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Academic Medicine, 2003; 78:491-496 From Case - based Reasoning to Problem-based Learning by Eshach, H and Bitterman, H. Reviewed by Kathleen V. Previll, The Brody School of Medicine


Academic Medicine, 2003; 78:491-496 From Case - based Reasoning to Problem-based Learning by Eshach, H and Bitterman, H.

Reviewed by Kathleen V. Previll, The Brody School of Medicine

Eshach and Bitterman disagree that problem-based learning has not been proven to improve the knowledge base and clinical performance of medical students as measured in a review by Colliver. The authors feel there are inadequate curriculum assessment research tools to make such an assertion and go on to compare the learning process of case-based and problem-based learning with traditional medical school curriculum approaches.

They propose we use three types of reasoning to solve medical problems: (1) rule-based reasoning which presumes logic and is presented in the formats of lectures, or text book reading, (2) personal knowledge which they equate to anecdotal reasoning, and (3)case-based reasoning which presents the learner with a memory of richer contextual reference and allows the learner to propose solutions which may be novel to the learner.

The authors clearly favor case-based/problem-based learning and declare that this form of learning is more efficient, provides an index of reference for the student and allows the learner to use operational thinking as opposed to abstract reasoning to problem solve.

Finally the authors feel the trend to test medical students on exams such as the USMLE using clinical cases might serve students taught in case-based and problem-based formats especially well.

(There is a great description of case based teaching - and a table that sets out the principles of excellent case based teaching. The key here is quality - excellent cases - which build on each other, compare and contrast to each other to highlight points of similarity and departure and which highlight actions and behaviors - teach reasoning - by demanding decisions.

Do you have case based teaching in your clerkship? Do you believe that case based teaching - in which you suggest models of reasoning - is superior to PBL - in which the learners develop their own models? Steve Miller)

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