Incorporation of a clinically oriented case study into a multi‐subject medical school block increased student engagement in a remote learning environment

Abstract

At Texas Tech University Health Sciences Center School of Medicine, our curriculum begins with rigorous and fast-paced basic science blocks followed by clinical clerkships. During the first semester of the first year, medical students take a combined Biochemistry, Cell Biology and Histology block (called BCT) after successfully finishing an anatomy block. Historically, the medical students have had difficulties in both assimilating the amount of content presented and in appreciating how the topics covered in BCT help them better understand the pathophysiology and treatment of diseases. Further, because the COVID-19 environment prompted a change from a categorical to a Pass/Fail grading system and shifted the delivery of didactic material from in-person to remote learning, retention of student engagement became a priority. It has been demonstrated by others that using clinical correlations to teach basic science concepts is an effective way to enhance student engagement and retention of basic science knowledge. The primary hypothesis for this study was that student engagement and interest in basic science knowledge would be enhanced by the incorporation of a clinically oriented, case-based exercise. A second hypothesis was that students would be able to apply information provided during lectures to successfully complete it. The BCT block is 8 weeks long and consists of 3 units primarily focused on medical biochemistry (unit 1), cell biology (unit 2) and histology (unit 3). The case study, focused on diabetes, was designed to run as a ?thread? through all of the units and build in complexity with each unit in order to better understand the pathophysiology of this disease. The case was revealed progressively in three units, each of which consisted of a portion of an hypothetical scenario and a matched, five-question quiz that was offered both at the beginning and the end of each unit. The correct answers were given to the students after completion of each post-quiz. To enhance student participation, 2% was added to their grade after successful completion of at least 3 quizzes. Comparison of the pre- and post-quiz data revealed that for units 1 and 3, students scored significantly higher on post-quizzes as compared to pre-quizzes (unit 1- 86% vs 48%, a 78% change, and unit 3- 66% vs 61%, an 8.9% change). For unit 2, there was a trend toward significance;however, the average post-quiz score (87% vs 83%, a 4.5% change) was not significantly different from the pre-quiz score (p=0.07). Students responded favorably to the exercise (as reported in an end-of-block survey), wherein it was ranked higher as a learning resource than any of the recommended textbooks or atlases. Collectively, these data reveal that addition of a case study effectively enhances students learning of the didactic material as well as their ability to apply basic science knowledge to a clinical case-based scenario.