinking, problem solving and analysis, encourage the synthesis of course content and engage students in learning.

While valuable, teaching cases is time consuming, both in terms of finding and adapting a suitable case and in taking classroom time to present it.

Cases can be developed by the professor, by students, or found online and modified to suit the class, Nicoll said.

When planning to teach a case, professors must be sure to clarify their objectives, Nicoll said. “What do you want students to walk away from and learn? What do they already know? The issues that are raised in the case have to be correlated with student learning outcomes,” she said.

In addition, care must be taken in the way the case is introduced, what preparation is expected and how to evaluate students’ participation in the exercise.

Nicoll encouraged faculty to consult with CIDDE instructional designers to help in implementing case-based learning in the classroom, or to observe current classroom procedures to help fine-tune existing presentations.

Using cases as a teaching tool has long been a part of clinical and business education, but case-based learning can be adapted to a wide range of subjects, Nicoll said.

At the recent CIDDE workshop, about half of the three dozen faculty members in attendance indicated they have used case-based learning in their classrooms.

An engineering professor said he used examples from his design work in the corporate world to demonstrate the sequence of problem solving that students will need to use when working on their own projects.

A faculty member from communication science and disorders said she draws examples from the media to engage her students. When Rush Limbaugh was diagnosed with hearing loss, he became a case to follow for one class; another time, the TV series “ER” featured a character who had lost his hearing. She edited video of the show to follow the character’s progress from diagnosis through treatment.

Elizabeth Gettig of the Graduate School of Public Health sometimes has actors perform as patients when teaching genetic counseling students how to deal with difficult emotional as well as informational issues. “The actors actually were the most fascinating part,” she said, noting that some took it upon themselves to go to their own physicians to do background research for their roles. Five counseling students work together, taking turns interviewing a simulator couple. When necessary, she said, the interviewers can request time out to ask for instruction or direction from their peers.

Using professional actors allows for this starting and stopping because they are familiar with performing multiple takes without losing focus or being unable to repeat what has been done before.

“I think it’s been very beneficial to the students,” Gettig said.


In recognition of rising interest in case-based learning, Pitt’s Center for Instructional Development and Distance Education (CIDDE) chose the method as the topic of a recent Summer Instructional Development Institute workshop.

Pitt professors from business, nursing, Germanic languages and literatures, and rehabilitation science and technology shared their ways of using cases in the classroom.

Beverly Harris-Schenz of Germanic languages and literatures uses case-based learning in her Germany Today course to help students understand through role-playing how the reunification of East and West Germany affected various groups of people.

Harris-Schenz said she found the case she uses online and modified it slightly to suit her needs. “It’s not perfect, but it’s pretty close,” she said. “It helps a lot to have a good case to work from,” she advised.

She said the case study makes the issues real to students and allows her to expand on and review classroom content.

The exercise “is probably the part students like best, have the most fun with and learn the most from,” she told colleagues.

Students are divided into teams of six. One group is devoted to social issues, another to security issues. Students are provided with thumbnail sketches of each character plus more in-depth information on the character they are to play. They’re expected to take on the assigned role and play the part in the first person.

The groups must meet to discuss the issues and arrive at a consensus on how to address all the group members’ needs and concerns.

To wrap up the project, the groups present their solutions and recommendations. They also must discuss any areas where issues remain unresolved, and why.

In addition to the group grade, Harris-Schenz gives individual grades on an essay that each student must write from the viewpoint of his or her character.

Harris-Schenz dedicates four class sessions to the project, admittedly a significant amount of time. “I really think it’s worth it,” she said.

She schedules the exercise late in the semester for several reasons. By then, students are familiar with her grading policies and what she expects. And, perhaps more important, she knows her students well, which helps when she assigns roles.

To stretch the students, she assigns them a character as far removed as possible from their own personalities. For instance, one quiet student was given the role of a border guard accused of murder. An aggressive student was given the role of a pastor. “You can’t play a role if it’s the way you are,” she said.

She noted that it’s important to have each team be diverse as well: not all male or all female, not all the most vocal students or the most retiring ones on the same team.

While students spend several class periods discussing the issues, Harris-Schenz moves throughout the room, ensuring that everyone is heard. She said she spends time with the students who are reluctant to act out, taking aside the quiet ones to encourage their participation. “Some students need more help in how to enter the discussion,” she admitted.

Because her classes are large enough to accommodate two sets of groups, students can see the differences in how individuals interpret their roles.

The time spent pays off in positive student feedback, Harris-Schenz said.

“My personal impression is that it works much better than I’d even expected,” she said, noting that she’s been impressed with how involved in the assignment students get and with the quality of their discussions. “They are very thoughtful in their recommendations,” she said, impressed with the creativity students display.

For the students’ part, they overwhelmingly report it was valuable to take on the persona of someone affected by real-life issues brought about by political change. Some also have commented on how the debate enabled them to see consequences of various policies and to think critically.

“I don’t know if there’s anything I’ve done in 30 years of teaching that was 95 percent ‘do it again,’” she said.

Students also have made suggestions for improvement that she’s taken to heart. They asked for expanded character biographies and for a wider variety of characters — more female roles, more young characters and a wider range of ethnic and racial groups. “I have responded,” she said, adding that she plans to work on developing a new character this summer.

“While walking in someone else’s shoes is not reality, it does provide unique insights and really is the next best thing to being there,” Harris-Schenz said.

Nursing professor Paula Sherwood uses case studies in several of her courses, noting that probably 90 percent of nursing classes include them. “Nursing is very easy to use case studies in,” she said.

Sherwood’s classes are made up of adult learners in the RN to BSN program — nurses who are seeking their bachelor’s degree in nursing. “We have people who are very used to being in an academic setting sitting next to people who haven’t been in the classroom for 30 years,” she said, adding that she must be sensitive to the fact that some of her students feel intimidated and vulnerable as they return to an academic setting after many years in the workplace.

Because she’s dealing with adult learners she’s sensitive to how pressed for time they are in coming to class at night after work. Some may spend three to five hours preparing their case report; others might spend up to 10 hours.

Sherwood’s use of case studies in her applied pathophysiology course is simple. She asks students to describe the case of a patient with a condition that was either interesting or complex. One student outlined his grandmother’s macular degeneration as his case study.

“I’m looking for their ability to take information and translate it into clinical practice,” she said.

Her students are graded both on written and oral components, but she’s not looking for anything fancy. Her emphasis is on content rather than presentation style. “This is strictly: Do they get what I want them to get?” she said. “The way I see it, there’s no PowerPoint at the bedside.”

The written cases are limited to three pages. Bullet point format is acceptable. Sherwood posts them all on Blackboard and assigns the students to read them in preparation for class.

Oral presentations must include questions for classroom discussion, and students are responsible for stimulating class participation — even if they have to plant a leadoff question with a friend in the audience to get the ball rolling.

Grades are given in conjunction with a very specific rubric that outlines exactly what Sherwood wants, both in terms of content and presentation.

Sherwood said she sees clear advantages and disadvantages to using case studies. On the plus side, it makes the student the expert. Working with adult students in particular, she said, these nurses are accustomed to being the experts. “They know what they’re doing. They’re respected.”

She said the students become engaged and collegial and get exposed to cases from a wide range of nursing specialties because of the variety of backgrounds represented in the class.

The disadvantage is that the technique is time consuming. She devotes two weeks of a 15-week course to the presentations. “It’s a trade-off of valued class material,” she admitted. However, students are interested in the real world cases that represent what their classmates are doing in the workplace.

Sherwood said she also uses cases in a doctoral-level ethics class. The objective is to look at how ethics theories and decision-making practice apply to nursing practice.

Students in this class are advanced practicing clinicians, she said, explaining that they are assigned to identify an ethical dilemma they’ve been part of and to write a one-page paper that offers a synopsis as well as reactions from different points of view. In addition, during the semester an ethics committee from a local hospital presents a case study, followed by class discussion.

“Case studies engage the class in a way I have not been able to do,” she said.

John Camillus, a professor of strategic management in the Katz Graduate School of Business, said case studies are second nature in his area. “It’s a method I live and breathe and consequently don’t think about it much,” he admitted, noting that he’d studied literally hundreds of cases during his years in business school.

“This is so natural to the big context it’s difficult for me to see what’s good and bad about it,” he said.

Cases can range from very simple to extremely complex. Because management is fraught with the challenges of complexity and uncertainty, cases have particular relevance in “wicked problems” — situations in which the problem is slippery, without precedent, filled with conflicting priorities among stakeholders and containing elements of ambiguity and chaos.

“The discipline of management would be irrelevant if there was no complexity or uncertainty,” Camillus said. “We ultimately try to bring order to chaos.”

Case studies are probably the most appropriate way to study wicked problems, he said, noting that many problems — including Harris-Schenz’s German reunification example — fit the definition of wicked.

In business cases, “Often you don’t know the problem, only that you’re having difficulty,” he said, adding that situations often are filled with ambiguities, but managers have to make decisions and take action. “I’d like a world where you do A then B happens, but that’s not the case,” he said.

Camillus said “in-basket cases” are among the types he uses in class. These illustrate a situation, then, he said, he “throws in a zinger” of a breaking development after discussion progresses, to illustrate what happens in real-world situations where the unexpected is inevitable.

Another technique he uses is tackling the same case twice — once early in the semester, then later, when students have the advantage of more experience and knowledge.

Camillus’s years of experience have familiarized him with difficulties that can arise in using cases.

One risk is that students may not prepare. He manages that by requiring “preliminary position outlines” of 1-3 pages in which students state key issues and possible responses. “It helps them formulate their perspective and provides a basis for discussion,” he said.

Camillus noted also that teachers must be sensitive to cultural differences that might prevent some students from speaking out.

Some students come from cultures that don’t encourage them to question their professors or to think that students’ opinions are important.

Professors may need to take those students aside to encourage them and to say they’ll be watching for them to raise their hand in class, Camillus said.

Michael Pramulka, a professor in the Department of Rehabilitation Science and Technology, uses case studies to prepare graduate students for careers in rehabilitation counseling — where every client is a case. “The human beings who come to see you are a case. They have a story,” he said.

“I try and use my own experiences and background in rehabilitation to make this very real for students,” he said.

In the real world of rehabilitation counseling, his students will need to be prepared to be the main point of contact on a team that can include a number of professionals working together to help a client get the services he or she needs. “We meet people who’ve been through something, figure out what they need, and help them move on,” he said. “They will need to be able to see a human being’s story across disciplines,” he said.

“People have to learn to work in groups. There’s no way around it,” he said, noting that he requires students to do both individual presentations of case studies as well as group-based explorations.

To mirror what will become reality in the professional world, he presents students with very little information that must be assimilated rapidly. “When I give a case study, I give a paragraph. That’s it,” he said. In the professional world, “We get a short story from one direction,” he said. A rehabilitation counselor might be managing 180 cases, making the ability to sort out information quickly and cut to the heart of issues an important skill.

Pramulka said he chooses not to present clear-cut, organized, sequential information in his case studies. When he did, “I felt like I was doing all the work,” he said. Instead, students again learn what the workplace will be like: Often, in speaking with a family member of the patient, information will conflict, for example.

Because “staffings” in which a client’s case, progress and rehabilitation plan are reviewed are a common format in the profession, he assigns students to play different roles in a mock staffing session.

They could find themselves playing the part of a physician who’s integral to the patient’s team, a physical therapist, an occupational therapist, a neurologist new to the case, or a family member who’s never met the care team.

Pramulka said this role-playing forces students to imagine what a physician or a family member might say. During the staffing, Pramulka said he listens in, walking behind the students and whispering in their ears — what to question, how to remain in a professional role.

He also pushes students to address practical issues they’ll face in their work. If there are two physical therapists in the meeting, why is the second one there, and can he or she bill for the time spent in the meeting?

He uses a timer to keep the discussion under control. “Once people start talking about a client, they won’t shut up,” he observed. After 10 minutes elapse, it’s time for questions, he said.

His goal is to get students to anticipate questions early on and become confident in communicating professionally and succinctly to other professionals.

“It doesn’t match the textbook thing, but it matches the real world,” he said.

—Kimberly K. Barlow

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