Tärnvik Arne
Department of Clinical Microbiology, Umeå University, Sweden.
Med Teach. 2007 Feb;29(1):e32-6. doi: 10.1080/01421590601039968.
In current renewal of medical education, problem-based learning (PBL) is the predominant approach. PBL is afflicted with limitations, which cause uncertainness about its future. A profoundly different approach is the case method, developed a century ago and today attracting much less interest in developmental work than PBL.
To compare the characteristics of PBL and the case method and ask the question of whether the case method may serve as an alternative approach to student-centred learning.
The comparison was literature-based.
PBL implicates fostering of self-directed learning and its prospects deal with depth and retention of knowledge and clinical reasoning skills. Problems are used to define learning goals and to stimulate students' interest in various aspects of an item, rather than just for problem-solving. In the small-group tutorials of a PBL curriculum, the teacher is assigned to facilitate the process of self-directed learning and needs not necessarily be a subject-matter expert. In spite of its exciting philosophy and an increased input of students' and teachers' time, the superiority of PBL as a mode of learning has not been convincingly demonstrated, either in terms of acquisition of knowledge or in clinical performance. Moreover, dysfunction is a well-recognized phenomenon. In some PBL tutorials, indifference towards the group discussion is encountered, including individual quietness or dominant behaviour and incomplete attendance. To cope with dysfunctional problems, efforts are recommended aiming to increase PBL tutors' and students' understanding of the group process. As opposed to PBL, the case method relies strongly on teacher-directed learning. Students are placed in a dilemma or a problem to be solved. After preparatory work, they meet for a discussion, lead by a subject-matter expert, who preferably has experienced the case in reality. As a chairperson, the teacher is supposed to stimulate the discussion and detect gaps and misunderstandings. Due to its teacher-dependent approach to learning, the case method is less susceptible to group dysfunction. The case method is also less resource consuming, primarily because it can be practised in groups several times larger than those of PBL.
A revival of the case method seems warranted as an alternative means of interactive learning, which is simpler, easier to realize and less time-consuming with regard to both institutions and students.
在当前医学教育的改革中，基于问题的学习（PBL）是主要方法。PBL存在局限性，这使其未来发展具有不确定性。一种截然不同的方法是案例教学法，它在一个世纪前就已形成，如今在发展工作中所受关注远少于PBL。
比较PBL和案例教学法的特点，并探讨案例教学法是否可作为以学生为中心的学习的替代方法。
基于文献进行比较。
PBL涉及培养自主学习能力，其前景在于知识的深度掌握、留存以及临床推理技能。问题用于确定学习目标并激发学生对某一主题各方面的兴趣，而非仅仅用于解决问题。在PBL课程的小组辅导中，教师的职责是促进自主学习过程，不一定需要是学科专家。尽管PBL理念令人兴奋，且学生和教师投入的时间有所增加，但无论是在知识获取还是临床实践方面，PBL作为一种学习模式的优越性都未得到令人信服的证明。此外，功能失调是一个广为人知的现象。在一些PBL辅导中，会出现对小组讨论冷漠的情况，包括个别学生沉默或主导行为以及出勤不完整。为应对功能失调问题，建议努力提高PBL教师和学生对小组过程的理解。与PBL相反，案例教学法强烈依赖教师指导的学习。学生置身于一个有待解决的困境或问题中。经过准备工作后，他们会面进行讨论，由一位最好在现实中经历过该案例的学科专家主持。作为主持人，教师应激发讨论并发现差距和误解。由于其依赖教师的学习方式，案例教学法较不易出现小组功能失调。案例教学法消耗的资源也较少，主要是因为它可以在比PBL小组规模大几倍的小组中实施。
案例教学法作为一种交互式学习的替代方法似乎值得复兴，它更简单，更易于实施，对机构和学生而言耗时也更少。
