Thistlewaite et al defined case based learning in the following manner as “CBL is a form of inquiry based learning and fits on the continuum between structured and guided learning.” ⁽¹⁾.Further,  He also stated that “The goal of CBL is to prepare students for clinical practice, through the use of authentic clinical cases which  links theory to practice, through the application of knowledge to the cases, using inquiry-based learning methods^”(1).In an another article from Africa CBL is defined as “Case-based learning is structured so that trainees explore clinically relevant topics using open-ended questions with well-defined goals^.”(2). A modern definition of CBL is that CBL is a form of learning, which involves a clinical case, a problem or question to be solved, and a stated set of learning objectives with a measured outcome. ⁽³⁾ And Thus Using clinical cases to aid teaching has been termed as case-based learning (CBL)⁽³⁾.

CBL has been widely implemented as a teaching method to enhance learning by pushing students to work in teams to solve authentic problems, while developing content knowledge, reasoning, and interpersonal skills ⁽³⁾. Moreover, the involvement with problem-solving also helps to keep students interest in course material, since students may realize that they are learning skills needed to be successful in the field ^{(4, 5)}.The emphasis on ‘learning by doing’ forces students to be conscious of what information is already known about the problem, which information they need to know to solve it and the possible strategies to apply ^{(6, 7, 8)}.

In Traditional; Conventional Traditional Lecture Based method (CTM), students solely receive information from the lecturer and attempt to memorize the content instead of understanding the concepts and using them but still Case-based learning (CBL) is a practice underutilized in many colleges despite having many studies, which demonstrates how Problem solving can positively affect student engagement and retention of the knowledge. The purpose of this review was to improve educational implementation of Case-based learning in the classroom setting which will allow for increases in student engagement. Our study testified the student’s retention of knowledge with a formative assessment method which stands as a unique feature of this study and will let us know the impact of Case based learning on students’ knowledge retention. The research was focused on developing a module of Case Based Learning on Cardiovascular System testing the Academic performance of second phase medical students which will reveal the importance of implementation of Case based learning as a tool to increase student engagement and retention across the entire educational process.

Aim of the Study:

The present study was planned with an aim todevelop a module of Case Based Learning on Cardiovascular System and testthe Academic performance of second phase medical students

Objectives of the Study were:

1. To develop a module of  Case Based Learning on Cardiovascular System
2. To Assess/Measure the impact of Case based learning on students’ performance and retention of Knowledge.

Methodology:

The study was a Prospective Observational study and was conducted in the Department of Pharmacology, Nandkumar Singh Chouhan Government Medical College and Associated Hospital, Khandwa (M.P) India. The study was conducted after its approval by Institutional Ethics Committee, NSCGMC Khandwa vide letter no 90/IEC/NSCGMCK/2023.dated 28/07/2023.

Target Population: The batch 2021 students already pursuing the Pharmacology Subject were enrolled in this study.

Study Site:Dept. Of Pharmacology, Nandkumar Singh Chouhan Government   Medical College and Associated Hospital, Khandwa (M.P) India

Sample Size: 100-120 batch 2021 students already pursuing the Pharmacology Subject

Consent requirements:Voluntary informed consent was taken by the students.

Study Duration: 6 months.

1. 1. Inclusion Criteria:

All 120 Students already pursuing the Pharmacology Subject were selected in this study. Voluntary informed consent was taken by the students and those willing to participate were included in this study

1. 2. Exclusion Criteria:

Those not willing to participate /absent /had fallen sick during the study period will be excluded from this study

Developing a Module of Case Based Learning on

Cardiovascular System:

A Case based learning module was developed on Pharmacological aspects of cardiovascular system.The module so developed was validated by both external faculties and internally within the department.

Procedure:

1. The study involveddeveloping a module of Case Based Learning on Cardiovascular System testing the Academic performance of second phase medical students. The module developed was validated
2. After this, The study involved role of students and 100-120 studentswere enrolled in the study of current academic batch (2021 batch) which were divided in two groups of 50- students each as per the practical demonstration Batch A And Batch B. Voluntary informed consent were taken by the students and those not willing to participate were excluded from this study
3. Batch A and Batch B werealternatively given the  opportunity to be problem-solvers, explore their curiosity, and participate in a collaborative learning experience with their teacher by allocating them Case based learning group and Conventional teaching i.e. lecture teaching methodology for a particular system such as Cardiovascular System related to the subject Pharmacology .
4. Batch Awere allocated  to Case based learning group in one lecture topic and Batch B were allocated  to Conventional teaching i.e. lecture teaching methodology for the same lecture topic from  Cardiovascular System related to the subject Pharmacology, Vice versaBatch Bwere allocated  to Case based learning group in next lecture topic and Batch A were allocated  to Conventional teaching i.e. lecture teaching methodology for the same lecture topic in next lecture from  Cardiovascular System related to the subject Pharmacology. Cross over design pattern was followed for the whole cardiovascular system lectures.

Data Collection Methods:

An conjoint Assessment was done for both the batches per day on the lecture day after the scheduled lecture with an 25Multiple choice Question paper test and 5 Structured Short answer Questions (total 50 Marks Paper) for a duration of 1¹/2 hourfor the same Lecture topic taught on that day and performance of Both the batches were assessed.

v. Post feedback was taken from both the batches regarding the teaching methodologies and their impact on retention of knowledge and their liking for the teaching methodologies.

vi. Resultsof per day analysis of performance assessment were further tabulated and were compared in both the groups in i.e.Case based learning group Vs Conventional teaching i.e. lecture teaching methodology.

Process of Validation of Problem based Learning Module:

1. The CBL Module developed wassent for validation and wasvalidated by Faculty of Pharmacology withinthe institute as well as outside the institute before implementation in the classroom.
2. The question paper developed for conjoint assessment was discussed and validated by Faculty of Pharmacology within the institute before implementation within the classroom.

Feedback:

Post analysis feedback was taken from both the batches regarding the teaching methodologies and their impact on retention of knowledge and their liking for the teaching methodologies.

Statistical Analysis:

Test score was represented as Mean ± SD for the marks obtained and Independentt test was applied for testing the significance of Mean Score. P value < 5 %, was considered as statistically significant

Results:

Table 1: Comparative Assessment of Mean Score ofCBL and CTMMethodsbetween different topics of cardiovascular system using Independent t Test

Table 1. Reveals various Assessment of Mean Score of CBL and CTM Methods between different topics of cardiovascular system using Independent t Testof thisProspective Observational study between different topics of cardiovascular system taught between the two batches in an alternative cross over design pattern in Case based learning and Conventional teaching Method. On assessment of Anti-Anginal’s learning session test mean score was higher (26.80±6.77) in CTM as compared to CBL (22.43±6.38). The difference was found to be highly statistically significant as P value < 1 %. Similarly on Assessment of Anti-Arrhythmic’s learning sessions , test mean score was higher (26.95±4.80) in CTM as compared to CBL (19.84±6.76) which was also found to be highly statistically significant as P value < 1 %.  , But    On assessment of Anti-HypertensiveDrugs  learning session test mean score was higher (25.07±4.66) in CBL as compared to CTM (21.03±4.97), ). The difference was found to be highly statistically significant as P value < 1 %. In other three learning sessions assessment (Drugs for CHF, Drugs Affecting Rennin Angiotensin Aldosterone System, and Shock and its Management) the difference was not statistically significant as p value > 5 %.

Post feedback was taken from both the batches regarding the teaching methodologies and their impact on retention of knowledge and their liking for the teaching methodologies on a 5 pointLikert scale and majority of students showed the interest and liking towards Problem based learning with the clarity of thought and better academic interaction in comparison to conventional teaching classes.

Student Feedback Reflects that Coverage of the Course, also interest development  in CBL was much better than CTM, Also academic interaction was much better along with background knowledge provisions which favoured CBL and encouraged CBL as a better teaching learning tool. They found CBL session as more effective in developing analytical, problem solving skills and development of independent thinking.

Table 2: Student Feedback Analysis CBL VS CTM