As an introduction to this discussion, various problem-oriented learning methods were briefly reviewed.  These included lecture-based cases, case-based lectures, the traditional case method as used in many business schools, modified case method, problem-based, and closed-loop problem-based.  The case-based examples being presented in this session were characterized as intermediate between a case-based lecture and the traditional case method.

Implementation issues that were addressed included methods for gaining student trust and building student confidence to enhance participation in case discussions.  It was noted that instructor expectations of students should be high and that student participation should be a clearly communicated goal of the class. 

Mechanisms for encouraging classroom participation focused on a structured presentation of case material using the standard format of signalment, chief complaint, history, physical exam, additional data, problems list, problems evaluation and reassessment.  It was noted that biochemistry is a first year class in the veterinary curriculum and so students have had no introduction to clinical presentations.  Learning how to structure and present a case is a skill that students must acquire if the case-based method is to be effective. 

The bridge between clinical data collection and reasoning and basic science problem-solving is the use of  “essential  questions” and student-identified learning issues.  Rather than working forward from the clinical problems list to arrive at differential diagnoses, this case-based method works backward from the problems list to relate clinical signs to key learning issues.  Essential questions that students might pose to get at the key learning issues include:

• Presence of this clinical sign correlates with derangement of which physiological and biochemical functions?
• Derangement of function is related to alterations in which specific pathway(s)?
• In which cell/tissue is this pathway relevant?
• What are the key elements of the pathway (e.g., input, output, regulation)?
• Are further assessments (diagnostics) or interventions (treatment) related to this clinical sign indicated?

It was the consensus of the group that, although a case-based approach was less efficient than a traditional presentation of biochemistry content, it was worth the expenditure of time.  It was felt that relevance of basic science content was enhanced and that retention of information was improved when presented in an active, problem-solving context.