Presentation on theme: "Case-Based Learning: early identification of ‘at risk’ learners and provision of on-line support Helen Fraser, Carole Gannon, R. Daniel Kortschak, Anne."— Presentation transcript:
Case-Based Learning: early identification of ‘at risk’ learners and provision of on-line support Helen Fraser, Carole Gannon, R. Daniel Kortschak, Anne Tonkin Medicine Learning and Teaching Unit, University of Adelaide, South Australia, Australia
Background The University of Adelaide MBBS – Six year undergraduate entry course – Years 1-3: Case-based learning CBL – 1 tutor 9 students 3 x 2 hrs /wk (4 sessions/case) – CBL handbook with the steps for each session – scaffolding in year 1 - students transitioning from courses with high levels of support
CBL Assessment Tutor assessment of students in tutorials: every 6 weeks, covers 4 domains – assessment of knowledge – reasoning – personal & professional development (preparation, participation…) case presentations Grades A - E (D & E fail) Support for students ‘at risk’ in the process Follow-up interviews and strategies
Lack of success in Year 1 CBL 1.Year 1 transition issues – e.g. away from home, distractions - extra-curricular activities. 2.personal stressors - e.g. illness, relationship problems - often requires counselling 3.learning difficulties - requiring referral to psychologist 4.lack of competency in knowledge-base and reasoning (organisation & synthesis) 5.problems with communication
1. Self-regulation skills Organising research “better preparation with the appropriate texts would assist [C’s] contributions in developing mechanisms” Organising study “Regular study will facilitate integration of information from previous cases to the current case.” “A is not able to consistently develop mechanisms and should improve his knowledge-base by doing all the learning issues and making a summary to aid his discussions”
Incorporating reasoning “She [C] should practise putting together small mechanisms first initially making them quite general. Then she should identify gaps in between the general steps and devise mechanistic processes which occur in them.” “It would be useful if J wrote out and re-evaluated her hypotheses and devised strategies to test them before coming into each session which will give her more confidence and ensure her contribution to this essential activity.” 1. Self-regulation skills
2. Participation/ Confidence “It is not possible to assess [S’ s] knowledge development adequately when participation in discussion is almost non-existent.” “C’s reasoning is hampered by the fact that her knowledge is not as strong as other members of her group, consequently she finds it hard to keep up.”
Iterative framework with practice elements to assist in developing strategies to be used consistently to increase the amount and quality of CBL participation. – organisation and monitoring – self-commitment and practice The framework included a checklist The online human tutor - positive reinforcement
Framework for research and analysis of Learning Issues (FRALI ) 1.During study period, check your progress: ask how the information relates to the case, explains the Px’s condition 2.Review your information and decide which are the 3 most useful learning issues (LIs) 3.Prioritise these 3 LIs for presentation at the next CBL session 4.Rehearse 2 of these issues - how will you present this information to the group? 5.Say why they are important in understanding the case. 6.Identify remaining knowledge gaps in the LIs.
3 most significant pieces of information from research How does this relate to the Px symptoms / signs? Which one do I plan to present?
Methodology Framework for researching and analysing learning issues (FRALI) + online tutor 18 students invited to participate – 16 interviewed and given framework – 9 wanted to work with the framework and the online tutor – to send key research points to online tutor before each new CBL session 5 cases
Online Tutor 1.clarify and assist in solving research or reasoning issues as they arose 2.provide both cognitive and affective support 3.encourage students to embed a regular reflective research process into their CBL preparation 4.build confidence.
Online Tutor Feedback Appendicitis remains our primary hypothesis, and so the physical examination results are important Absolutely If appendicitis is present on physical examination the abdominal wall is very sensitive to palpation and there is rebound tenderness. [etc.] This is good, and if your tutor is inclined to ask you to provide information about what you would be looking for on physical examination and what you would predict, this should be offered to the group.
Students who used the FRALI did more preparation at the beginning of a new case spent more time analysing their researched information were better prepared to participate in CBL were better able to demonstrate their reasoning
Student Feedback The online tutor was good. I only ended up using it for a few sessions, but prior to this resource I didn’t really understand the CBL process, and it made me summarise and see what parts of my information I didn’t understand…a key step in CBL… It helped me contribute in CBL through making me want to put my information up, so that I could ask the group if they could fill in the blanks. Although I only used the actual program a few times I applied the strategies it was trying to make me develop for the rest of the term.
Student Feedback It was useful to have someone confirm that what I was doing was relevant to the case and also correct. I now do much more revision and try to keep it more relevant to the case. I don’t stay on one area too long if I feel I’m not making progress.
Results Non - Online group InterviewTerm 1Term 2Term 3Term 4Band Gained 10InterviewECBA4 11InterviewDCBB2 12No InterviewDCCB2 13FrameworkCBCB1 14InterviewBBBB0 15InterviewDDDC1* 16No InterviewDDDE-1* * = Failed the year
Conclusions The tutor assessment is important for improving CBL performance. Early intervention is critical for some students. – identify students struggling with CBL early (i.e at the 6 week mark) – identify their problems – strategise to develop appropriate skills – provide support for skill development The FRALI framework is of assistance in this. The online tutor may be necessary only in the initial phase, to get the students on track and to build their confidence.