Without anyones permission: The open web and online learning

As teaching and learning activities move into online and blended learning environments we need to think carefully about how we use those spaces, which is often determined by the features of the platforms and services we choose. One topic in the field on online learning that’s been getting a lot of attention, is the MOOC (the New York Times declared 2013 the year of the MOOC). However, for all the rhetoric about how MOOCs are disrupting higher education, we have yet to see any strong evidence that they lead to any kind of improved learning, and we are slowly starting to realise that “MOOCs are essentially a dead end with regard to providing learners who do not have adequate access to education with high quality qualifications.” In other words, if you don’t already have a good foundation upon which to build, the promise of MOOCs seems to be an empty one.

One of the reasons that disruption is difficult to apply to the mainstream MOOC phenomenon is that – for all intents and purposes – these MOOCs (specifically, xMOOCs) are not doing anything particularly innovative. They reproduce distance learning models that have existed for decades and moreover, they do so less well. This post will focus on the Open aspect of xMOOCs – in particular how they are anything but open – and to discuss some of the ways that educators need to think differently about how we use the web in our teaching practice.

The majority of xMOOC providers design their courses using non-open formats and use restrictive content licenses preventing reuse and sharing of the content and learning experiences. These MOOC providers are fencing in and closing off the educational experience, while at the same time preaching openness and enhanced accessibility. This loss of openness in online learning – as it is conceived by the major xMOOC providers – is, according to some, a horrific corruption, as more and more of our learning experiences are controlled by organisations that dictate the direction that online and blended learning is taking. Which brings me back to the idea that started this post; if we are going to move teaching and learning into online environments it is important for us to understand the environment that we’re moving to. We need to remember that when we talk about online learning, we should be talking about learning on the web. Not learning on an app, or on Coursera, or on Facebook. And therein lies the problem:

This isn’t our web today. We’ve lost key features that we used to rely on, and worse, we’ve abandoned core values that used to be fundamental to the web world. To the credit of today’s social networks, they’ve brought in hundreds of millions of new participants to these networks, and they’ve certainly made a small number of people rich. But they haven’t shown the web itself the respect and care it deserves, as a medium which has enabled them to succeed. And they’ve now narrowed the possibilities of the web for an entire generation of users who don’t realize how much more innovative and meaningful their experience could be.

Anil Dash

Maybe we need to reclaim online learning for what it is and what it represents. The open source movement has provided the tools we need to build our own (open) online courses, so what exactly do we need Coursera and Udacity for? As we give up more and more (or, as platform providers take more and more?), we must remain cognisant of what it is that we’re losing. The restrictive licensing requirements of most xMOOC providers has shown that we – the people doing the teaching – need to take the online learning environment back, eliminating (or at least reducing) our reliance on convenient platforms that do more to impoverish the learning experience than enhance it. We can provide an open online learning experience while at the same time enabling a culture of democratized, permission-less innovation in education.

We need to remember that delivering mass media is the least of the Net’s powers.
The Net’s super-power is connection without permission. Its almighty power is that we can make of it whatever we want.

We, the People of the Internet, need to remember the glory of its revelation so that we reclaim it now in the name of what it truly is.

No one owns that place. Everybody can use it. Anyone can improve it.

Doc Searles – New Clues

Anil Dash described how we lost the web and then followed up with how to rebuild the web we lost, highlighting the utility of the open web to enable transformative change in the world. The web as an open platform for creative expression and unfettered communication is slowly being eroded and replaced by gilded cages. As the services we champion make it more difficult to move content into and out of, it’s becoming increasingly difficult to create connections between people and ideas in open online spaces. Sure, if you want to do everything in Facebook, then Facebook works. But just try taking something out of Facebook to use somewhere else.

We get bullshit turf battles like Tumblr not being able to find your Twitter friends or Facebook not letting Instagram photos show up on Twitter because of giant companies pursuing their agendas instead of collaborating in a way that would serve users. And we get a generation of entrepreneurs encouraged to make more narrow-minded, web-hostile products like these because it continues to make a small number of wealthy people even more wealthy, instead of letting lots of people build innovative new opportunities for themselves on top of the web itself.

Anil Dash

In his post about rebuilding the web we lost, Anil made the following suggestions for taking back the open web, which I’ve repurposed here in an online learning context. I’m sure that my take on it isn’t perfect, and I’d be happy to hear any other interpretations.

  1. Take responsibility and accept blame. This is our fault. Educators have allowed companies like Coursea / Udacity / Future Learn to take over and drive the online learning agenda. We did this because we didn’t understand what the web was and how we could build enriching educational experiences with it. Instead of embracing the web, we’ve spent the past few decades demonising it. We blame it for increases in cheating, lower levels of critical thinking, and encouraging lazy approaches to student work. Just think of all the rants about why students shouldn’t use Wikipedia, instead of taking on the challenge of making Wikipedia as good as it could possibly be. Educators and students could have used the platform in ways that would have improved the content of the site, while also helping students to develop important 21st century skills that are not covered in the formal curriculum. We dropped the ball, and now we need to ask what we’re going to do about it.
  2. Don’t just meet the UX standards, raise the bar. Coursera, Future Learn, Udacity, Facebook, Twitter, Pinterest are all beautifully designed. They have great websites and come with user-friendly mobile apps, and we marvel at how easy they are to use. They must be wonderful places for learning. All we have to do is provide the content. But is that all there is to learning? Pre-packaged collections of readings, with no opportunities to empower students as part of that process? High quality, well-produced video lectures that students can’t download? Forum discussion boards that were also boring in the 90s? Why do we put up with it? Because it’s pretty? We can do better.
  3. Rethink funding fundamentals. If we want to move the learning experience into online spaces – and with it, open up access to education that xMOOCs so proudly take credit for – we must rethink how we are going to fund the development of those experiences. Is it realistic for individual lecturers to try and manage courses with thousands of students? Does everyone understand that Facebook, Twitter, Pinterest and every other social network that exists does so in order to make a profit for their shareholders or their founders. These are companies designed to make money, not enhance learning. We will need to come up with different ways of funding large-scale online education if we are going to take it seriously.
  4. Explore architectural changes. The ability to manage enormous numbers of users used to require banks of servers and the installation of costly database software. Now you can get the same functionality as a service, either from Amazon (AWS) or a range of other providers. Cloud-based storage providers (Dropbox, Google Drive, OneDrive, etc.) provide hosting and collaborative editing of files – largely for free – that just a few years ago would have been prohibitively expensive. By making use of free or cheap services, we can reproduce platforms that previously would have been impossible or very expensive. Changes in how software and services are offered provide new opportunities for growth and innovation. We need to not only be aware of these services but to think carefully about how we can use them in ways that are truly disruptive.
  5. Exploit their weakness: Insularity. Be sceptical of those who tell us that This New Thing is open in any sense of the word, other than open = free. But even the use of “free” in this context means simply “without cost”, and is dissociated from the freedoms we have come to expect with the web. Instead of looking to the big institutions for guidance – and therefore falling prey to their limited perspectives – we must establish collaborations outside of the walled gardens of closed online learning environments.
  6. Don’t trust the trade press. Stop believing everything that the mainstream media tells you is true. “MOOCs are disrupting higher education”; only…they’re not. Not yet, and certainly not by the Coursera’s of the world. It is essential that teachers, principals, students, parents and every other stakeholder involved in learning educates themselves on what the web is, and how it evolved to become what it is. It’s only by knowing what we’re losing that we can take steps to reclaim it. Even as the mainstream media and uncritical academics proclaim the disruption and end of traditional models of higher education due to the emergence of whatever is trending on Twitter, we must maintain a critical perspective in how we design our online learning experiences.
  7. Create public spaces. Think about this; almost every online space where you can currently assemble large groups of people is privately owned. Facebook, Google+, Instagram…there are no truly open and public spaces where we can engage in public performances, at least not in any real numbers. This holds true for educational online spaces too; Coursera, Udacity, EdX, Canvas. All are privately held and all exist to make a profit. Where are the open spaces that position learning as a public good? Other than a few marginalised experiments like Wikiversity it’s difficult to point out a truly open learning environment. It seems that if this is something that we want – that we value – we are going to have to build it ourselves.

While this list isn’t perfect – it was written for a different context – I think it gives us some ideas about how we can think differently about moving education into online and blended learning spaces. It’s not enough to simply add online to our teaching and learning activities, and think that we’re changing anything. We need to stop doing “business as usual”. The mainstream xMOOC providers offer little more than structured collections of content, well-produced video lectures and extremely limited forms of engagement. There is nothing fundamentally innovative about this approach, nor does it have any pedagogical foundations to support learning. The promise of technology – and the web – in teaching and learning is not simply to reproduce a poorer version of the classroom experience. We need to ask who is setting the online learning agenda and whether or not we are comfortable with that (hint, the correct answer is “No”).

Open source software has given us the tools to create sophisticated online spaces for learning – all we have to do is learn how to use them. We would be asking no more of ourselves than we ask of our students every day i.e. to push ourselves to learn something new; to make a difference in the world. As long as we’re performing in closed spaces, we are disempowering our students and colleagues, preventing them from participating in educational experiences that are liberating and that develop a sense of agency.

Stephen Downes offers us four principles of open and networked learning via the theory of Connectivism – principles that could be useful in our designs for online learning experiences. We could do worse than these concepts when it comes to interrogating what kinds of online platforms we use, and how we use them. It would be an enlightening experiment to take an honest look at our learning spaces – online and physical – and ask if they encourage and facilitate the development of these concepts:

  • Autonomy:  Learners should have the ability to choose where, when, how, what and with whom to learn
  • Diversity: Learners represent sufficiently diverse populations to avoid group-think and “echo-chambers”
  • Openness: The learning environment accommodates all levels of engagement, with no
    barriers between ‘in’ and ‘out’, helping to ensure the free flow of information through the network, and encouraging a culture of sharing
  • Connectedness: “Connectedness” and interactivity is what makes all this possible, as knowledge emerges through the connections that learners make

At the risk of sounding like an uncritical fanboy, I’m well aware that the web is not the panacea we sometimes make it out to be. The presentation below – given at the 2014 meeting of The Network – Towards Unity for Health, in Fortaleza – was largely inspired by the ideas presented here, and highlights the challenges with online and blended learning, especially when we are uncritical about what we use and why.


This uncritical perspective is most evident than when we talk about the web. We speak about it as a discrete entity, something defined, bounded and imbued with a set of characteristics that is inherently Good. The web positioned as the solution to our many educational problems is somewhat the essence of the xMOOC contingent, and most solutions to the “education problem” that emerge from Silicon Valley. Evgeny Morozov has suggested that our tendency to look to the internet as the solution to everything is problematic, calling it the “quasi-religion” of “Internet-centrism” where Internet-centrism views the internet as being inherently special. As educators responsible for using the web and it’s features to our advantage, we must ensure that we are cognisant of both it’s utility and potential for harm (or, at the very least, it’s potential for ineffectiveness). Taking a critical position – one of the roles of academics in society – allows us to see mainstream xMOOCs for what they really are: impoverished walled gardens that diminish the learning experience. Learners are treated as users, content is viewed as knowledge, and the learning interaction is regarded as linear and subject to control. But it doesn’t have to be this way.

The internet is essentially a set of agreements (protocols) that tell us how to write a page that can link to any other page without needing anyone’s permission. Without needing anyone’s permission. Without having to ask if it is OK. Without needing to login. Without needing to share our personal information. Without giving up our content through resrictive licensing requirements. “Every link by a person with something to say is an act of generosity and selflessness, bidding our readers to leave the page to see how the world looks to someone else.” When we construct our learning experiences behind closed doors, hiding our interactions inside platforms and apps that we can’t make real choices about, we give up something.  As we continue to move teaching and learning into spaces like Facebook – because it’s “where the students are” – we cede our autonomy and ability to make real choices about how we teach and how students learn. We change our teaching practices, not because it is in the students’ best interest, but because it is all that we are allowed to do.

We all love our shiny apps, even when they’re sealed as tight as a Moon base. But put all the closed apps in the world together and you have a pile of apps.
Put all the Web pages together and you have a new world.
Web pages are about connecting. Apps are about control.
As we move from the Web to an app-based world, we lose the commons we were building together.
In the Kingdom of Apps, we are users, not makers.
Every new page makes the Web bigger. Every new link makes the Web richer.
Every new app gives us something else to do on the bus.

New Clues

Abstract: Student Success and Engagement project

Our faculty has implemented a 3 year research project looking at improving Student Success and Engagement in the faculty. The project is being coordinated across several departments in the faculty and is the first time that we are collaborating on this scale. I will be using this blog as a public progress report of the project, in order to highlight our processes and challenges, as well as to report on draft findings. Here is the abstract of the project proposal.

Achieving promising throughput rates and improving retention remains a challenge for most higher education institutions. Student success in South African higher education has been unsatisfactory and universities have not been effective in developing strategies to enhance students’ learning experiences. Low throughput and poor retention rates have been identified as challenges in the Faculty of Community and Health Sciences at UWC. While success rates of students in the faculty are reported as students who complete their qualification in the shortest possible time, many students require an additional year to graduate. It is important to develop strategies that exploit students’ capacity to engage in their learning, as this may create a space that is conducive to student success. Therefore, the aim of this project is to identify and implement strategies to improve student success in the CHS faculty at UWC through an exploration of student and lecturer engagement. This project will explore student engagement in relation to the domains of assessment, academic literacies and tutoring.

Design-based research has been selected the overarching method as it is informed by the teacher’s desire to improve learning, based on sound theoretical principles. All of the undergraduate students (N=2595) and lecturers in the CHS faculty will be invited to participate in this study. Phase 1 includes the implementation of the South African Survey for Student Engagement (SASSE) and the Lecturer Survey for Student Engagement (LSSE). We will also conduct in-depth interviews and focus group discussions among key informants, who are likely to have insight into the challenges experienced in the areas of assessment, literacy and tutoring, and will be identified through purposive sampling. In addition, document analyses of UWC Assessment policy, Teaching and Learning policy and the Charter of Graduate Attributes will be conducted.

During phase 2, a systematic review will be conducted in order to ascertain which interventions have been demonstrated to increase student engagement in higher education. This data will be combined with the insights gained from Phase 1, and used to inform a series of workshops and seminars in the faculty, aimed at developing and refining principles to enhance student engagement. In addition, course evaluations and other documents will be reviewed, and data related to the domains of assessment, literacies and tutoring will be extracted and compared to the recommended guidelines and principles derived from the systematic review. These principles will then be used to inform interventions that are then implemented in the CHS faculty.

Following implementation of the interventions, Phase 3 will consist of focus group discussions with lecturers and the students who were involved in the project, especially those in areas of assessment, literacy and tutoring. A second South African Survey of Student Engagement (SASSE) and Lecturer Survey of Student Engagement (LSSE) will be conducted at the end of 2016 in order to determine if there has been a change in student engagement. By the end of Phase 3 of the project, a range of interventions within the domains of assessment, literacies and tutoring would have been implemented and evaluated. Ethics clearance will be sought from the University of the Western Cape Senate Research Committee, as well as permission from the Registrar and the various Heads of Department in the Faculty.

This will revolutionise education

Great video on the problems with making predictions about how certain technologies are poised to revolutionise education. There’s nothing particularly new in the video, but the presentation makes it really clear why comparison-type studies of technology in education are problematic. It also does well to make the point that learning is about what happens inside the student’s head and is a process that, while influenced by teachers, is not dependent on them.

Learning is difficult

“He who would learn to fly one day must first learn to stand and walk and run and climb and dance; one cannot fly into flying.” Friedrich Nietzsche

Learning how to do anything well takes time and often involves the achievement of small steps. When you’ve mastered a skill it’s often difficult to remember a time when you struggled to even understand the basic principles, so it’s important to try and remember what our students struggle with every day. Let’s give them the space to stand, walk, run, climb and dance, before we expect them to fly.

T&L seminar with UCT Law Faculty

Earlier this year I was invited by Alan Rycroft at the UCT Law Faculty to give a presentation at a seminar on T&L. The seminar took place yesterday and I presented some research that I did in 2012 where we used Google Drive as an implementation platform for authentic learning. I’ve written about authentic learning before, so I won’t go into any more detail here.

I would however, like to share some of my thoughts and notes from the session. Unfortunately, I had to leave halfway through the presentations, so I missed the second half of the day.

Anton Fagan – The use of laptops in the classroom. Anton made a strong case for banning laptops in the classroom under certain conditions, specifically when students are taking notes during lectures. There seems to be evidence that, while using a laptop to take notes can result in higher fidelity (more notes and more accuracy) it also results in less understanding, probably as a result processing information differently depending on whether we type it or write it. However, we do need to be careful about conflating lecturing with learning. Most of the articles discussed seemed to posit that the ability to recall facts presented during a lecture was the same thing as learning. Coincidentally, I had recently read this article in the New Yorker, which discusses the same thing:

regardless of the kind or duration of the computer use, the disconnected students performed better on a post-lecture quiz. The message of the study aligns pretty well with the evidence that multitasking degrades task performance across the board.

There are other studies that present similar findings but should we really be surprised by this? We’re saying that distracted students score poorly on tests of recall and understanding. This doesn’t seem to be about laptop usage, but rather that there are two other issues present.

  1. Students are more likely to be distracted when using an internet connected device during lectures, and are more likely to distract others
  2. Even when they are trying to take notes during the lecture, the act of typing those notes can degrade their processing relative to hand writing them

It seems that these two issues are relatively simple to address. In the first instance, work on improving your lecture so that students are less likely to be distracted, and in the second, make students aware that typing notes leads to lower levels of recall and understanding, but allow them to choose the method that best suits them. For example, I prefer that my notes more accurately capture what the speaker is saying. Afterwards, I go through my notes again, adding additional thoughts, linking to additional resources, and therefore engaging with the content a second time around. This is what I have done with these notes.

Geo Quinot – The LLB between profession and higher education. Geo presented his perspective on a set of policy frameworks, including recent proposals by the Council on Higher Education Task Team on Undergraduate Curriculum Structure. He discussed the relationships between the Profession and Higher Education the Quality Enhancement Project (QEP).

I found the talk to be a really comprehensive overview of the relevant policies and frameworks that will be placed centre stage over in South African higher education over the next few years. Unfortunately, there was way too much that was covered for me to try and sum up what was presented. I’ve linked to some of the documents that Geo referred to in the list at the end of this post.

Jacqui Yeats – Student engagement in lectures and tutorials: an experiment. Jacqui shared some of her experiences of teaching large classes in the Law Faculty. I was impressed with her systematic approach to changing the way she lectures, and took away the following ideas:

  • When your class size exceeds a certain number (and no-one really knows what that number is) you move from being a lecturer to being a performer or public speaker. The Presentation Zen blog has some really great resources for lecturers who are intentional about how they present.
  • Lecturers rely a lot on student feedback and reaction. Even if they’re not actually saying anything, it makes a huge difference to at least see some nodding heads when you make eye contact. I’ve never thought much about students’ responsibilities in terms of giving something back to the lecturer. This comment made me think a bit about my own accountability when listening to others’ speak.
  • Use more “soft” breaks. Soft breaks are short breaks (2-3 minutes) where Jacqui presents students with “educationally useful” content that is still marginally relevant to them in order to keep them interested. In other words, the cognitive distance is not so close to the lecture content that it doesn’t count as a break, but not so far removed that students are distracted and find it difficult to get back into the topic when the break is over. The example she gave was giving students writing tips, which I thought was a great idea.
  • Encourage friendly competition between students or groups of students. Jacqui made it clear that aggressive competition and ranking students probably isn’t a great way to get them to engage but that friendly competition with low risk that wasn’t explicitly linked to module outcomes seemed to get them more motivated. This is something that we’re struggling with in our department…student motivation and engagement seems quite low. We’re trying to figure out ways to develop a community in our department and I think that this idea of friendly competition is worth exploring.

Thank you to the UCT Law Faculty for inviting to present some of my work. I appreciated the opportunity and also learned a lot from the experience.

Additional resources related to the post

Faculty member on FAIMER Brazil (2014)


I’m spending a week in Fortaleza, Brazil as part of the FAIMER-Brazil programme for 2014. FAIMER is an international programme aimed at developing capacity in medical education and research, especially in developing countries. There are regional institutes in South Africa, Brazil, India and China, and the main organisation in Philadelphia. I was here in 2013 and found the experience both professionally and personally rewarding. I’m not by nature a very sociable person or emotionally expressive…so being in Brazil is definitely an “opportunity for growth” for me, because they are SOCIAL! and EXPRESSIVE!

As part of my time here in Fortaleza, I’ll be assisting with a session on distance and technology-mediated teaching and learning, as well as helping the programme participants with their research projects. During that session I’ll be sharing the results of the open online module on professional ethics that we ran last year, using that project as an example to illustrate some general principles of distance and online learning.

On a side note, a few days ago one of the other faculty members approached me and started chatting. I’d realised that he looked familiar but couldn’t place him until he introduced himself as Roberto Esteves. I immediately recognised him as a physician and teacher who I’d become aware of through his posts on Google+, and who blogs at Educação Médica.

We ended up having a great conversation about medical education in general, as well as the possibilities for collaborative research projects between our institutions. For me, this was a wonderful example of how connecting with people online can strengthen the interactions and relationships you experience in the “real world”. This hasn’t happened to me very often (I don’t travel enough) but when it does it’s really powerful.

Principles of learning

World_Cyber_Games_2004_AuditoriumI’ve been cleaning up my office over the past few days and came across a handout that I probably received at a T&L workshop sometime during the past year, and thought I’d post a summary of it here. There is a link on the document to this online version, although the hard copy that I have has different content under the same headings. Developing learning activities that try to take into account the following principles is more likely to result in deeper learning. Note: I couldn’t help but think about how video games incorporate all of these principles, which says a lot about a) what the gaming and entertainment industries know about engagement, and b) how boring a lot of classroom activities must be for students.

  1. Prior knowledge can help or hinder learning. How we mis/understand information changes how we perceive new information. If our prior knowledge is incorrect or incomplete, it affects how we understand new things. Teachers must therefore ensure that students articulate prior knowledge, in order to correct or consolidate it.
  2. Motivation generates, directs, and sustains learning behaviour. Our interests, goals, expectations, beliefs and emotional responses directly influence how much time and effort we devote to learning.
  3. The way students organise knowledge determines how they use it. When representations of knowledge are accurately formed, we’re better able to store and retrieve new information. When knowledge is organised according to superficial features, or when the relationships are inaccurate, or when the representation is of disconnected and isolated facts, we are more likely to incorrectly organise new information.
  4. Meaningful engagement is necessary for deeper learning. Meaningful engagement leads to the formation of more connections between concepts. The more connections that exist between concepts, the more likely it is that we will be able to retrieve and use those concepts as tools, instead of having them exist as isolated facts. Examples of meaningful engagement include asking (and also answering) questions, making analogies, and using knowledge to solve problems, lead to longer lasting and stronger representations of knowledge.
  5. Mastery requires developing component skills and knowledge, synthesising, and applying them appropriately. Performance of complex tasks (e.g. writing) is composed of many interrelated but discrete component skills. In order to gain mastery of the complex task, we must first practice and gain proficiency in the component skills, and then organise and itnegrate them into a coherent whole. These new skills must also be practiced in different contexts, which enables us to transfer the skills from one place to another.
  6. Goal-directed practice and targeted feedback are critical to learning. Learning is enhanced when we work towards a specific level of performance and regularly evaluate our progress against a clearly defined goal. Feedback should explicitly relate performance to the goal criteria, should be timely, frequent and constructive, and there must be opportunities to use the feedback in future activities.
  7. Students must learn to monitor, evaluate and adjust their approaches to learning to become self-directed learners. We must learn to be conscious of our own thinking process (metacognition). We should help students monitor, evaluate and reflect on their own performance, and provide feedback on their progress. Teachers must also model their own thinking and reasoning strategies for their students.
  8. Because students develop holistically, their learning is affected by the social, emotional and intellectual climate of the classroom. We are all intellectual, social and emotional beings and any learning activity needs to take all of these dimensions into account. The social and emotional aspects of the environment will influence the learning process. For example, in trusted settings, we may be more likely to take creative risks, whereas if we fear ridicule we are more likely to disengage from the process completely.

Note: I wrote a similar post earlier in the year, on the theoretical underpinnings of problem-based learning, which has some of the same ideas, as well as an even earlier post on the principles of authentic learning.

Small group teaching

This is the first draft of an articles that published in my Clinical Teacher mobile app.


Small group learning is one of several educational strategies used to promote student learning, as it promotes a student-centred approach in the educational context (as opposed to a teacher-centred approach, in which the teacher determines the objectives, content to be covered and assessment tasks). There are a variety of benefits associated with learning in small groups, which is why they are often integrated into different learning approaches. For example, working in small group is usually an integral component of problem-based learning (Dent & Harden, 2005).

The learning objectives are what should determine the teaching strategy and as such, small group learning should not be seen as universally appropriate for all educational contexts. In addition, the success of small group learning will be influenced by the availability of resources, including physical space, facilitators and materials. In addition, the relative experience of the facilitators can play a major role in the outcomes of the learning experience.

There are four important group characteristics for small group learning to be effective:

  • There should be active participation and interaction among all group members
  • There should be a clearly defined, specific task or objective/s, that the group is working towards
  • The group should reflect on learning experiences and modify their behaviour accordingly
  • There is no defined number of students that should be in a small group, and in fact, the size is often dictated by the availability of facilitators and other resources

Advantages of small group teaching

Students have opportunities to develop important skills for working in multidisciplinary teams. They learn how to communicate effectively, as they are encouraged to discuss new concepts that arise. They learn how to prioritise tasks, which is usually a component of the PBL process (Kitchen, 2012; Dent & Harden, 2005; Crosby, 1997; Entwhistle, Thompson & Tait, 1992; Walton, 1997).

  1. Promotes ‘deep’ learning: Encourages deep learning and higher order cognitive activities, such as analysis, evaluation and synthesis. Engage by being active participants in the learning process, as opposed to passively “absorbing” information.
  2. Develops critical thinking skills: Allows students to develop critical thinking by exploring issues together and testing hypotheses that are difficult to do well in a lecture. This practice develops problem-solving skills.
  3. Promotes discussion and communication skills: Environment is conducive to discussion. Students do not feel exposed or hidden, but are comfortable. Each student is encouraged to actively participate.
  4. Active and adult learning: Help identify what a student does not understand, and discussion aids understanding by activating previously acquired knowledge. Students are encouraged to reflect on their experiences and develop self-regulatory skills.
  5. Self motivation: Encourages involvement in the learning process, increasing motivation and learning. By taking responsibility for their learning they become self-motivated rather than being motivated by external factors e.g. the lecturer (teacher-centred approaches usually do not facilitate self-directed learning).
  6. Develops transferable skills: Helps develop skills necessary for clinical practice, e.g. leadership, teamwork, organisation, prioritisation, providing support and encouragement for colleagues, problem solving and time management.
  7. Application and development of ideas: Yields opportunities to apply ideas and consider potential outcomes. Making connections during group discussion enhances student understanding.
  8. Tutor as a role model: A logical and systematic tutor approach demonstrating ‘transferable’ skills motivates student learning and development.
  9. Recognises prior learning: Students are encouraged to surface their own prior knowledge, including their own perceptions (and misconceptions) of material previously covered.
  10. Social aspects of learning: Participation and social aspects of small group learning means that learning is more enjoyable than solitary approaches.
  11. Encourages alternative viewpoints: Encourages an awareness of different perspectives on various topics and can therefore help develop an attitude of tolerance.

Small group processes

“Appropriate ground rules make students feel ‘safer’ in sharing and expressing their views” – Kitchen (2010)

Students often find that working in small groups is a greater challenge than expected, probably because they are used to situations in which they work as individuals within a group. However, when individual success is dependent on the group cohesion and collaboration, and the group struggles to perform effectively, students may resist the process. It is therefore important to make them aware of the normal progression of group development (Tuckman & Jensen, 1977).

  1. Forming – a collection of individuals attempting to establish their identity within the group
  2. Storming – characterised by conflict and dissatisfaction that may lead to the development of trust
  3. Norming – attempts to function effectively by developing a sense of group identity and norms
  4. Performing – group performs at an optimal level by being focused on the task, and manages disagreement appropriately

The role of the facilitator

“Small group productivity depends on good facilitation, rather than on topic knowledge” BUT “Less than one third (of clinicians) have received formal training in small group teaching” – Kitchen (2010)

The facilitator plays an essential role in small group, and traditionally would design the module. This would include the development or preparation of stimulus material, which can be in the form of questions, scenarios, images, video, research papers or case studies (Kitchen, 2012). In addition, the facilitator would present the objectives of the session, initiate the process, encourage participation, promote discussion and close the session. In these cases, the facilitator is very clearly leading the process and is in control. This approach is probably the one that most clinical educators are familiar with, and derives from a combination of ability, expertise, experience and enthusiasm. However, when the facilitator clearly dominates the process, self-directed learning and interaction between learners can be limited. Increasingly, small group learning is looking to students to provide more initiative, explore learning options, test hypotheses, develop solutions and review outcomes. In these situations the role of the tutor is less clear and will vary depending on the type of learners making up the groups.

The facilitator/s (often, small groups have multiple facilitators) must all be informed of the objectives of the session. If not, there is the possibility of different groups moving in different directions. This is not as much of a problem if exploration of a concept is the goal. However, if all groups are meant to achieve the same objective, consistency among facilitators is important. For this reason, staff training is vital whenever small groups are being considered as a teaching strategy. It is important to understand that, while content-specific expertise is useful, facilitation skills are essential.

“A fundamental feature of effective facilitation is to make participants feel that they are valued as separate, unique individuals deserving of respect” – Brookfield (1986)

One of the most important roles of the facilitator is to ensure that an atmosphere of trust and collaborative enquiry is created in the small group. This can be achieved by the group setting their own norms and objectives for the session, or if they are inexperienced in groupwork, for the facilitator to guide them through this process. It would also be useful to have the students express their own expectations for the session, especially of their role and responsibilities in the group. As the group members grow in experience, they should take over more and more of the facilitators role, until it may be difficult to tell them apart. As the learners take more control of the group session, more traditional teachers and facilitators may have a challenge adjusting to the new dynamic.

Finally, it is the responsibility of the facilitator to arrive early in order to check that the venue is appropriately prepared for the session. Arriving early is not only useful in order to ensure that the session runs smoothly, but also to set an example for students.

Assessment of small groups

“With undergraduate medical education currently carrying a health warning because of the stress and anxiety exhibited by students and young graduates, any educational process that promotes enjoyment of learning without loss of basic knowledge must be a good thing” – Bligh (1995)

As with all assessment, it is important for students to be aware of the assessment process and outcomes. Teachers and facilitators must decide beforehand on the nature of the assessment task, as well as whether it will be formative or summative, and who will be responsible for conducting it. If the person responsible for assessing the students is also involved with facilitating the groups, it is especially important for students to feel that the environment is a safe space. If not, they may be reluctant to fully participate in the process, as in doing so, they may reveal their ignorance and therefore be vulnerable. This may be addressed by the facilitator being open and discussing their role in assessment as part of the process. If students will be evaluating the facilitators, there may also be a sense of shared responsibility for assessment, thereby “equalising” the balance of power in the relationship.

Assessing the group outcomes is reasonably straightforward and can relate to either the achievement of objectives, or the process of working in a group. Determining the achievement of objectives can be be through student self-report, facilitator observations, or observation by an external assessor. While the assessment of individuals within the group is more challenging it is nonetheless possible, especially when students are able to assist in the process by evaluating their peers. Individual performance can be measured through attendance, contribution or participation, conducting research for the group, and by supporting or encouraging others.

Challenges when working in small groups

“The size of a small group is less important than the characteristics of the group” – Dent & Harden (2005)

When considering implementing small group learning in your course, bear in mind that a change in teaching approach should complement the overall programme strategy and objectives, as well as actually enhance the learning experience. Small group learning should be seen as an integrated component of the curriculum and should be related to other components. In other words, small group learning should be seen as a simple addition.

Often, busy clinical teachers struggle to find the time to implement small group learning strategies, especially when you take continuity of the teaching experience into account. However, this has an impact on scheduling of other teaching activities, which can be challenging to arrange. Careful planning is therefore an important aspect of integrating small groups into the curriculum.

There is a perception that students do not enjoy working in small groups. However, this is possibly based on situations in which students either were not able achieve the objectives, or their learning experience was poor. Careful planning and design are essential in order for the group to successfully achieve the outcomes that are set. Too often, teachers think that group work is about a group of individuals working in a team. It is essential for the groups’ success to be based on cooperative behaviour. In other words, the individuals must work together in order to achieve shared goals that are difficult to achieve as individuals.

Practice points

  • Working in small groups is characterised by student participation and interaction, in order to promote student learning.
  • The size of the group is dependent on the learning activity, although 3-6 students is usually recommended. The size of the group is less important than the group characteristics.
  • Facilitator training is an essential factor for small group success, although most small group facilitators have received no formal training.
  • Integrating small group learning into a curriculum should be carefully considered as part of an overall teaching and learning strategy, rather than as an addition.


Small group work can be an exciting and engaging approach to teaching and learning practice, especially if it is implemented with careful thought and consideration as part of an integrated curricular strategy. The reasons for making the choice should be pedagogical and as such, have educational advantages as the primary motivating factor for the move. Small group teaching has been shown to be beneficial in terms of developing self-directed approaches to learning, critical thinking and reasoning, tolerance of the views and perspectives of others, and the development of interpersonal skills. While there are challenges in its implementation, they can be addressed with thoughtful design and regular feedback from all stakeholders.

References and other sources

Case-based learning


It is useful to think of case-based learning (CBL) as a teaching method that uses a set of events unfolding over time to stimulate an activity (Shulman, 1992). In clinical education cases make use of clinical narratives to create an authentic learning activity. CBL represents an approach to unstructured learning that can nonetheless be scaffolded in the sense that students choose the details of what they want to explore, while the case designer chooses the broad themes that must be covered. It is therefore an attempt to convey a balanced, multidimensional representation of the context, participants and reality of a clinical situation.

Cases are based on complex clinical situations or problems that should aim to stimulate discussion and collaborative groupwork among students (Flynn & Klein, 2001). They usually involve the interactive, student-centred exploration of those problems while being guided by facilitators. Since the cases are complex, students must analyse them as they try to resolve problems and answer questions that have no single, or simple, correct answer.

Case-based learning reduces the likelihood of students constructing inert knowledge that is decontextualised from how that knowledge will be used in the real world. If the case is an accurate representation of what can be expected in the real world, then the knowledge produced is more likely to be of use when they encounter similar events in the clinical context.

Benefits of CBL

CBL offers the following advantages (David, 1954; Flynn & Klein, 2001; Herreid, 1997; Lombardi, 2007):

  • It provides students with authentic situations in which to explore and apply a range of behaviors and information that can strengthen the learning of knowledge that transfers between different situations.
  • When students participate in the analysis and discussion of alternative solutions they come to better understand difficult or complicated issues and analyse them more effectively.
  • The emphasis on the process of decision making requires students to synthesise information from a variety of disciplines and subject areas.
  • Students can use the case as a base from which to launch their own, personally meaningful investigations into a topic or theme.
  • New technologies and resources can be integrated in order to solve problems. The use of images, video, audio and collaborative writing platforms can enhance the case, increasing the authentic context that promotes deep learning.
  • Cases can help students develop multiple perspectives, as opposed to hearing about patient management from only one point of view (usually the lecturer’s). Cases emphasise the value of interdisciplinary and collaborative approaches, skills that are increasingly important in health care systems.
  • In the process of finding solutions and making decisions through collaborative group work, students must sort out factual data, apply analytic tools, discuss issues, reflect on their experiences, and draw conclusions that can be related to new situations. Through this, they develop analytic, collaborative, and communication skills that are essential for the clinical context.
  • Cases provide students with the opportunity to see how to apply theory in practice. This can lead to graduating students who are more engaged, interested, and involved in the clinical environment.
  • CBL develops students’ skills in group learning, public speaking, and critical thinking.
  • Cases can be used effectively with both large and small classes or groups.

In summary, the benefits of using CBL in the classroom can lead to the development of knowledge that is not decontextualised, as well as skills that are relevant for working as part of multidisciplinary clinical teams.

Theoretical foundations of CBL

Collins (1988, pg. 2) described the idea of “learning knowledge and skills in contexts that reflect the way they will be used in real life”, as situated learning and cognition. When decontextualised material is presented to students (as it is during a lecture), they have difficulty deciding how to integrate that knowledge into their practice i.e. to bridge the gap between the classroom and clinical spaces. Being able to use information effectively requires that students learn it in the same, or similar, contexts as those in which they will be expected to use it. When knowledge and context are separated, knowledge is seen by learners as a product of education, rather than a tool to be used within dynamic, real-world situations. Authentic learning positions the task as the central focus for authentic activity, and is grounded in the situated cognition model (Brown et al, 1989; Herrington, Oliver & Reeves, 2003). In other words, meaningful learning will only take place when it happens in the same social and physical context in which it is to be used.

In addition, to situated learning and authentic learning, CBL also draws on elements of constructivism, in which students actively work to construct their own meaning from the learning opportunities presented to them. No matter what the intention of the teacher is, if students do not engage with the learning experience, they will have difficulty integrating the concepts that the teacher is presenting (Prideux, 2005). Social constructivism builds on this concept still further, and suggests that meaningful knowledge is only developed through discourse with a more knowledgeable other (Vygotsky, 1978). The teacher (or more experienced peer) helps guide the student through the zone of proximal development, the conceptual distance between what the student can do alone and what they can only do with the assistance of another (Vygotsky, 1978).

It is clear then, that CBL as a teaching and learning method has significant theoretical support, offering more than a practical framework for the design of classroom activities. It is an approach that helps students develop the ability to apply abstract concepts and ideas to clinical situations, in an authentic context that leads to personally meaningful learning.

Common characteristics of cases

While cases can cover a broad range of topics, patients, conditions and environments, most effective cases have the following generic characteristics (adapted from Dolmans et al., 2009; Flynn & Klein, 2001; Herried, 1997; Wasserman, 1994):

  • Content should be closely aligned with one or more of the overall learning objectives for the course or module.
  • They tell a story and focus on a current issue that arouses interest. It should draw the reader into the story and enhance interest in the subject matter, helping to sustain discussion about possible solutions and encourage students to explore alternatives. The ending of the narrative could be open-ended, allowing students to develop their own conclusions.
  • It should be well-written and appropriate for the level of the students and could include direct quotes, using the characters’ dialogue to tell the story. It should be compelling and create empathy with characters, aiming not only to make it more engaging but because the attributes of the characters can influence the decisions that students make.
  • Include situations that students know about or are likely to face, therefore making it worth their while to complete. The content should adapt well to their prior knowledge and contain cues that stimulate them to use that knowledge.
  • Stimulate self-directed learning by encouraging students to generate their own learning outcomes and conduct literature searches in order to answer research questions that they come up with themselves.
  • Should provoke conflict and force decision-making, clearly presenting the dilemma but not resolving it. Include conflict or ambiguity so that students do not agree on the outcome, encouraging compromise and decision-making.
  • Collaboration and cooperation should be encouraged, rather than competition.
  • The case should be short. It is easier to hold someone’s attention for brief periods than long ones.

Designing effective cases

Before beginning to design the case, it’s important to determine what the objectives of the case will be. Begin by explicitly stating the purpose of the case and what specific knowledge and skills you’re trying to develop in the students (Dent & Harden, 2005). Provide some background for the case by inserting it into a larger health system context, which serves to inform students why they are going to be working on this particular case and why it is appropriate for them as part of their training. By making it more relevant, they are more likely to actively engage with it. Learning outcomes might need to be changed in order to reflect the idea that the knowledge gained should be used as a tool as part of a process, rather than an end in itself. In other words, it’s not enough to know a series of facts, but rather how those facts can be applied to solve real-world clinical problems. Designing authentic tasks is challenging, and readers are encouraged to review Authentic Learning as a framework to guide this process (Herrington, Oliver & Reeves, 2003).

It is useful to design cases that based on actual patients, which serves to increase its authenticity, as well as leaving less room for error (Marks & Humphrey-Murto, 2005). Place less emphasis on the volume of content to be covered and spend more time designing cases that facilitate the development of critical thinking and clinical reasoning. Pay attention to preparing resources for the case, including artefacts like policy documents, X-rays, referral letters, research papers, readings from textbooks, images of real patients, and videos. The range of materials is enormous and depends on the level of the students, complexity of the case, the creativity of the case designer and objectives of the module. These resources should be as authentic as possible in order to reduce the cognitive dissonance experienced by students when the classroom context is logically inconsistent with reality.

It should be noted that the key to success is the quality of the small group discussion, which is an integral aspect of CBL (Christensen 1987; Flynn & Klein, 2001; Wetley, 1989). Without the discourse associated with exploring new territory, students will not have the opportunity to analyse, generate and evaluate solutions, solve problems, or make decisions. These are the types of learning activities that give students an active role in the learning process, thereby helping them to develop and improve their higher-order thinking abilities. The content of cases and the process of discussion are therefore inseparable in CBL and designers should ensure that reasonable time is allocated for this activity.

Generic content, or content that is relevant across a wide range of contexts, should be included in multiple cases in order to show students the different ways it can be used. For example, hypertension is a concept that is relevant for a range of cases that could involve heart disease, amputation, stroke and maternal health. The same is true of professional ethics, which can be explored across a diverse range of cases. In this way, the student is introduced to the idea that information can be used in many different ways, and that knowing the facts is less important than knowing how those facts can be used to solve problems in different contexts.

Finally, a multi-disciplinary team approach is recommended when designing cases. This has several advantages, including the increased likelihood of catching errors, more creativity, better resources, the inclusion of domain-specific expertise and ultimately, a more authentic case.

Preparing students for CBL

If this is the first time students are faced with CBL they will most likely have a few concerns. These can include the fact that they will be more responsible for their learning, the realisation that they are covering less content than friends from other classes or institutions (who are not using CBL), and general anxiety because the approach is new to them. These concerns can be addressed by discussing with them (as many times as necessary) the benefits of using CBL. You can also use one session to guide them through the process of completing a case, possibly with a topic that isn’t formally included in the course, to take the pressure off of getting the “right” answer.

While we may like to think that our students are capable of working collaboratively in groups, we often find that they work cooperatively as individuals. They split the work into smaller chunks and then assign those chunks to people in the group with one person taking responsibility for combining all the pieces at the end. The problem with this is that no single member of the group actively works on the project as a whole. Even the person who combines it all is only acting as an editor, giving a consistent aesthetic and voice to the content. Without actively engaging with all of it throughout the process, this form of cooperative groupwork has little value in CBL. Therefore, students will have to be taught and guided through a process of collaborative groupwork, including how to allocate roles, what those roles should be, how to negotiate group norms, setting consequences for failure to comply with group norms, resolving conflict, reporting what is learned back to the group and a host of other skills necessary for effective groupwork.

Designers should aim to create a space in the module for students to share and discuss their concerns, helping them to resolve any issues that arise. As they become more experienced with working in groups students will begin resolving their own problems.

Working through a case

Working through a case usually involves the following problem-based approach, although the specific steps used will likely be an adaptation of this. The following structure (or some variation of it) is usually used by groups when working through a case.

  1. One person reads the case out loud for the group.
  2. The group members identify words and phrases they don’t understand.
  3. They confirm what they do understand, and ensure that they all have the same understanding.
  4. Identify the clinical or functional problems (depending on the objectives of the case) that may arise as a result of the information presented.
  5. Brainstorm possible causes of the problems, taking on board every suggestion no matter how unlikely. This needs to be a safe space for students to be OK with sharing openly and without judgment.
  6. Structuring and hypothesis: students begin to systematically and logically explore relationships between concepts, narrowing down possible causes of the problems identified. They should create a list of statements that look something like “We believe that….because of….”
  7. Generate research questions in order to fill in the gaps in understanding and to “prove” the statements that they have made.
  8. Conduct research in order to find evidence to support (or refute) the statements.
  9. Finish with a set of notes that: i) Define words and phrases relevant to the case. ii) Present problems the patient is likely to have, possibly using the International Classification of Function (ICF), or another outcome measure that they would be expected to use in the clinical context. iii) Highlight relationships between clinical presentation and functional problems, supported by evidence. iv) Document the appropriate assessment and management of the patient. v) Note that the items presented above would vary significantly depending on the type of case, and the learning outcomes described at the outset.
  10. At the next session, each member of the small groups present to each other within the small groups. The purpose of this is to consolidate what has been learned, clarify important concepts and identify how the group is going to move forward (if the case is still not complete).
  11. At the end of each week each small group presents to the larger group. This gives them the opportunity to evaluate their own work in relation to the work of others, to make sure that all of the major concepts are included in their case notes, and the opportunity to learn and practice their presentation skills. Students could also be expected to evaluate other groups’ work.
  12. Note that students may begin moving between steps as they develop their clinical reasoning skills, which is only a problem if the process becomes one of unthinking, rote behaviour, in which case completing the activity will not have the desired impact on critical thinking.

In addition to the more detailed steps listed above, students could also use a simpler, six step IDEALS approach when working through a case:

  1. Identify the problem (What is the real question we are facing?)
  2. Define the context (What are the facts that frame this problem?)
  3. Enumerate the choices (What are the plausible actions?)
  4. Analyse the options (What is the best course of action?)
  5. List reasons explicitly (why is this the best course of action?)
  6. Self-correct (What did we miss?)

Using the questions above, they begin to get a sense of the case and what it is about as well as situating themselves and their prior knowledge within that context. They identify the basic concepts and questions that will serve as a basis for progressing through the rest of the case. This approach helps to create a broad outline for the case before delving into the more complex aspects. For very simple cases students can also be guided by the following questions:

  • What do I know that will help me to solve this problem?
  • What do I think I know that I’m uncertain of?
  • What don’t I know that I need to learn more about?

A typical case is designed to be integrated with small group learning. However, it is also possible to create shorter, less complex cases that can be resolved independently as part of self-study. Note that students will need to be quite motivated to work through cases alone and the facilitator should still be available for short discussion and guidance. Remember that cases are a type of formative learning experience, where the process of working through the case is more important than the final product i.e the completed case.

Cases can also be distributed to students before or after a lecture, so that they can prepare for the work ahead, or to consolidate what has been covered. In these situations, the case would more likely contain more information, and leave fewer gaps because the objective is less about stimulating critical thinking, and more about revising content in an authentic, clinical context.

The role of the facilitator

Different facilitators take on different roles during the CBL process. They are, at various stages students, listeners, analysts, questioners, paraphrasers and lecturers, and it is important to recognise that this can have a significant impact on the students’ experience. Try to avoid having the facilitator take on the “teacher” role too often, providing students with the answers to all of their questions. The “all-knowing” facilitator who is the inquisitor, judge and jury can be seen as trying to extract wisdom from the student “victim”. In its worst form it can be a version of “I’ve got a secret, and you have to guess it.” But, in its best form it can bring about an intellectual awakening as insights emerge from a complex case.

The facilitator should aim to stay on the sidelines as the students take over the analysis but can begin the discussion by simply saying, “Well, what do you think about the case?” From then on, they may simply ensure that some semblance of order is kept and that all students in the group get to voice their views. They should also try to avoid being too far on the periphery and not providing students with the structure they need to not feel lost. Highlight the fact that they don’t have all the answers and that they are co-learners in the classroom.

The facilitator should aim to guide the discussion but not control it, which requires the confidence to give up control. This is the only way to get students to actively construct their own learning experiences by asking questions, gathering information, testing hypotheses, and convincing others of their findings. During this process, facilitators should work with the groups in order to make sure that students have not left out important concepts as they progress through the case.

It is important that the facilitator withholds personal or professional judgments and opinions during discussions. They need to guide the discussion in a way that generates as many different issues, perceptions and solutions as possible, which will be limited if they project their own opinions into the discussion. Using the basic questions, “who, what, why, when and where” helps to engage the students in the activity. Facilitators must also summarise the main concepts and ask questions that help students identify issues and stay on track, but that also do not lead them to a specific conclusion. Facilitating student discussion may appear to be simple but in reality it requires skill in helping students explore and discuss the case in ways that maximises their learning opportunities.

The facilitator’s work can be divided into two broad general categories: setting up the learning environment and facilitating discussion and exploration (Blackmon, Hong & Choi, 2007). They should provide the context for the class and the depth to which students should explore questions. They can also decide which questions are prioritised and which ones can be answered via different methods e.g. lectures, essays, or assignments. It is worth noting that CBL may not be appropriate for every aspect of the curriculum.

Finally, the facilitator needs to add additional information and be able to direct students to resources that are appropriate to the topic (Blackmon, Hong & Choi, 2007). Most practitioners of the discussion method prefer a middle ground, with the facilitator providing an introduction, directed but not dominating questioning, highlighting the essential issues, and an appropriate summary (Welty, 1989).

The role of the student

Although some teachers will assign cases as the basis for individual work, many would argue that discussion in groups is at the core of the CBL approach. The group discussion in CBL can be an effective and motivating method of learning if students are well-prepared and given time for both individual preparation and group discussion (Flynn & Klein, 2001). You might even say that the student’s role is as important as that of the facilitator. Students who take their “jobs” seriously in CBL will prepare in advance by reading through the cases and describing the issues, perceptions, and possible courses of action. They could also review relevant materials in advance if the case is presented early enough.

In addition to preparation the successful student will continually evaluate the proposed solutions and reflect on what is learned and what still needs to be learned. In this process of evaluating and reflecting, they are able to take more responsibility for, and control of, their own learning. Finally, the student must commit to working collaboratively with their peers. Even students who reported disliking groupwork were more satisfied with their learning experience than those who worked alone (Flynn & Klein, 2001). While working through cases, students should aim to:

  • Engage with the characters and circumstances of the story
  • Identify and define the problems as they perceive them
  • Connect the meaning of the story to the clinical and professional context
  • Bring their own prior knowledge and principles to bear on the problem
  • Highlight relevant points and questions, and defend their positions
  • Formulate strategies to analyse the data and to generate possible solutions
  • Work with others to develop a collaborative solution to the problem

Case-based assessment

Initially, assessment and performance evaluation in CBL may seem daunting, as it can be more subjective than other methods and some teachers may be uncomfortable with that. However, with careful planning and preparation, assessment in CBL can be done efficiently, effectively and fairly. Students might also be uncomfortable with assessment, especially those who are accustomed to multiple choice or other forms of assessment that have clear right and wrong answers. This is one reason why the learning objectives need to be established at the beginning, and referred to regularly. Once those are clear and students understand what is expected of them, they should be able to keep track of their own progress and play a greater role in regulating their learning (Wasserman,1994).

The following questions should be considered when deciding how to evaluate a case (Schneider, 2010):

  • What parts of the process need to be assessed?
  • What parts can be graded as a group?
  • What can be submitted for individual assessment?
  • What are the time constraints for the grading?
  • How do you balance grading workload with the need to externally motivate student performance?
  • How will you ensure that the students actually know the content?

Assessing a student who has used a CBL approach can make use of something called key-feature approach questioning (Schuwirth & van der Vleuten, 2005). In this context, the assessor can use short cases that are followed by a limited number of questions aimed at addressing specific decisions that the student must make. Ensure that all of the information necessary to answer the question is presented in the case; not only medical information, but contextual information as well. Ensure that the questions are directly linked to the case, so that the correct answer is based on the students’ ability to integrate all of the relevant information in the case i.e. students should not be able to answer the question without comprehending the case. Ensure the question elicits important decisions where an incorrect decision would lead to incorrect management of the patient.

Teachers and students may both find scoring rubrics helpful, as these can help to establish a clear picture of successful behaviour or work quality, removing subjectivity and some of the ambiguity inherent in using CBL. Cases and group performance can also be assessed with case presentations, which are conducted at the completion of a case. Facilitators and other students can challenge the approaches and outcomes of the case, using a rubric that is distributed to students well before the presentations.


Case-based learning provides opportunities for the richer, deeper exploration of concepts and ideas in clinically-orientated teaching and learning. Students are able to develop experience in analysing ideas and applying concepts to solve problems, rather than simply acquiring abstract knowledge. It also requires students to engage with one another and their environment and facilitate the development of a wide range of social and cognitive skills. Case-based learning requires careful preparation and skilled facilitation on the part of teachers, as they aim to guide students towards personal learning, as opposed to providing them with content. Assessing student learning and evaluating their performance requires more than the traditional multiple choice or short-answer tests. Clear learning objectives, performance standards and relevant criteria can help enable teachers use a more holistic approach in order to better tailor the learning activities to students’ needs. Case-based learning is a valuable teaching and learning method that aims to develop contextualised knowledge and skills that will help students succeed in the clinical context.

References and Resources

  • Association of American Medical Colleges (1984). Physicians for the 21st century: Report of the project panel on the general professional education of the physicians and college preparation for medicine. Journal of Medical Education, 59, part 2:1-208.
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  • Christensen, C. R. (1987). Teaching and the case method. Boston: Harvard Business School Press.
  • Collins, A. (1988). Cognitive apprenticeship and instructional technology. Technical Report No. 6899. BBN Labs Inc., Cambridge, MA.
  • David, D.K. (1954). Forward In McNair, M.P. (Ed.), The case method at the Harvard business school. New York: McGraw-Hill (p.viii).
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  • Schuwirth, L.W.T. & van der Vleuten, C.P.M. (2005). Written assessments. In Dent, J.A. & Harden, R.M. (Eds). A practical guide for medical teachers. Elsevier.
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  • Vygotsky, L. S. (1978). Mind in society: The development of higher psychological processes. Cambridge, MA: Harvard University Press.
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  • Washington University in St. Louis (n.d.). Asking questions to improve learning. The Teaching Center, accessed 11 January, 2013 at http://teachingcenter.wustl.edu/asking-questions-improve-learning.
  • Wenger, E. (1998). Communities of practice. Cambridge University Press, New York.
  • Weltey, W. (1989). Discussion method teaching: A practical guide. Change, July/August, 40-49.

Interview: The use of technology-mediated teaching and learning in physiotherapy education

Selection_001I was recently asked to do a short interview by Physiospot, on the use of technology-mediated teaching and learning in physiotherapy education. As it turns out, the bulk of the interview relates more specifically to a Scholarship of Teaching and Learning, rather than the use of technology. However, I think that this makes it potentially more relevant for physiotherapy educators, especially those who may not be interested in the “technology” aspect. Thanks to Rachael Lowe at Physiospot for the invitation to chat.

Here is the link to the interview.