gms | German Medical Science

Case based learning (CBL) is a highly interactive teaching format widely used in medical education (e.g. [4]). The present study analyses the interaction between teachers and students in CBL. We focus the research question how different characteristics of clinical teacher questions (open vs. closed, reproduction vs. reasoning, initial vs. follow-up) influence whether students respond in a reproductive or elaborative way – or if they do not respond at all.

We video-recorded 32 case based clinical seminars (16 internal medicine, 16 surgery) taught by 21 medical teachers and on average attended by 15 students We analysed the videos using a theory-based hierarchical categorical scheme [3] with high interrater-reliability ICC=.70 [2]. We performed basic descriptive analyses and calculated evolutionary trees [1], an innovative classification and regression tree method.

Regarding student contributions, we found a high prevalence – 54% – of student non-response to teacher questions (see figure 1 [Fig. 1]). Elaborative and reproductive student responses had a similar prevalence of around 17%.

In predicting student answers, we found that follow-up reasoning questions were connected with a high rate of elaborative responses (50%) and a low rate of non-response (30%). The highest degree of student non-response (around 60%) was observed following open reproduction questions and initial reasoning questions. Most reproductive statements (53%) by students were made following closed reproduction questions. Furthermore, clinical teachers asked closed questions more than three times as often as they asked open questions (cf. figure 2 [Fig. 2]).

Our results show that CBL-seminars are characterized by a balance of reproduction and elaboration on the side of students. Furthermore, the outcomes of our evolutionary trees-analysis allow to conclude that posing reasoning questions, especially open ones, is the best way to make students engage in elaboration and deep reasoning. A striking result is the high student non-response observed in our study. This is interesting in two respects: In many instances, medical teachers simply out-talked their students. This means that non-response was connected to very little time being available for students to mentally deliberate upon a teacher’s question and find a potentially suitable response. We hence argue that, in medical education, the phenomenon of teacher wait time is a relevant focus for future empirical research. Also, students often seemed hesitant to answer teacher questions if they were unsure about whether their answer would be correct. So, teachers striving to make students in their seminars more responsive should motivate them to verbalise their thoughts rather than presenting the perfect answer to them.