- 7-8 students with a faculty preceptor (physician or PhD professor), a new random group for each 12-week block
- MWF 8:00-10:00 AM; Required
- Mondays are used for introduction to the two cases/problems (1 hr per case). Group assigns a leader and scribe, go through reading each case and formulating hypothesis and differential diagnoses based on medical knowledge and deduction. Discuss labs, imaging, how to manage and treat. After reading through, team comes up with learning objectives and assigns tasks for each member (i.e. research pathogenesis of the disease, pharmacology, how to interpret the MRI). Even as the objectives may be split up, every participant is expected to review all aspects of the case and the generalities of each disorder.
- Wednesdays and Fridays are used for case discussion and presentations (2 hrs per case). The leader gives an overview of the case with pertinent findings and sets up the timeline for the impeding discussions. Students can draw diagrams, show graphs, and point out anatomical structures in addition to talking about relevant aspects of a disease process such as epidemiology, work-up, pathophysiology, and management/treatment. Often, open discussions are used to reiterate important clinical pearls of a case and bring up questions concerning a difficult or murky areas of understanding. The preceptor has minimal involvement in directing the case but can sometimes bring up facets of the case that the group may have missed to hint at what should be brought up in the conversation. At the end of the two hours or when the team believes they have covered all pertinent information in the case, everyone opens up a document containing the “ideal” learning objectives that the faculty expected students to look up and learn for the case. Depending on each group, students can independently research what goals they have missed or work together outside of class to fill in the missing learning objectives.
- CBL is active learning. Active learning methods allow students to process and apply information in a variety of ways. Here, discussing and solving problems with fellow students help reinforce a multitude of scientific and medical concepts. Medical students have the opportunity to do research and review notes beforehand to simulate the aspects of expert reasoning and problem-solving, then receive immediate feedback from peers and the preceptor in the discussion part of CBL. This allows an integration of material received from lecture with the application of clinical knowledge to a specific patient case.
- CBL is also active teamwork. Medical students have different personalities. And it is always fun to work with other bright and intelligent people with a variety of mindsets and attitudes. Because each case is interdisciplinary in nature, students have a chance to learn from each other and gain valuable insight from teammates who may have special experience in an aspect of the case (i.e. a student who has worked in infectious disease research contributing their knowledge of MRSA in a case concerning hospital-acquired bacterial infections, a student who has first-hand experience volunteering at hospices contributing insight into the psychological and societal implications of end-of-life patients, etc.). On one end, CBL prepares students to work towards how to talk and interact with attendings, residents, interns, nurses, and other team members on rounds to incorporate all opinions on how to manage a patient’s imminent care and establish a medical plan.
3. Time Commitment
- Six hours of in-class CBL each week
- Variable out-of-class preparation. Can range from 2-5 hours depending on complexity of each case and additional resources used. CBL is not an assignment; it is practicing to apply concepts learned in class and research to solve a simulated patient encounter.
4. Note Taking Tips
- Here are some of the resources that fellow classmates and I have used to help us with the CBL cases:
- Lecture material, notes
- The powerpoints and lecture notes often provide a good basis for starting deeper research into the subject matter.
- UpToDate.com has a variety of “beyond the basics” articles that contain clinical content authored by leading physicians synthesized into summaries and evidence-based recommendations for patients, students, other physicians, and educators alike.
- Secondary sources
- Often in the syllabus for each block, textbook/s will be recommended (in addition to anatomy books and guides required for the whole year). For example in the BB&M (Brain, Behavior, and Movement) block, a neuroscience and neurology book is incredibly useful for understanding the physiology and biological basis of diseases and disorders.
- ClinicalKey.com allows students to search for journals and books online that provide variable levels of detail. They can range from generalized guidelines for physicians in resources like First Consult, Ferri’s Clinical Advisor, Goldman’s Cecil Medicine to more specialized books like Orthopaedic Sports Medicine, Abeloff’s Clinical Oncology to mention a few.
- Most cases also have pathology and anatomy components (see first bullet) that may require outside resources for complete understanding. Books like Robbins and Cotran Pathologic Basis of Disease are useful for seeing the histological patterns of some diseases.
- Review articles
- Several journals also contain very recent reviews of some disorders and their diagnoses options. These include but are not limited to Nature Reviews, New England Journal of Medicine, etc.
- Primary sources
- One can used PubMed, Google Scholar, MEDLINE to look up specific clinical articles, basic science/molecular research pertinent to the case
- These can be used to give insight on a new experimental drug, recent findings concerning risk factors for an autoimmune disease, and alternative theories and pathways for disease manifestation
- Often, CBL groups use shared google docs or work together to put notes they take concerning a specific topic into one file. This can then be accessed in class to show pictures, flowcharts, etc on the projector for everyone to see. People can also see what resources others have used to compare levels of evidence.
5. How to Succeed
- Be prepared, be involved, ask questions, have fun.
- I believe the most important trait to have in CBL is openness. There is a wealth of knowledge, experience, and insight in your classmates and preceptor. CBL allows students to listen and collaborate with each other in a way that raises the level of understanding in every participant. Don’t be afraid to ask someone to reiterate how pancreatic neoplasms can develop, don’t be hesitant to test your peers and let fill in the blanks on reviewing how to workup a UTI (urinary tract infection), and don’t be a passive learner. The CBL experience is one that is so enriching because it incorporates everything and makes you think/interact like a real doctor. You respect others’ opinions and are affected by their modes of thought, appreciating the interpersonal connections you form in the group.