Revival of the case method: a way to retain student-centred learning in a post-PBL era.

BACKGROUND: In current renewal of medical education, problem-based learning (PBL) is the predominant approach. PBL is afflicted with limitations, which cause uncertainness about its future. A profoundly different approach is the case method, developed a century ago and today attracting much less interest in developmental work than PBL. AIM: To compare the characteristics of PBL and the case method and ask the question of whether the case method may serve as an alternative approach to student-centred learning.
METHOD: The comparison was literature-based.
RESULTS: PBL implicates fostering of self-directed learning and its prospects deal with depth and retention of knowledge and clinical reasoning skills. Problems are used to define learning goals and to stimulate students' interest in various aspects of an item, rather than just for problem-solving. In the small-group tutorials of a PBL curriculum, the teacher is assigned to facilitate the process of self-directed learning and needs not necessarily be a subject-matter expert. In spite of its exciting philosophy and an increased input of students' and teachers' time, the superiority of PBL as a mode of learning has not been convincingly demonstrated, either in terms of acquisition of knowledge or in clinical performance. Moreover, dysfunction is a well-recognized phenomenon. In some PBL tutorials, indifference towards the group discussion is encountered, including individual quietness or dominant behaviour and incomplete attendance. To cope with dysfunctional problems, efforts are recommended aiming to increase PBL tutors' and students' understanding of the group process. As opposed to PBL, the case method relies strongly on teacher-directed learning. Students are placed in a dilemma or a problem to be solved. After preparatory work, they meet for a discussion, lead by a subject-matter expert, who preferably has experienced the case in reality. As a chairperson, the teacher is supposed to stimulate the discussion and detect gaps and misunderstandings. Due to its teacher-dependent approach to learning, the case method is less susceptible to group dysfunction. The case method is also less resource consuming, primarily because it can be practised in groups several times larger than those of PBL.
CONCLUSION: A revival of the case method seems warranted as an alternative means of interactive learning, which is simpler, easier to realize and less time-consuming with regard to both institutions and students.