The effectiveness of case-based learning in health professional education. A BEME systematic review: BEME Guide No. 23

Figures & data

Table 1  Results from databases

Database	Total abstracts	Excluded	Duplicates	Full papers	Excluded full	Coded
Medline	173	94		79	30	49
CINAHL	53	37	2	14	4	10
EMBASE	71	47	7	17	6	11
Education research	115	92	4	19	6	13
ASSIA	13	6	6	1	0	1
WoK	374	291	35	48	26	22

Table 2  Coding based on first review

Kirkpatrick level	1 student reaction	86
	2a change in attitude	9
	2b change in knowledge	41
	3 change in behaviour	0
	4 organisational change	0
Strength of findings	1	29
	2	40
	3	22
	4	13
	5	0
Overall impression	Poor	53
	Acceptable	38
	Good	13
	Excellent	0

Table 3  Double coding (n = 34)

Coding	Reviewer 1	Reviewer 2
Excellent + 4		1
Good + 4	13	8
Acceptable + 4		2
Poor + 4		1
Good + 3		3
Acceptable + 3	19	9
Poor + 3	2	1
Good + 2		1
Acceptable + 2		5
Poor + 2		0
Acceptable + 1		1
Poor + 1		2
Total significant papers	34	23

Table 4  Geographical location

Location	Number in full sample (n = 104)	Number in significant sample (n = 23)
UK	5	0
Other Europe	19	6
Asia	9	0
North America	54	14
South America	1	0
Africa	2	0
Australasia	14	3

Table 5  Year of publication

Year	Number in full sample (n = 104)	Number in significant sample (n = 23)
2010	6	2
2009	9	1
2008	12	2
2007	15	5
2006	14	4
2005	9	5
2004	6	1
2003	1	0
2002	10	1
2001	2	1
2000	3	0
1990–1999	14	1
Pre-1990	3	0

Table 6  Professions of students

Student profession	Number in full sample (n = 104)	Number in significant sample (n = 23)
Chiropractic	1	0
Dentistry	5	1
Medicine	68	15
Nursing	9	2
Paramedic	2	0
Pharmacy	2	0
Psychology	3	1
Social science	1	1
Speech pathology	1	0
Veterinary	5	3
Mixed	7	0

Table 7  Number of students in studies

Total number	Number in full sample (n = 104)	Number in significant sample (n = 23)
Fewer than 50	22	2
51–100	13	4
101–200	32	9
Over than 200	21	7
Not given	16	1 (but 4 years data)

Note: The smallest study had six students and the largest over a 1000 (exact number not given).

Table 8  Number of students learning together on cases per group

Number in group	Number in full sample (n = 104)	Number in significant sample (n = 23)
Working alone	13	4
2–15	41	7
16–30	5	2
More than 30	9 (usually whole year group)	2
Not given	36	8

Figure 1. Student learning in CBL on an inquiry-based continuum (adapted from Entwistle 2009 and Banchi & Bell 2008).

Table

No.	Database	Search term	Hits
1	CINAHL	((case-based)).ti [Limit to: (Age Groups All Adult) and (Language English)]	460
2	CINAHL	((case stud*)).ti [Limit to: (Age Groups All Adult) and (Language English)]	5229
3	CINAHL	((case method*)).ti [Limit to: (Age Groups All Adult) and (Language English)]	68
4	CINAHL	1 OR 2 OR 3 [Limit to: (Age Groups All Adult) and (Language English) and (Age Groups All Adult) and (Language English) and (Age Groups All Adult) and (Language English)]	5473
5	CINAHL	((Learning OR teaching OR instruction*)).ti,ab	61,223
6	CINAHL	4 AND 5 [Limit to: (Age Groups All Adult) and (Language English) and (Age Groups All Adult) and (Language English) and (Age Groups All Adult) and (Language English)]	169
7	CINAHL	((Collaborative learning)).ti,ab	896
8	CINAHL	((self directed learning)).ti,ab	742
9	CINAHL	((active learning)).ti,ab	1011
10	CINAHL	7 OR 8 OR 9	2558
11	CINAHL	((case-based)).ab	10618
12	CINAHL	10 AND 11	99
13	CINAHL	(((case study) OR (case studies))).ab	31453
14	CINAHL	10 AND 13	163
15	CINAHL	((case method*)).ab	18006
16	CINAHL	10 AND 15	100
17	CINAHL	12 OR 14 OR 16	209
18	CINAHL	6 OR 17 [Limit to: (Age Groups All Adult) and (Language English) and (Age Groups All Adult) and (Language English) and (Age Groups All Adult) and (Language English)]	206
19	CINAHL	exp EDUCATION, HEALTH SCIENCES/	139577
20	CINAHL	18 AND 19 [Limit to: (Age Groups All Adult) and (Language English) and (Age Groups All Adult) and (Language English) and (Age Groups All Adult) and (Language English)]	53

Figure 2. Flow diagram of literature search and paper selection.

Table

Authors	Year	Journal	Location	Students	No	CBL type	Topic	Group size	LO's	Design	Groups	Outcomes	Level 1	Level 2a	Level 2b	Qualitysignif
Anderson & Helberg	2009	S Dakota J	N Am	Medical	45	2 × 1.5 hours	SOAP notes	3–4	Y	Pre/post	S	Valuable	x	x
Bair	1980	J Community Health	N Am	Medical	159	1/12 + 4 meetings	Comm med	4–10	Y	Post	S	Fostered confidence			x
Baumberger-Henry	2005	Nurs Educ Today	N Am	Nurse		1 case	Nursing	3–4		Pre/post	M	No difference		x
Beech & Domer	2002	J Cancer Educ	N Am	Medical	28	90 mins case	Physiol	8–10		Pre/post	S	Inc knowledge			x
Bernheimer et al.	1982	J Med Educ	N Am	Medical		20 problems	Fam med			Post	S	Enjoyed	x
Bezuidenhout et al.	2006	J Clin Pathol	Africa	Medical	142	1 week	Clin path	5	Y	Post	S	Enjoyed	x
Blewett & Kisamore	2009	BMC Med Educ	N Am	Medical/osteopath	390	2 hours	Microbiol	8	Y	Pre/post	S	Better interactive	x		x
Boeker et al.		AMIA Annu Symp Proc	Eur	Medical	31	Computer-based	Neuro-oncology			Post	S	No difference	x		x
Bowe et al.	2009	Med Teach	N Am	Medical	135	1 case	Organ systems		Y	Post	S	Interaction contributed	x
Braeckman et al.	2009	J Occup Environ Med	Eur	Medical	338		Occ health		Y	Post	S	As good as workplace visits	x		x
Canham et al.	2008	Med Teach	Eur	Medical	242	2-hour workshop	Pathophysiol	120		Post	MY	Satisfied, stimulating	x
Carrero et al.	2009	Med Teach	Eur	Medical	68	1-hour workshop	BLS	34		Pre/post	M	No difference			x
Chan et al.	2008	Ann Acad Med Singapore	Asia	Medical	137	5 months	Cross curric			Post	MY	Aids integration	x
Chew et al.	2005	Acad Radiol	N Am	Medical	141	5 cases in 1/52	Radiology	3–4	Y	Post	S	Worthwhile	x			*
Choi et al.	2009	Br J Educ Technol	Asia	Dental	70	9 modules	Anaesth	1 (e)		Inter/post	S	Not affected by learning styles	x		x
Cliff	2006	Adv Physiol Educ	N Am	Nurse	42	1 case	Resp physiol	3–5	Y	Pre/post	S	Reduced misconceptions			x	*
Critchley et al.	2009	Anaesth Intensive Care	Asia	Medical	149	6 cases	Anaesth	8–10	Y	Post	S	Well received	x
Curran et al.	2008	Med Teach	N Am	N/P/SW		6 modules	IPL care plans			Post	S	Satisfied	x
Damjanov et al.	2005	Croat Med J	N Am	Medical	846	2nd yr pathology	Pathology	20		Post	M	Change in pathology score	x		x	*
Dayal et al.	2008	J Nutr Educ Behav	N Am	Medical	268	2 hour workshop	Ob/Gyn	25	Y	Pre/post	S	Self report increased knowledge	x
DeMarco et al.	2002	J Nurs Educ	N Am	Nurse	7	10 × 1 hours	Nursing	1		Post	S	Motivated, gained confidence	x
DeSanto-Madeya	2007	Nurs Sci Q	N Am	Nurse		Weekly case	Med/surg			Post	S	Benefited	x
Dietrich et al.	2010	J Padiat Adolesc Gynecol	N Am	Medical	6	20 cases	Paed adol gynae	1 (e)		Pre/post	S	Improved test score			x
Drakeford et al.	2007	J Paediatr Child Health	Aust	Medical	40	2 × 1.5 hrs	Asthma		Y	Pre/post	S	Enhances skills	x		x
Dupuis	2008	Am J Pharm Educ	N Am	Pharmacy	252	1 semester	Clin pharm	4–5		Post	MH	Increased knowledge	x		x
Engel & Hendricson	1994	J Dent Educ	N Am	Dental	93	6 × 1 hr	Orthodontics	10–11	Y	Post	S	Positive	x		x
Ferguson	2006	Med Educ	N Am	Medical		3 cases	Clin practice			Post	S	Assessed by essay	x
Friedl et al.	2006	Ann Thorac Surg	Eur	Medical	69	1 module	Cardiac surgery	1	Y	Pre/post	M	Variable			x	*
Garvey et al.	2000	Eur J Dent Educ	UK	Dental	76	3 hours weekly	Dentistry	7–8	Y	Post	S	Positive	x
Gemmell	2007	Clin Chiropr	UK	Chiro	100		Major pain			Post	M	No difference			x
Grauer et al.	2008	J Vet Med Educ	N Am	Vet	110	14 hours	Small animal urology	Large		Post	S	No difference in exams	x		x	*
Hakkarainen et al.	2007	Australas J Educ Technol	Eur	Soc	33	videos	Networks	3–5 online		Post	S	Variable	x			*
Hansen & Krackov	1994	Clin Anat	N Am	Medical	295	12 × 1.5 hrs	Anatomy	12–13	Y	Post	MY	Positive	x
Hansen et al.	2005	Am J Obstet Gynecol	N Am	Medical	183		Obs gynae	3–5		Post	S	Enjoyed more, links theory	x			*
Hege et al.	2007	Med Teach	Eur	Medical/law		Online	Internal med			Post	M	Students accepted	x
Henning et al.	2006	Nurse Educ	N Am	Nurse	13	6 × 2 hrs	Complex needs	3		Inter/post	M	Used discourse analysis
Hilgenberg & Schlickau	2002	J Transcult Nurs	N Am	Nurse		online	Cultural comp	2	Y	Post	S	Learn from content	x
Hoag et al.	2005	Clin Lab Sci	N Am	Med	123	9 × 50 minutes	Clin immunol			Post	S	No change in critical thinking	x		x	*
Hofsten et al.	2010	Nurse Educ Today	Eur	Nurse	69	5 weeks	Disease			Post	S	Learnt through discussion				*
Hong et al.	1998	Med Teach	Asia	Pharm	55	4 cases	Pharm			Post	S	Positive	x
Horsch et al.	1999	Med Inf Eur	Eur	Medical	32	2 × 4 hrs	Med imaging			Post	S	Liked	x
Horsch et al.	2000	Int J Med Inform	Eur	Medical	75	Online	Radiology			Post	S	Mixed	x
Howard et al.	2010	Comput Inform Nurs	N Am	Nurse	49	2 hours	Acute coronary syn			Pre/post	M	HPS better	x		x
Hudson & Buckley	2004	Adv Physiol Educ	Aust	Medical	254	Whole year	Physiol	Large	Y	Post	MY	Valued as non-threatening	x
Irby	1994	Acad Med	N Am	Medical	6	3 teaching rounds	Internal med	2 + 2 interns		Post	M	Interactivity good	x
Jamkar et al.	2006	Med Educ	Asia	Medical		8 sessions	Surgery	8–10		Post	M	Scored better		x	x
Katsikitis et al.	2002	Educ Psychol	Aust	Medical	64	1.5 hrs	Psych	3–4 10–12		Post	M	No difference with PBL			x	*
Kaufert et al.	2010	Med Health Care Philos	N Am	Medical			Ethics			Post	S	Adds important perspective	x	x
Koh et al.	1995	Occ Med	Asia	Medical	105	2 hrs	Occup med	20	Y	Post	S	Enjoyed	x
Kolb et al.	2007	Int Arch Occup Environ Health	Eur	Medical	212		Occup med			Post	M	Variable	x
Koles et al.	2005	Med Educ	N Am	Medical	80	19 hrs	Pathology	15–20 5–6		Inter/post	M	No difference CBL and TBL	x		x	*
Kopp et al.	2008	Med Educ	Eur	Medical	153	1 session	Clin reasoning			Pre/post	M	Working through errors helps			x	*
Krockenberger et al.	2007	J Vet Med Educ	Aust	Vet		online	Pathology			Post	MY	Satisfied	x			*
Kumagai et al.	2010	Med Educ	N Am	Medical	170	1 online case	Multicultural	1?		Post	S	Helpful	x
Lechner et al.	2001	Br Dent J	Aust	Dental	32	1 session CDROM	Orthodontics		Y	Post	S	Positive	x
Leonard et al.	2002	Teach Psychol	N Am	Psychol			Intro psychol		Y	Post	S	Helpful	x
Lindqvist et al.	2005	J Interprof Care	UK	Mixed	46	× 1/wk for 7 wks	Interprof learning	5	Y	Pre/post	M	Feasible, change in attitude	x	x
Loving & Siow	2005	J Nurs Educ	N Am	Nurse			Pharmacol		Y	Post	S	Helpful	x
Lyon et al.	1991	J Med Syst	N Am	Medical	328	Online	Haem/cardiology			Pre/post	M	No difference	x		x	*
Maleck et al.	2001	Radiographics	Eur	Medical	225	Online	Radiology			Post	M	No difference			x	*
Massonetto et al.	2004	BMC Med Educ	S Am	Medical	113	120 hours	Obs/gynae	10		Post	S	Positive	x
Mayo	2002	J Constr Psychol	N Am	Psychol	136	2/52 course	Intro psychol	5–7		Post	M	Positive, better results	x		x
Mayo	2004	J Constr Psychol	N Am	Psychol	122	Case series	Psychol adjust	1?		Post	M	Positive, better results	x		x	*
McBride & Prayson	2008	Anat Sci Educ	N Am	Medical	32	33 hrs	Histol/microanat	4–32	Y	Post	MH	Above average USMLE	x		x
Morrow et al.	2010	Fam Med	N Am	Medical	210	3 cases over 4/52	Fam med	1		Post	M	No change in knowledge	x		x	*
Novak	1971	J Med Educ	N Am	Medical			Pathology	Whole class		Post	S	Well accepted	x
Owen et al.	2007	Med Educ	Aust	Medical		Last 2 yrs	Clinical			Post	S	Appreciated	x
Patterson	2006	J Vet Med Educ	N Am	Vet	365	15 wks of 2 × 2 hrs	Vet sci reasoning	8–9	Y	Pre/post	MY	Increased confidence & reasoning	x		x
Peplow	1990	Med Educ	Aust	Medical	159	3 × 1 hr	Anatomy	10		Post	S	Satisfied	x
Peplow	1992	Med Educ	Aust	Medical		3 × 1 hr	Anatomy	10		Post	S	Superficial satisfaction	x
Peplow	1996	Med Teach	Aust	Medical	391	5 cases 2 sessions	Anatomy			Post	M	Satisfied, no difference in marks	x		x
Peplow	1998	Med Teach	Aust	Medical	162		Anatomy	11		Post	S	Gender difference in marks	x
Quattrochi et al.	2002	J Sci Educ Technol	N Am	Medical	12?	Online 8 cases	Neurosci			Post	S	Liked	x
Rabe & Cadrona-Carlos	2007	Med Educ	Asia	Medical	165	3 voluntary	Paeds			Post	S	Helps	x
Radon et al.	2006	Ann Agric Environ Med	Eur	Medical	337	2 online	Occup med	1		Post	S	Enjoyed	x
Reimer et al.	2006	Rheumatol Int	Eur	Medical	92	3 online courses	Rheumatol	1 (e)	Y	Pre/post	S	Exceeded expectations	x
Richards & Inglehart	2006	J Dent Educ	N Am	Dental	204	12 × 50 mins	Care management	5		Pre/post	M	Showed increased importance or psychosocial and cultural issues		x		*
Richardson & Birge	2000	Adv Physiol Educ	N Am	Mixed	36	1 hr/week	Physiol	Up to 11		Post	M	Satisfied, increased marks	x		x
Rodríguez-Barbero & López-Novoa	2008	Adv Physiol Educ	Eur	Medical	150/yr	25% of practicals	Circ physiol	1		Post	S	Variable	x
Rybarczyk et al.	2007	Biochem Mol Biol Educ	N Am	Pre-med	157	1 case	Cellular resp			Pre/post	M	Enhanced learning & collaboration	x		x	*
Schoeman et al.	2009	J S Afr Vet Assoc	Africa	Vet	130	4 cases in yr 4	Intro clin sci	7	Y	Post	S	Increased problem solving	x
Schwartz et al.	1994	Acad Med	N Am	Medical						Post	S	Rated well	x
Schwart et al.	2007	Acad Emerg Med	Aust	Medical	102	Month long clerkship	Chest pain	52 + 50	Y	Post	M	No difference in simulation and CBL			x	*
Scott	1994	Med Educ	N Am	Medical		22 cases in 8 hrs	Anatomy	2–8	Y	Post	S	Broadly positive, anatomy relevant	x
Sheehan et al.	2000	Am Surg	N Am	Medical	63	23 cases in 12 wks	Surgery	30		Post	MY	Does not help with concepts			x
Simonsohn & Fischer	2004	Deutch Med Wochenschr	Eur	Medical	380	Online	Int med	1		Post	S	Increased motivation & satisfaction	x			*
Smith Jr & Christie	2004	J Am Diet Assoc	N Am	Physio/nutr	28	1 case?	Nutrition	? 1 + 1	Y	Post	S	Enhanced teamwork & communication	x
Srinivasan et al.	2007	Acad Med	N Am	Medical	286	12–15 sessions				Post	M	Preferred CBL to PBL	x		x	*
Steinberg et al.	2002	Acta Cytol	N Am	Medical		10 × 15/20 mins	Cytopathology			Post	S	Enjoyed practical application	x
Stewart & Gonzalez	2006	Commun Disord Q	N Am	Speech path	29	10 cases studies	Profess issues	2–3 + large	Y	Post	S	Learned analysis & synthesis	x
Stjernquist & Crang-Svalenius	2007	Med Teach	Eur	Medical	254	Whole curric	Clinical			Post	S	High satisfaction of PBL	x
Street et al.	2007	Med Educ	UK	Med/nurse	94/66	2 weeks	Child disability, IPL	2	Y	Pre/post	M	Enhanced learning	x	x
Struck & Teasdale	2008	Gerontol Geriatr Educ	N Am	Medical	167	4/52 geriatrics	Geriatrics	8–12	Y	Post	MY	Effective to cover concepts	x
Sutphen et al.	2003	Am J Prev Med	N Am	Medical	144	5 cases	Prevent med			Post	S	Liked, helped with preventative medicine	x		x
Sutyak et al.	1996	Am J Surg	N Am	Medical	36	1 session	Surgery	15 + 21		Pre/post	M	Unstructured more enjoyable than structured	x		x
Sutyak et al.	1998	Am J Surg	N Am	Medical	42	4 cases	Surgery			Pre/post	M	Effective with knowledge, mixed results	x		x
Tarnvik	2002	Med Teach	Eur	Medical	>1000	2 hrs	Infect dis			Post	MY	Highly valued	x
Thurman et al.	2009	J Vet Med Educ	Aust	Vet	105	7 wks	Physiol	6	Y	Pre/post	S	More positive to group work	x	x		*
Tian et al.	2008	Int Cong	Asia	Medical	122	3–5 cases	ENT	15		Post	M	Better with CBL and multimedia			x
Trevena & Clarke	2002	Am J Prev Med	Aust	Medical	130	8 wks	Population health	2	Y	Post	S	Traditional case presentation useful	x
Waydhas et al.	2004	Med Teach	Eur	Medical	136	6 × 45 mins	Surgical exam	6–9	Y	Post	M	Helped students prepare	x
Williams	2006	J Emerg Prim Health Care	Aust	Para-med	69	Weekly online	Clin pract			Post	MY	Enjoyable	x
Williams	2009	Australas J Educ Technol	Aust	Para-med	247	E-tutorial 8 cases	Clinical	10–25		Post	S	Improved and enjoyed	x
Wilson et al.	2006	Rheumatology	UK	Medical	31	Online	Rheumatol	1 (e)		Post	S	Liked, some knowledge gained	x		x
Chan et al.	2008	Ann Acad Med Singapore	Asia	Medical						Post	S	Helps learning	x
Zebrack et al.	2004	J Gen Intern Med	N Am	Medical	115	1 month	Women's health	8–10	Y	Pre/post	S	Mainly about web-based evaluation	x		x

Note authors in bold: Though both Horsch et al. (1999) and Horsch et al. (2000); and Peplow et al. (1990) and Peplow et al. (1992) are included as four separate papers, in the analysis there are counted as two papers only because of duplicate data.

Entwistle N. Teaching for Understanding at University. Deep approaches and distinctive ways of thinking. Palgrave Macmillan, Basingstoke 2009

 Google Scholar

Banchi H, Bell R. The many levels of inquiry-based learning. Sci Child 2008; 46: 26–29

 Google Scholar

Hong CY, Chan LW, Lim LH, Chan SY. Case studies in community pharmacy: The contribution of family physicians to the teaching of community pharmacy. Med Teach 1998; 20(5)476–479

 Web of Science ®Google Scholar

Horsch A, Balbach T, Hogg M, Sturm F, Minov C. The case-based Internet textbook ODITEB for multi-modal diagnosis of tumors – Development, features and first experiences. Stud Health Technol Inform 1999; 68: 513–516

 PubMedGoogle Scholar

Peplow P. Attitudes and examination performance of female and male medical students in an active, case-based learning programme in anatomy. Med Teach 1998; 20(4)349–355

 Web of Science ®Google Scholar

Peplow PV. Self-directed learning in anatomy: Incorporation of case-based studies into a conventional medical curriculum. Med Educ 1990; 24(5)426–432

 PubMed Web of Science ®Google Scholar