Lessons in Implementing Virtual Case-Based Learning

Dr. Hanh Huynh, Supervisor, Jessica Dawson and Geoffrey Ching – part of the required FLEX project

What problem was addressed?

In March 2020, 1st and 2nd year medical curricula at the University were shifted from an in-person to a virtual format to comply with provincial health authority guidelines in the face of the COVID-19 pandemic. This posed a logistical challenge to the faculty responsible for medical education implementation as early undergraduate medical education at the University is built around a combination of both didactic and case-based learning (CBL). While didactic learning was easily transitioned to an online format with the use of previously recorded video lectures, little literature exists on virtual CBL. As such, CBL was experimentally transitioned to a video-based group discussion format.

Jessica Dawson, fourth year med students

What was tried?

Literature on virtual CBL is scant and unfocused and did not provide a unified understanding as to the effectiveness of a virtual, collaborative CBL model in comparison to an in-person model. In fact, our literature review yielded only an overview of the effectiveness of online learning in medical education. Interestingly, a study by Kamin et al. (2003) at the University of Colorado found that virtual groups had higher critical-thinking ratios in comparison to face-to-face groups based off of pre-existing coding schemes reflective of critical-thinking stages [1].

To our knowledge, no studies on the effectiveness of video CBL using narrative analysis as a means to holistically assess student and tutor-perceived performance measures exist. As such, an online survey following the University medical school transition to virtual CBL was carried out in order to determine the effectiveness of this alternative format of CBL and its associated challenges. This survey was provided to 576 [both 1st and 2nd year] medical students and their 72 CBL tutors. Thematic analysis of answers to 8 questions targeted to students and 9 questions targeted to CBL tutors surveying the strengths, weaknesses, and potential points of improvement for future virtual CBL sessions or other medical virtual learning sessions was then carried out on the survey answers.

Lessons Learned

Lessons Learned 18% (51/288) of 1st year medical students, 16% (45/288) of 2nd year medical students, 81% (29/36) of 1st year CBL tutors, and 69% (25/36) of second year CBL tutors responded to the survey. Better work-life balance (e.g., no commute to the university), technologically enhanced collaboration, improved facilitation, and a better learning environment were cited as benefits of virtual CBL. However, technology issues (e.g., lack of white board as a focal point of discussion), distracting learning environments (e.g., home surrounding, easy access to social media like Facebook), and facilitation difficulties (e.g., loss of the opportunity for reading body language) were cited as challenges in virtual CBL. Over 60% of tutors and 49% of students felt that the learning experience in virtual CBL was much worse or slightly worse than the in-person experience of CBL.

Recommended strategies to improve the learning and overall experience associated with virtual CBL included assigning student facilitation roles, turn taking, expert adoption of technology as problem solving methods, and implementation of collaborative customs and attitudes.

Geoffrey Ching , fourth year med students


1. Kamin, Carol, EdD; O'Sullivan, Patricia, EdD; Deterding, Robin, MD; Younger, Monica, MS A Comparison of Critical Thinking in Groups of Third-year Medical Students in Text, Video, and Virtual PBL Case Modalities, Academic Medicine: February 2003 - Volume 78 - Issue 2 - pages 204 – 211.

Submitted to “Medical Education” in Sept 28, 2020 and accepted for publication on Feb 9, 2021.