case study in clinical biochemistry

Case Studies in Clinical Biochemistry

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T1 - Case Studies in Clinical Biochemistry

AU - Murphy, M.J.

AU - Srivastava, R.

AU - Gaw, Allan

N2 - Clinical Biochemistry is about patients - how we investigate their signs and symptoms, how we diagnose their illnesses and how we treat them. In this book the authors present a series of clinical cases, all based on real patients, and invite the reader to answer key questions using their knowledge and experience of each topic. Each case and its questions are accompanied by the authors' detailed answers, which can be found by simply turning the page. As such, it is an ideal revision aid for those studying Medicine, Nursing and Biomedical Sciences and for those preparing for post-graduate membership examinations.Case Studies in Clinical Biochemistry by Michael Murphy, Rajeev Srivastava and Allan Gaw was published in 2012. The book was incorporated in its entirety into the online sixth edition of Tietz: Fundamentals of Clinical Chemistry and Molecular Diagnostics - the 'bible' for clinical chemists everywhere.

AB - Clinical Biochemistry is about patients - how we investigate their signs and symptoms, how we diagnose their illnesses and how we treat them. In this book the authors present a series of clinical cases, all based on real patients, and invite the reader to answer key questions using their knowledge and experience of each topic. Each case and its questions are accompanied by the authors' detailed answers, which can be found by simply turning the page. As such, it is an ideal revision aid for those studying Medicine, Nursing and Biomedical Sciences and for those preparing for post-graduate membership examinations.Case Studies in Clinical Biochemistry by Michael Murphy, Rajeev Srivastava and Allan Gaw was published in 2012. The book was incorporated in its entirety into the online sixth edition of Tietz: Fundamentals of Clinical Chemistry and Molecular Diagnostics - the 'bible' for clinical chemists everywhere.

SN - 9780956324245

BT - Case Studies in Clinical Biochemistry

PB - SA Press

Case Studies in Clinical Biochemistry

Murphy MJ, Srivastava R and Gaw A. SA Press, June 1, 2012, Paperback, 132 pp, Kindle e-book, ISBN 978-09563242-4-5

• Book Review
• Published: 14 October 2012
• Volume 27 , page 426, ( 2012 )

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• Praveen Sharma 1  

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Each case study consists of a short clinical history accompanied by key clinical findings and laboratory results, and a series of questions. The authors’ detailed answers and explanations to these questions can found by simply turning the page. The case studies and their questions are designed to address key teaching points in Clinical Biochemistry and to do so in the context of real clinical experience. As such it is an ideal revision aid for those studying Medicine, Nursing and Biomedical Sciences and for those preparing for post-graduate membership examinations.

As an important added extra, a unique facebook page has been created to allow readers to access additional educational material not found in the book, and to interact directly with the authors, Michael Murphy, Rajeev Srivastava and Allan Gaw. You may find them on www.facebook.com/ClinicalBiochemistry and you can follow them on twitter @SAPress42.

The 132 page book is available to purchase on amazon. A kindle version is also available for download at $7.43 from www.amazon.com .

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Department of Biochemistry, All India Institute of Medical Sciences, Jodhpur, India

Praveen Sharma

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Sharma, P. Case Studies in Clinical Biochemistry. Ind J Clin Biochem 27 , 426 (2012). https://doi.org/10.1007/s12291-012-0254-3

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Published : 14 October 2012

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DOI : https://doi.org/10.1007/s12291-012-0254-3

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Introduction to Biochemical Genetics from the Clinical Laboratory Prospective: A Case-Based Discussion

Irene de biase, margarita diaz-ochu, mary rindler, wendy l hobson-rohrer.

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Received 2017 Jan 16; Accepted 2017 Apr 14; Collection date 2017.

This is an open-access publication distributed under the terms of the Creative Commons Attribution-NonCommercial-Share Alike license.

Introduction

Inborn errors of metabolism (IEM) are individually rare, but their cumulative frequency is high. Most importantly, IEM are in the differential diagnosis for common clinical emergencies and childhood illnesses. Biochemical genetics (BCG) testing is used to diagnose IEM or follow-up with patients after treatment. A basic grasp of the strengths and limitations of biochemical testing is critical for clinicians to understand test results, identify when to seek a consultation with a specialist, or explain results to patients.

This resource is designed as an introduction to BCG testing for aminoacidopathies and urea cycle disorders, and includes eight cases. The resource was first developed for the Genetic Counseling Graduate Program at the University of Utah School of Medicine, and used in the last 2 years in small-group settings, where students were each engaged with one case (eight per session).

Overall, students gave high ratings to the effectiveness of the examples used, and the interactive format encouraged students' questions. The resource has been tested with medical students and residents rotating through the Maternal Newborn Care Unit at the University Hospital. In this setting, a small-group case-based discussion was used. As expected, prior knowledge of IEM or BCG testing was low. Confidence in evaluating BCG testing after completing the learning activity improved.

This resource facilitates the integration of specialized knowledge of IEM in a primary care-oriented setting. Genetics counseling students' feedback demonstrated the overall success of this activity in the specialized, genetics-oriented setting.

Keywords: Genetics, Inborn Errors of Metabolism, Biochemical Genetics, Newborn Screening, Newborn Infant Screening, Amino Acids, Aminoacidopathies, Urea Cycle Disorders

Educational Objectives

By the end of this session, learners will be able to:

Define inborn errors of metabolism.

Review the key concepts in laboratory testing as applied to the diagnosis and follow-up of inborn errors of amino acids metabolism.

Employ these key concepts and prior knowledge to critically discuss the questions posed by the case studies.

Inborn errors of metabolism (IEM) are a very broad group of disorders, clinically presenting either acutely as a medical emergency, or as a chronic, progressive condition. 1 Because of their variability in clinical manifestations, IEM are in the differential diagnosis of several common conditions such as sepsis, adrenal insufficiency, and congenital heart disease. Specific biochemical genetics (BCG) testing is routinely performed on patients, especially pediatric, to exclude IEM. Correctly identifying these conditions is paramount since prompt and specific treatment is, in most cases, life-saving. Newborn screening (NBS) programs aim to increase early presymptomatic detection and improve outcomes in most cases. 2 – 4 Many NBS programs now include IEMs, increasing the number of newborns requiring confirmatory testing for a positive screen. The primary care physicians play an important role in supporting the newborn screening system by informing families of a positive newborn screen, arranging confirmatory testing, and seeking referral to subspecialties when an IEM is confirmed. 5 , 6 However, physicians recognize a lack of training as a barrier to adequately provide follow-up care for these children. 7 , 8 Moreover, physicians acknowledge the lack of knowledge about genetic tests and the need for more education. 9 Evaluating the results of these tests can be daunting for health care providers unfamiliar with these conditions. Seeking a consultation with a metabolic specialist is ideal, but increasingly difficult due to the scarcity of board-certified medical geneticists. 10

Understanding the significance of laboratory findings and the limitation of the information provided by testing is critical to patient care. Providing detailed examples of test results within the context of clinical cases can improve disease awareness and comfort level with evaluating test results. Three educational resources currently available on MedEdPORTAL provide a review of IEM 11 and examples of clinical presentation and laboratory testing suggestive of IEM. 12 – 13 The limited amount of resources available, covering a limited number of specific conditions or laboratory testing examples, emphasizes the difficulty in accessing examples of BCG testing. Accessing detailed examples of BCG testing performed on patients with IEM can be difficult, especially outside specialized laboratories. Here, we provide educational material focused on examples of BCG testing while highlighting both the information conveyed to physicians and the limitations of testing. We aim to provide the necessary tools to integrate this information in the medical training of genetics and nongenetics specialists.

Clinical case studies have been extensively and successfully used to engage students. 14 A recent study examining genetics curricula in US and Canadian medical schools found that approximately only half of the time is spent in formal lecture setting, and small-group and problem-based sessions account for about 30% of curriculum time. 15 Availability of educational material focused on BCG testing using a clinical case format will improve clinicians' training and will allow a better understanding of these esoteric laboratory findings, ultimately improving patient care.

The objective of this educational material is to familiarize learners such as medical students, genetic counseling (GC) students, residents, laboratory fellows, and clinicians in nongenetics specialties to the intricacies of BCG testing results and interpretation. Although this resource would be best used with students that possess a basic knowledge of biochemistry and genetics, introductory slides in the included PowerPoint presentation contain the background key concepts, and a review of important biochemical pathways to guide students in critically discussing the cases. The cases provided were referred to Associated Regional University Pathologists (ARUP) Laboratories (Salt Lake City, UT,) for a possible or confirmed metabolic disorder and contain some limited clinical information (provided at the time of testing) as well as the results of the biochemical tests performed. The BCG testing results and limited clinical information were obtained after a retrospective chart review of existing data after obtaining IRB exemption.

This resource was first developed for the Genetic Counseling Graduate Program at the University of Utah School of Medicine to introduce GC students to BCG test results for the diagnosis or follow up of patients with aminoacidopathies and urea cycle disorders. The usefulness of this resource for nongenetics specialists was then tested by a primary care pediatrician with medical students, interns, and pediatrics and family medicine residents rotating through the Maternal Newborn Care Unit at the University Hospital. The instructor does not have to be an expert in biochemical genetics, since the specific points about biochemical pathways and laboratory testing are provided in the resource.

This resource has been designed to be used in a small group setting (four to eight students), to allow for each student the opportunity to discuss at least one case. This presentation, including all eight cases, will take approximately 90 minutes (with student participation); however, this activity needs less time if only some of the case studies are discussed. The first 30 minutes of the presentation allow for the instructor to define IEM and cover BCG testing key concepts, while the final 60 minutes are used to engage each student with one of the eight cases. The activity can be broken down in two or three shorter sessions if necessary. After the background introduction, the instructor reads the clinical vignette for a case and then asks a student to describe the results of testing, which in some cases will include the diagnosis. A question slide is provided to help guide the students as they critically discuss the results interpretation. The answer to the question is presented in the following slides. Further points for discussion are included in the final slides. To help students correctly identify the metabolic blocks affecting the patients in these cases without having to memorize pathways, a handout illustrating these pathways is also provided.

The resource includes a PowerPoint presentation ( Appendix A ), with 16 slides summarizing the key concepts necessary for the case discussion and approximately five to seven slides per case; a case studies document ( Appendix B ) containing the background information and a brief description of each case (clinical vignette, results interpretation, additional points for discussion) for the instructor; a handout with simplified overviews of metabolic pathways ( Appendix C ); and a pre-/posttest document ( Appendix D ) to assess knowledge.

This resource was first developed for the Genetic Counseling Laboratory Rotation, which aims to expose first-year students to results and interpretation of complex clinical genetics tests. The rotation takes 3 weeks, and includes several small-group activities and case discussions. Specifically, this resource was designed to focus on BCG testing for aminoacidopathies and urea cycle disorders and has been used successfully in the last 2 years by the instructor, a biochemical geneticist. The allotted time for this activity was 90 minutes. Minor changes were made from the first to the second year based on student feedback and instructor's self-reflection. Given the Genetic Counseling Graduate Program's focus on genetics and genomics testing (including BCG), and the prerequisites to this rotation (which include a semester-long class in biochemical genetics), the GC students possessed a moderately advanced understanding of this topic.

As a postsession evaluation of the resource, the students provided feedback on a survey featuring both a 5-point Likert scale (5 being high/strongly agree), and open-ended questions. When asked if the resource was appropriate and contained useful examples to illustrate the material, the students rated the effectiveness of the examples in a positive light (4.88 out of a maximum score of 5; n = 16). Some students specifically commented on the usefulness of the case discussion, for example: “Really enjoyed using case examples to illustrate specific laboratory findings and relevance to testing.” Moreover, they agreed that the interactive lecture format encouraged student questions (4.75 out of 5) and provided an effective use of time (4.94 out of 5).

To further determine the usefulness of this resource, a general pediatrician used the same interactive lecture with medical students ( n = 4) and residents in either pediatrics or family medicine ( n = 15) rotating through the Maternal Newborn Care Unit at the University Hospital. Primary care pediatricians routinely provide care to newborns in critical conditions, in which IEM is suspected, or newborns with a positive family history for IEM. However, they are not specialists in biochemical genetics or laboratory medicine. To accommodate the busy clinical environment, the resource was broken down into two or three sessions (30 or 45 minutes long, respectively) during the week-long rotation, and used for a total of 4 weeks (from October to December 2016) in a small group setting (four to six students). The instructor reviewed the background key concepts in the first session and then facilitated the case discussion in the following sessions.

To evaluate this resource, the medical students and residents were asked to complete a standard postsession evaluation, rating the learning activity using a 10-point Likert-type scale (10 being very high/strongly agree). Students mean ratings are as follows ( n = 19):

The clarity of the information provided; mean = 7.79.

The overall quality of the learning activity; mean = 7.68.

The overall quality of the teaching/instruction; mean = 8.00.

The instructor's ability to stimulate you to think more deeply about the subject; mean = 8.16.

Because several students commented on the difficulty of remembering enzyme names and pathways (please see the following comments), a handout ( Appendix C ) was added containing the pathways discussed in the cases.

“By far, the visuals (pathways) and the cases are most helpful. Perhaps, a handout of the common biochemical pathways could be helpful, especially if distributed in advance. That way, it is easier to practice going through.”

“Would be helpful to have print out of the important metabolic pathways; was often a bit of information overload at times without having a reference for learners to return to for clarity.”

To gauge the knowledge level of the students before the activity, they were asked to rate prior knowledge of IEM and BCG testing. Although possibly higher than other nongenetics specialties since both pediatricians and family care physicians do provide care to newborns and children with a suspected or known IEM, and 60% of the students were residents in these specialties, their knowledge of IEM was rated low: mean = 4.26 (1 = no prior knowledge; 10 = extensive knowledge). Prior knowledge of BCG testing was, as expected in view of the esoteric nature of these tests, rated even lower: mean = 3.79. Students rated the confidence achieved in evaluating the results of amino acid testing after the completion of the learning activity as 6.16 on average (10 being very high).

This resource was initially designed to offer case examples from the laboratory perspective to familiarize GC students to BCG testing for aminoacidopathies and urea cycle disorders within a week-long rotation at ARUP laboratories. The case studies were chosen to illustrate both the information provided by BCG testing, and some of the pitfalls to consider when interpreting that information. The main objective was to discuss complex testing results and interpretation with first-year students after several lecture-based courses had covered the background information on genetic disorders, specifically IEM. However, the student responses to this learning activity and the postcourse evaluation confirmed the effectiveness of student-centered activities, such as this interactive case-based discussion, as helping to achieve a better understanding and recollection of the information presented when compared to traditional lecture-based courses. 16 In addition to a review of topics taught earlier, this activity allowed students to use the information in a context that mimics real-life clinical practice. A student commented: “I had not been able to apply what I had learned in Biochemical Genetics class until this rotation.”

GC student feedback showed the overall success of this activity in a specialized, genetics-oriented setting. Because of the relative rarity of IEM and the difficulty in procuring examples of BCG test results outside of specialized laboratories, this resource benefits nongenetics specialists such as primary care physicians who are tasked with caring for infants with a positive newborn screen. 5 , 6 The lack of training impacts the confidence level in interpreting results and the ability to adequately provide follow-up care for these children. 7 , 8 Moreover, the emerging trend in medical education is to integrate genetics teaching within other disciplines by using clinical examples and interactive activities. 14 – 16 This resource provides examples of esoteric laboratory testing results that can solidify knowledge in metabolic pathways and IEM, emphasize the importance of considering rare conditions in the differential diagnosis of common medical emergencies, and highlighting the use of laboratory medicine for the follow-up of patients treated for genetics conditions.

The usefulness of this resource within the primary care setting was tested by a pediatrician with medical students, interns, and pediatrics and family medicine residents. The confidence level in evaluating the results of amino acid testing improved after completing the learning activity. The mean score of 6.16 (10 = very high; n = 19) is fairly high, considering the low initial knowledge of IEM (4.26) and BCG testing (3.79) (1 = no prior knowledge; 10 = extensive knowledge). It would be interesting to assess this resource within nonmedical settings such as an undergraduate biochemistry course. Unfortunately this was outside the authors' educational practice. However, the modular nature of this resource, organized in cases, lends itself to be used within very different contexts. For example, case #6 (patient with Hyperornithinemia-Hyperammonemia-Homocitrullinuria Syndrome) may be used to illustrate the effect of an impaired intracellular transporter when teaching cellular trafficking to undergraduate students.

Using this resource with larger groups is possible; however, the authors believe that it would significantly limit the opportunity for student engagement. To evaluate the sessions, a pre- and posttest are included to assess the improvement in BCG-specific knowledge (not utilized in our courses prior to publication).

In our opinion, the instructor's role is to primarily facilitate discussion and not to serve as an expert on IEM or BCG testing, and they may easily prepare for this activity by reviewing the PowerPoint presentation, the case studies provided, or other publically available material. However, in our study the resource was administered by a pediatrician, who, although not an expert in BCG testing, routinely provides care to newborns at risk of IEM. Interestingly, during two out of the four rotations in the Maternal Newborn Care Unit, when testing this resource, there were two newborns affected with a metabolic disorder. Both were eventually diagnosed with ornithine transcarbamylase deficiency, a urea cycle disorder. An infant boy presented acutely and an infant girl was tested because of a positive family history. In both cases, BCG testing was ordered together with a metabolic specialist consultation. Anecdotally, the occurrence of these cases during the rotation greatly increased the interest of the group of students in the activity. It is reasonable to speculate that in view of the IEM prevalence in infancy and childhood, medical students or residents rotating in pediatric specialties or sub-specialties would benefit from this activity, as they are learning about BCG testing when they are most likely to care for these patients.

Overall, we consider our experience a successful proof-of-concept that it is possible to integrate biochemical genetics and laboratory medicine, both considered specialized knowledge and somewhat removed by daily clinical practice, in a primary care-oriented setting.

A. PowerPoint Presentation.pptx

B. Case Studies.docx

C. Pathways Handout.docx

D. Pre and Posttest.docx

All appendices are peer reviewed as integral parts of the Original Publication.

Disclosures

None to report.

Funding/Support

Ethical approval.

Reported as not applicable.

• 1. Valle D, Beaudet AL, Vogelstein B, et al, eds. Scriver's Online Metabolic and Molecular Bases of Inherited Disease. New York, NY: McGraw-Hill; 2013. http://ommbid.mhmedical.com/book.aspx?bookid=971 Published 2013. [ Google Scholar ]
• 2. Wilcken B, Wiley V, Hammond J, Carpenter K. Screening newborns for inborn errors of metabolism by tandem mass spectrometry. N Engl J Med. 2003;348(23):2304–2312. https://doi.org/10.1056/NEJMoa025225 [ DOI ] [ PubMed ] [ Google Scholar ]
• 3. Schulze A, Lindner M, Kohlmüller D, Olgemöller K, Mayatepek E, Hoffmann GF. Expanded newborn screening for inborn errors of metabolism by electrospray ionization-tandem mass spectrometry: results, outcome, and implications. Pediatrics. 2003;111:1399–1406. [ DOI ] [ PubMed ] [ Google Scholar ]
• 4. Pasquali M, Longo N. Newborn screening and inborn errors of metabolism. Am J Med Genet C Semin Med Genet. 2011;157(1):1–2. https://doi.org/10.1002/ajmg.c.30290 [ DOI ] [ PubMed ] [ Google Scholar ]
• 5. Raghuveer TS, Garg U, Graf WD. Inborn errors of metabolism in infancy and early childhood: an update. Am Fam Physician. 2006;73(11):1981–1990. [ PubMed ] [ Google Scholar ]
• 6. Newborn Screening Authoring Committee. Newborn screening expands: recommendations for pediatricians and medical homes—implications for the system. Pediatrics. 2008;121(1):192–217. https://doi.org/10.1542/peds.2007-3021 [ DOI ] [ PubMed ] [ Google Scholar ]
• 7. Hayeems RZ, Miller FA, Carroll JC, et al. Primary care role in expanded newborn screening: after the heel prick test. Can Fam Physician. 2013;59(8):861–868. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• 8. Kemper AR, Uren RL, Moseley KL, Clark SJ. Primary care physicians' attitudes regarding follow-up care for children with positive newborn screening results. Pediatrics. 2006;118(5):1836–1841. https://doi.org/10.1542/peds.2006-1639 [ DOI ] [ PubMed ] [ Google Scholar ]
• 9. Mainous AG 3rd, Johnson SP, Chirina S, Baker R. Academic family physicians' perception of genetic testing and integration into practice: a CERA study. Fam Med. 2013;45(4):257–262. [ PubMed ] [ Google Scholar ]
• 10. Cichon M, Feldman GL. Opportunities to improve recruitment into medical genetics residency programs: survey results of program directors and medical genetics residents. Genet Med. 2014;16(5):413–418. https://doi.org/10.1038/gim.2013.161 [ DOI ] [ PubMed ] [ Google Scholar ]
• 11. Maul E. Inborn errors of metabolism. MedEdPORTAL Publications. 2009;5:726 http://doi.org/10.15766/mep_2374-8265.726 [ Google Scholar ]
• 12. Anderson M, Kirkish M. Sophie Claiborne's upset stomach - an ornithine transcarbamolyase deficiency problem-based learning case. MedEdPORTAL Publications. 2007;3:642 http://doi.org/10.15766/mep_2374-8265.642 [ Google Scholar ]
• 13. Anderson M. Biochemistry and molecular biology PBL cases. MedEdPORTAL Publications. 2006;2:210 http://doi.org/10.15766/mep_2374-8265.210 [ Google Scholar ]
• 14. Metcalf MP, Tanner TB, Buchanan A. Effectiveness of an online curriculum for medical students on genetics, genetic testing and counseling. Med Educ Online. 2010;15(1). https://doi.org/10.3402/meo.v15i0.4856 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ]
• 15. Plunkett-Rondeau J, Hyland K, Dasgupta S. Training future physicians in the era of genomic medicine: trends in undergraduate medical genetics education. Genet Med. 2015;17(11):927–934. https://doi.org/10.1038/gim.2014.208 [ DOI ] [ PubMed ] [ Google Scholar ]
• 16. Graffam B. Active learning in medical education: strategies for beginning implementation. Med Teach. 2007;29(1):38–42. https://doi.org/10.1038/gim.2014.208 [ DOI ] [ PubMed ] [ Google Scholar ]

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Virtual clinical biochemistry case studies for learning applied pathology

What was the activity.

The final year module ‘Clinical Biochemistry’ [originally shared between the BSc in Biomedical Science and BMedSci in Medical Science, De Montfort University (DMU), UK] was comprehensively reviewed to introduce specialised case studies to strengthen the clinical applied component and facilitate acquisition of analytic and diagnostic skills for prognosis and management of disease (Peña-Fernández et al ., 2019). Throughout the course, students attended specialised workshops to resolve case studies of increasing difficulty, specifically designed to facilitate acquisition and strengthening of clinical reasoning and reflection skills, as reflection is effective in enhancing continuous learning and gaining practical skills (Davi et al. , 2017). These formative case studies consisted of a short medical history with a detailed biochemical profile and a few short answer questions about potential strategies and biochemical techniques to appropriately manage the patient. To encourage precision and writing skills, students were asked to produce a short report. They were provided with comprehensive feedback and formative marks on their ability to: a) extract all the fundamental concepts; b) synthesise information; and c) reflect and comment. A case study was also introduced in the unseen final exam to substitute the traditional long-answer question used, which presented a similar structure to those used for training (normal/reference ranges were provided so students can focus on the applied aspect of clinical biochemistry rather than learning data). Students select one from a pool of two case study questions, which has a significant weight in their exam (30 marks out of 100). Higher marks are provided for demonstrating critical thinking, a process of reflection pivotal for making safe, evidence-based, effective decisions in a clinical environment (Carter et al ., 2017). Health and medical programmes are required to promote the development of clinical reflective practice (Sweet et al ., 2019).

To overcome time constraints and strengthen students’ confidence to face an unseen case study in an examination, implemented to evaluate acquisition of clinical capabilities and reasoning, we populated, in 2020, the open-access virtual environment e-Biology © ( http://parasitology.dmu.ac.uk/ebiology/ ) with different resources for the teaching and learning of Clinical Biochemistry, including specific laboratory practicals and specialised case studies in liver and kidney pathology. To assist navigation, the package has four interactive modules (see image below): i) theoretical; ii) laboratory (to learn important biomedical techniques, for example, medical histology/ tissue staining); iii) microscope (with digitised virtual human tissue slides); and iv) case studies. The package also covers the specifications for AS and A level described by the Assessment and Qualifications Alliance (AQA) for human biology and the specifications of the first-year modules related to human biology and biomedicine, to support the large variety of students’ backgrounds in our clinical science programmes, including the Business and Technology Education Council (BTEC) qualification, and to aid retention/transition.

Mini and major virtual case studies were created following students’ feedback collected in the specialised workshops, and previously successful experience in the development of multimedia units. The e-Biology © resource contains multiple media (text, images, video, audio) to facilitate active learning (Roberts, 2017) Briefly, each case study is presented with a medical history of a “virtual patient”; the user is requested to provide a potential diagnosis based on the clinical biochemistry profile provided and other e-Biology © resources (for example theoretical or laboratory units). To enhance engagement and support self-learning, students are prompted with different formative assessments and mini-games meanwhile navigating through the case study, for the management, differential diagnoses or treatment of the virtual patient. Instant feedback is provided for each mini-game/case study question, which the user could use to attempt the subsequent exercise, as well as to check their natural learning progression. Specific information about how this virtual package and the assessments were developed can be found in Peña-Fernández et al . (2019). Owing to the occurrence of the COVID-19 pandemic, the e-Biology © package also proved pivotal for the online delivery of Clinical Biochemistry in the BSc Biomedical Science course, specifically for the teaching of the laboratory practicals and specialised workshops.

How did it impact students?

By the end of the course and following completion of the virtual clinical biochemistry case studies, 82.6% students (n=46/166; 2021/21) indicated learning of specific tests for diagnosing pathologies affecting the kidney; 69.6% gained knowledge of specific tests to manage patients with kidney diseases. Although students reported high levels of learning, our results did not show statistical differences when comparing the scores of two MCQ tests distributed at the beginning ( prescore ; 46.2% successful) and end of the module ( postscore ; 38.6% successful) using a Kendall’s tau b correlation analysis ( p =0.262), possibly attributed to the low number of questionnaires that were able to be paired (n=11). A significant positive correlation ( r =0.61, p <0.001) was found between the design of the e-Biology © package and the students’ impressions that learning this content will be useful for their future careers. They also pointed out that the package helped them to prepare their final exam (71.7%). The use of specialised clinical case studies seemed to facilitate the acquisition of reflective skills, pivotal to gaining clinical skills, which could be easily adopted by other academics and institutions, seemed to aid the learning of basic skills to work in a chemical pathology laboratory.

Any advice for others?

The different resources available in the e-Biology © package are publicly available. We suggest introduction of the package at the beginning of the course, and using its resources to deliver mini-case studies (for example using the microscopic virtual slides of tissues) within lectures to encourage familiarisation, prior to the introduction of the virtual case studies. e-Biology © can be also used for learning other biomedical sciences, such as histology or general human anatomy and physiology. 

Other contextual details

The e-Biology © package was an appropriate resource for online teaching during the COVID-19 pandemic. The package was also used by other colleagues from higher education institutions (for example Chester Medical School) delivering bioscience degree programmes during this time, as previously reported by our team (Peña-Fernández et al. , 2021). The package is being used this current academic year as a support teaching of ‘Clinical Biochemistry’ in a hybrid model (in other words using a combination of face-to-face and online teaching as a blended approach).

Carter, A. G., Creedy, D. K. and Sidebotham, M. (2017) ‘Critical thinking evaluation in reflective writing: Development and testing of Carter Assessment of Critical Thinking in Midwifery (Reflection)’, Midwifery , 54, pp. 73–80.

Devi, V., Abraham, R. R. and Kamath, U. (2017) ‘Teaching and assessing reflecting skills among undergraduate medical students experiencing research’, Journal of clinical and diagnostic research: JCDR , 11(1), JC01–JC05. 10.7860/JCDR/2017/20186.9142  

Peña-Fernández, A., Evans, M.D., Young, C., Escalera, B., Angulo, S. and Peña, M.Á (2019) ‘Learning clinical biochemistry diagnostic skills through reflection’, in Roig Vila, R. (Coord.) Lledó Carreres, A. Antolí Martínez, J.M. and Pellín Buades, N. (eds.) Redes de investigación e innovación en docencia universitaria. Volum 2019, Alicante: Universidad de Alicante. Instituto de Ciencias de la Educación (ICE), pp. 125-132. 

Peña-Fernández, A., Peña, MA., Smith, S., Evans, M.D., Torrado, G., Breda, C. and Randles, M.J. (2021) ‘Introduction of e-Biology at two English universities to strengthen self-learning of ‘clinical skills’, ICERI2021 Proceedings 2021 , pp. 9104-9109.

Roberts, D. (2017) ‘Higher education lectures: From passive to active learning via imagery?’, Active Learning in Higher Education , 20(1), pp. 63-77. https://doi.org/10.1177/1469787417731198

Sweet, L., Bass, J., Sidebotham, M., Fenwick, J. and Graham, K. (2019) ‘Developing reflective capacities in midwifery students: Enhancing learning through reflective writing’, Women and birth: journal of the Australian College of Midwives , 32(2), 119–126. 10.1016/j.wombi.2018.06.004

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• Empirical Research
• Open access
• Published: 18 February 2020

Large-scale application of case-based learning for teaching medical biochemistry: a challenging experience with positive impacts

• Sanaa Eissa   ORCID: orcid.org/0000-0001-8591-3244 1 ,
• Reem M. Sallam 1 ,
• Amr S. Moustafa 1 &
• Abdelrahman M. A. Hammouda 1  

Innovation and Education volume  2 , Article number:  1 ( 2020 ) Cite this article

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With the introduction of integrated approach in the medical curriculum, there is a need to teach basic sciences in a way relevant to real clinical scenarios. The aim of this study is to investigate the feasibility of case-based learning (CBL) for teaching of medical biochemistry to a large number of medical students. It also evaluates both the students’ and faculty members’ perception of this approach. CBL was introduced in teaching medical biochemistry in the Neuroscience block for the second-year medical students. This study’s students were from two consecutive academic years ( n  = 721 and 769). Four clinical cases were prepared. Students were divided into subgroups, each having one CBL session every 2 weeks. Students were encouraged to work together to understand the given clinical scenario by building on past knowledge obtained through other teaching modalities and new knowledge acquired during the session. A pretest was administered at the beginning of the session, and an identical posttest administered at the end of the session. Perception of both the students and facilitators of the CBL-teaching approach was evaluated using end-of-block questionnaires. In both studied academic years, students got higher scores in posttest compared to pretest scores with a statistically significant difference of the paired scores ( P  < 0.001). Analysis of the students’ questionnaire demonstrated that most students positively perceived the CBL approach, with a feeling that CBL has helped them learning the biochemistry concepts. Likewise, analyzing staff questionnaire revealed staff’s positive attitude toward the impact of CBL in teaching biochemistry on the students and on themselves. The current work suggests that CBL is both feasible and efficient to be applied for teaching medical biochemistry on a large scale. It is positively perceived by both students and teaching staff. Future work is still needed to solve certain challenges such as increasing work load on the faculty members and to test the impact of this teaching modality on long-term retention of knowledge.

Introduction

In order for schools of medicine to be globally accredited, international standards for quality in medical education should be considered and introduced at both the teaching faculty’s level and the medical students’ level (Harden 2002 ; Leinster 2002 ; Prideaux 2003 ). In the last few years, several changes have been introduced to the medical curriculum at the Faculty of Medicine, Ain Shams University (ASU), in Cairo, Egypt. Basic sciences are of special importance, since they are the first courses taught to medical students during the preclinical years. Until recently, medical biochemistry has been taught at ASU in the traditional, didactic teacher-centered system. Moreover, the curriculum was overloaded with facts and basic knowledge with few examples of clinical applications. Medical students usually demonstrate aversion to the pure biochemistry knowledge as it seems too remote from the real-world medicine. For them, biochemistry is a dry subject requiring extensive memorization of multi-step pathways, complex jargon, chemical names, and many inter-woven regulation and mechanistic events (Wood 1990 ). Almost all medical graduates from a traditional curriculum agree that biochemistry is one of the most difficult disciplines they have studied (Watmough et al. 2009 ). Biochemistry for many students is like lyrics in a foreign language, to be memorized but with no feeling. Students aim mainly at the examination marks and are almost unaware of the relevance of biochemistry to the practice of medicine. They may not realize the importance of biochemistry until they have graduated and gone to practice. By that time, they have already forgotten what they learnt, which compromises their professional efficiency (D’Eon 2006 ; Ling et al. 2008 ; Wilhelmsson et al. 2013 ). Therefore, new learning modalities are required to achieve better linkage of biochemistry as a basic medical science to the clinical practice (Boyer 2000 ; Hermes-Lima et al. 2002 ; Se et al. 2008 ; Ramasamy et al. 2013 ; Surapaneni and Tekian 2013 ; Jabaut et al. 2016 ). A curriculum reform should avoid giving too many details pertaining to the organic chemistry of biomolecules and concentrate on what is relevant to medicine (Wood 1990 ).

Medical students need to learn medically relevant biochemistry, and we must minimize rote memorization of materials and make information stick (Afshar and Han 2014 ). Recently, our faculty has approved a reform in the medical education system changing it from the traditional way to a more interactive, student-centered, and self-directed education. In the reformed system, an integrated approach is undertaken, in which medical biochemistry and molecular biology are integrated with other basic sciences in a body systems-oriented approach as opposed to the previous subject-oriented approach. Simultaneously, undergraduate medical biochemistry curriculum was revised to adapt to the new system. Unnecessary theoretical knowledge was filtered out while trying to bridge the gap between theory and practice through students’ exposure to clinical scenarios in the setting of small-group discussions.

Early clinical exposure is recommended by many studies (Dornan and Bundy 2004 ; Dornan et al. 2006 ; Dyrbye et al. 2007 ; Michalec 2012 ; Sathishkumar et al. 2007 ). It contributes to students’ satisfaction with medical education and avoids the abrupt transition from academic textbooks to patients and diseases. It helps medical students socialize to their chosen profession and makes their learning more real and relevant. Since actual on-patient experience is not possible for our students in preclinical academic years, other possible ways of clinical exposure ought to be sought (Abraham et al. 2008 ). Case-based learning (CBL) is a form of small-group learning that uses a guided inquiry method. The method was proven to assist in the development and improvement in problem-solving skills and critical thinking in medical students (McLean 2016 ). It helps retention of knowledge and proper perception of basic sciences in the medical curriculum (Malau-Aduli et al. 2013 ). In comparison with problem-based learning (PBL), CBL was demonstrated to offer more efficient use of students and faculty’s time in a goal-directed manner (Srinivasan et al. 2007 ). Each case in CBL has learning objectives that are shown to the students after discussing the clinical data and patient’s investigation. During the CBL session, students are presented with the clinical case, provided with the resources—textbooks and Internet access—and instructed about the time needed for actively working together to solve this case. Case solving in CBL requires integration of prior and newly acquired knowledge and is guided by the facilitator’s questions to keep the group on the right track toward solving the problem and fulfilling the case’s intended learning objectives (ILOs). CBL has already been highly recommended for teaching medical biochemistry (Hartfield 2010 ; Joshi et al. 2014 ; McRae 2012 ; Nair et al. 2013 ; Rybarczyk et al. 2007 ). This teaching method is capable of providing the medical students with the necessary training skills that will be required in their future clinical practice, i.e., collecting relevant information and the clever use of basic knowledge for solving medical problems.

Faculty members need to be well trained to properly facilitate the CBL session. It takes lots of faculty training to avoid acting as lecturer and abide by their expected role of group’s guidance and correction if needed, keeping the self-learning, scientific curiosity, and self-confidence merits of the students intact, and allowing each student to be a “content expert” at the end of the session. In addition, facilitator’s guidance aims at achieving the ILOs set ahead at the beginning of each CBL session (Costa and Magalhaes 2009 ).

We previously investigated the introduction of CBL approach for teaching of medical biochemistry on a relatively small number of second-year medical students who were involved in a special undergraduate medical program, Extended Modular Program (EMP), at Faculty of Medicine, ASU (Eissa and Sabbour 2016 ). The results were both encouraging and promising.

Motivated by our previous results and the recent introduction of the system-based curriculum for the main stream students at the ASU Faculty of Medicine, we proposed a large-scale application of CBL for teaching medical biochemistry. Certain logistic issues are needed to be considered to allow the introduction of CBL on a large scale at ASU. These issues include the large number of students, the limited space and educational tools, and the limited number of trained instructors. Therefore, the primary objective of the current study is to investigate the feasibility and efficiency of adopting CBL in the medical biochemistry curriculum at ASU on a relatively large number of students. Specific aims include designing proper cases to fit in the ILOs of the course being taught, preparing the faculty members to play the role of expert facilitator, preparing the environment for proper conduction of CBL sessions, and finally assessing the impact of CBL on the students’ performance, by pre- and posttests, and perception of the new teaching approach using questionnaire-based method.

The current work was conducted in the Department of Medical Biochemistry and Molecular Biology at the Faculty of Medicine, ASU, Cairo, Egypt. CBL approach was approved by the department’s undergraduate medical education committee, by the Faculty of Medicine Vice-deanship for Students Affairs, and by the ASU Faculty of Medicine Ethical Committee (document # 2016-88). Informed, written consent was obtained from all participants of the study. A flowchart of the study design is illustrated in Fig.  1 .

Flowchart of the study design. CSE CBL Scientific Committee, WG working group

This CBL approach was conducted during the first block for the second-year medical students, the Neuroscience block. Target students were from two consecutive academic years, 2016–2017 ( n 1 = 721 students) and 2017–2018 ( n 2 = 769 students). Prepared materials included 4 clinical cases, identical pretests and posttest, and students’ and staff members’ questionnaires.

A CBL scientific committee (CSC), including the authors of this work, was nominated by the chairperson of the Medical Biochemistry Department. Tasks of this committee included: defining the topics of the CBL’s cases, preparing the clinical cases, training of CBL staff, supervising the arrangement for conducting CBL sessions, preparing the assessment tools (pre- and posttest and end-of-block questionnaires), and statistical analysis and interpretation of the data obtained by these tools. A working group (WG) including senior and junior staff members prepared the draft of the cases and helped in conducting the session.

Defining the topics and designing of the clinical cases

The selection of topics of CBL session aimed at achieving the objectives of the Neuroscience block, re-enforcing the basic biochemical and molecular core concepts, and highlighting the biochemical pathways of relevance. Most of the cases were first prepared by junior staff, then revised, modified, and finalized as needed by the CSC. The CSC first defined the clinical cases that best reflect core biochemical concepts that are discussed in the Neuroscience block. A faculty orientation training workshop on how to formulate cases for CBL was conducted in the department. Topics of the clinical cases were allocated to the working group consisting of senior and junior faculty staff members. The prepared cases were then revised by the CSC to ensure that the proposed ILOs for each case were adequately illustrated. Four cases were designed. An example is “My girl has pallor and jaundice” (Appendix 1 ), a carefully designed case on a patient with pyruvate kinase deficiency hemolytic anemia that can gracefully address the most important glycolytic pathway and its connection to the patient’s anemia. In addition, the complex pathway of heme degradation and bilirubin production was also perfectly addressed in relation to the patient’s jaundice. Briefly, a CBL case began by introducing the personal information, clinical presentation, relevant history, and results of physical examination and requested investigations. This was followed by defining the case’s learning objectives and guiding questions as well as illustration of the relevant biochemical concept, pathway, or process involved in the case discussion.

Training and skill development of CBL’s Staff

All CBL staff members attended a hands-on workshop conducted by a medical education-qualified member of the CSC. The main topics of the training included but not limited to skills and tips for preparing CBL cases, conducting the CBL sessions, presenting the case, encouraging and guiding the students for active learning, answering the students’ questions if needed, and connecting all threads of thoughts to each case’s ILOs.

Students at the CBL session

All the second-year medical students at the Faculty of Medicine, ASU, for two consecutive academic years: 2016–2017 and 2017–2018, totaling 721 and 769 students, respectively, were exposed to the CBL approach. Each group of approximately 75 students was divided into smaller subgroups (~ 25 students/subgroup). The sessions were conducted every 2 weeks for each group. The CBL session was conducted in lecture rooms equipped with audiovisual tools and Internet access. Students were encouraged to work actively in a team and to interact with each other and with the facilitator during the CBL sessions. Medical biochemistry textbooks were available to the students during the case discussion. Each session lasted for approximately 2 h, divided as follows: 5 min for the pretest (5 MCQs or equivalent items), 20 min for the CBL case presentation, 45 min for the case discussion by students as a teamwork, 30 min for facilitator-guided whole subgroup discussion, 10 min for conclusion and case closure, and 5 min for the posttest (which was identical to pretest).

Students came to the CBL sessions prepared or partially prepared for the topic of the case by lectures and practical sessions conducted prior to the CBL session. However, the previously gained information was not sufficient for the students to master all of the learning objectives of the CBL case, and the students were required to solve the problem through interactive discussion of critical points that were presented in the case scenario. In addition, the biochemical and/or molecular basis of the disease and the diagnostic and therapeutic approaches were included in the discussion. During the session, the students were allowed to refer to the available textbooks and to conduct online searches in order to integrate prior and acquired knowledge. The facilitator guided the group discussion by correcting inaccurate information and explaining difficult concepts. The ongoing discussion was student-centered as the facilitator avoided lecturing or dominating the discussion.

Questionnaires

The end-of-block questionnaires were prepared following a standard previously published procedure (Williams 2003 ).

Student’s questionnaire At the end of the Neuroscience block of each academic year 2016–2017 and 2017–2018, the students were requested to reply to a 10-item, 5-point Likert scale questionnaire (Appendix 2 ) concerning their perception of the utility of CBL in learning medical biochemistry. The scale was from 0 to 4 (strongly disagree to strongly agree). The first section of the questionnaire included items related to the CBL session organization and preparation (item 1), as well as the ability of the method and the presented cases to challenge the students to think and interact (item 2), students’ understanding of the metabolic pathways (items 3 and 7 and 8), and the students’ interest in the field of medical biochemistry (item 4). In addition, the relevance of the cases presented to the biochemistry content of the block (item 5), and the clarity and logical framework nature of presenting biochemical information in the context of real-world cases (item 6) were evaluated. As an overall feedback, the students commented on whether they would recommend applying CBL to all medical biochemistry topics (topic 9) as well as to other basic science courses (item 10). The questionnaire also contained open-ended questions giving the students the chance to comment on what they liked/disliked about CBL approach (items 1.4 and 1.5). The second section of the questionnaire contained four personal questions pertaining to the student’s gender, nationality, and pre-university education.

Staff’s questionnaire The participating staff members were given a 16-item, 5-point Likert scale questionnaire (Appendix 3 ) at the end of the block and were requested to give their perception of the utility of CBL method. The questionnaire items aimed at assessing the staff opinion on 3 different, yet complementary, points: the impact of CBL on the students, CBL’s impact on themselves, and lastly, the process of conducting the CBL sessions. The questionnaire also contained four open-ended questions that gave the participating staff members the chance to comment on what they liked/disliked about CBL and give their recommendations. The questionnaire first asked for information about the staff’s gender, professional title, and the duration of practicing in the clinical field including laboratory medicine. This last question was critical as it was indirectly helpful to assess the expected level of clinical knowledge of participating staff members.

In both student’s and staff’s questionnaires, writing the name and phone number of the participating student or staff member was an optional entry to ensure obtaining unbiased, yet complete information.

Statistical analysis

Data analysis and graph preparation were conducted using Microsoft Excel and SPSS Statistical Package (IBM Corp. IBM SPSS Statistics for Windows, version 22.0. Armonk, NY: IBM Corp). A p value < 0.05 was considered statistically significant. Nonparametric tests (Mann–Whitney, Kruskal–Wallis) were used because the data did not show normal distribution as proved by Kolmogorov–Smirnov test.

The pre- and posttest

Two consecutive academic years, 2016–2017 (721 students) and 2017–2018 (769 students), were included in the study. All students attended the CBL sessions and took the pre- and posttests. Analysis of the paired results showed a statistically significant rise in the posttest scores ( p  < 0.001). Table  1 shows a summary of the pre- and posttest scores of all students for the CBL1 session.

Student’s questionnaire

Student’s questionnaire was distributed to students of both academic years. Response rate was almost identical in both years: 405 out of 721 students of the year 2016–2017 (56%) and 439 out of 769 students of the year 2017–2018 (57%). None of the students have missed all the items of the questionnaire. The first section of the questionnaire comprised 10 items assessing the students’ perception of the impact of the CBL approach, their level of agreement/disagreement to it, and their overall recommendation. Ten students did not respond to this section of the questionnaire. Students who completed all the 10 items were 780 students. The reliability coefficient (Cronbach’s alpha) of this part of the students’ questionnaire was 0.89. Table  2 shows a numerical summary of the student responses to the 10 questions. Figure  2 illustrates the responses of all students to individual items on the Likert scale. Figure  3 summarizes all the student responses. Overall, the majority of students gave a positive opinion regarding the implementation of this CBL method.

Responses to individual items in questionnaire by all students

The sum of all student responses

Only 782 of 844 students of the 2 years (92.7%) responded to the gender question. Of those, 287 students (36.7%) were males and 495 students (63.3%) were females. There was no significant difference between the average score of the ten items in the two groups (Table  3 ).

As to the student nationality, 782 students (92.7%) responded to this question. Of those, 665 students (85%) were Egyptian. There was no significant difference regarding the average score of the ten items between Egyptian and non-Egyptian students (Table  4 ).

Only 771 students (91.4%) answered the question about the location of their high school. Their distribution is shown in Table  5 . There was no significant difference regarding the average score of the ten items between students from Cairo, other governorates, or other countries high schools (Table  6 ).

As to the type of high school, 762 students (90.3%) answered this question. Their distribution is shown in Table  7 . There was no significant difference regarding the average score of the ten items between students from different types of high schools (Table  8 ).

Respondents to the open-ended questions commented in a generally positive manner. Comments as: “great job,” “better way of learning,” “we need summer CBL,” and “hope to be applied in other departments as well” were obtained from 10% of students. Students’ suggestions included adding videos and animations to the case presentation, providing the CBL material prior to attending the session, conducting lectures’ revisions prior to CBL to improve their performance in case discussion, and increasing the number of cases.

Staff’s questionnaire

The staff’s responses to the questionnaire were collected from 9 staff members. The reliability coefficient (Cronbach’s alpha) for the 5-point Likert scale items was 0.88. Total number of responses ( n  = 144) had a mean ± SD of 3.64 ± 0.56 (on a scale of 0–4). Figure  4 illustrates the number of responses given for each of the categories of the used scale.

The sum of all staff responses

As regards the staff opinion on the impact of CBL on the students, none of the points of inquiry received a negative response of “strongly disagree” or “disagree.” Eight participants gave positive responses of either “agree” or “strongly agree” to all ten points of this part. One participant gave positive responses to 5 points and a neutral response of “neither agree nor disagree” for the other 5 points. As regards the staff opinion on the impact of CBL on themselves, all the three points received a positive response of either “agree” or “strongly agree” by all participating staff. As regards the staff opinion on the process of conducting the CBL, the respondents strongly agreed or agreed that the sessions were organized and well prepared, that instructors were essentially monitoring the students’ performance, and that they were keeping control of the learning session. Only one staff member gave a neutral response to the point of the sessions’ organization and good preparation. This respondent disliked the time- and effort-consuming nature of the sessions’ preparation and organizations. This particular staff member added an important comment that involvement of clinicians, in his/her view, will improve the organization and preparation of the sessions.

In response to the open-ended questions, the staff members generally gave positive comments. Examples of positive comments from the facilitators included the following: “CBL sessions have helped the students to understand biochemical metabolic pathways,” “CBL sessions have increased students’ interest in studying biochemistry,” “CBL sessions have helped students to revise the biochemical information,” “I recommend applying this method to all biochemistry topics,” and “I recommend applying this method to other basic medical courses.” All participating staff members liked the fact that CBL bridged the gap between basic and clinical sciences; one staff member described this as “breaking the ice” between both fields of science. Exposing the students to “real-life” clinical situations has helped the medical students, as per the staff view, to better learn the biochemistry content and to “think strategies” as well. The staff believed that the students became more interested to attend the practical sessions and to learn biochemistry. One staff member commented on the benefit of applying CBL as: “it is an active and student-centered approach as opposed to the traditional passive and tutor-centered learning”. More detailed description for the active learning process included the students’ searching for, and applying information obtained from other disciplines to discuss the cases. One staff member liked the in-depth discussion of cases as it emphasized on “apparently subtle knowledge” that could be otherwise missed. The staff acknowledged the teamwork nature of preparing and conducting the sessions and mentioned that both teacher–student and student–student interactions were improved by applying CBL. Because of the small student’s number per group and interactive nature of CBL sessions, instructors reported a closer follow-up and monitoring of the students’ performance.

Other suggestions by respondents included increasing the manpower participating in CBL activity to increase its efficiency. Most of the staff members suggested specific topics to be the subject for further cases. Examples of these topics included vitamins, minerals, obesity, hyperuricemia, and hemoglobinopathies. One staff member suggested providing background knowledge about each case’s topic, via other learning tools, prior to conducting the CBL session. Encouraging comments from facilitators included the suggestion to use the CBL approach for “all possible topics in biochemistry” and for teaching biochemistry for “postgraduate students of clinical specialties.” A staff member commented that “Teaching through CBL is a new experience; however, some of the teaching habits of the staff need to be adjusted.”

Curriculum planning and full implementation of an integrated approach in medical education is not an easy job (Bandiera et al. 2013 ; Davis and Harden 2003 ; Harden 2000 ). The current work describes the impact of applying a new well-recommended approach in teaching medical biochemistry on a relatively large number of undergraduate medical students. Major challenges were faced in order to implement CBL, for instance, the large students’ number and a limited number of well-trained staff members capable of playing the role of expert facilitators. The large number of students and lesser number of teaching hours is already acknowledged as an obstacle that strongly pushes toward the teacher-centered education (Lee et al. 2010 ; Varghese et al. 2012 ). By careful subgrouping and schedule adjustment to allow a session every 2 weeks for each subgroup, we could have 25 students per session, just a slightly higher number than that proposed for efficient small-group teaching (Thistlethwaite et al. 2012 ).

Designing proper cases to fit in the ILOs of the biochemistry topics of the Neuroscience block was a multi-step task. The CSC first defined required clinical cases. A faculty orientation training workshop on how to formulate cases for CBL was conducted. Topics of the clinical cases were allocated to the working group (WG) consisting of senior and junior staff members. The prepared cases were then revised by the CSC. These cases served as scaffolds upon which facts and concepts could be reorganized and reinforced. Our designed cases were not much different from those described by other workers (McRae 2012 ). Our approach for designing the cases served not only to provide the teaching material, but also to prepare the faculty members to play the role of expert facilitators, which is another specific objective of this study.

Teaching and learning of biochemistry can be improved, by understanding the students’ perceptions (D’Souza et al. 2013 ). Evaluating the students’ perception of the CBL approach is a major specific aim of the present study. Our students’ questionnaire was formulated to explore the respondents’ opinions about CBL sessions. Internal consistency of the questionnaire is evident by the high value (0.89) of Cronbach’s alpha (Tavakol and Dennick 2011 ). Although most medical students enrolled in Ain Shams Faculty of Medicine are Egyptians, there are an increasing number of students coming from different countries. In addition, Egypt is a relatively big country with different cultural and socioeconomic nature of its various regions. Therefore, in an attempt to explore these potential factors that might have an influence on the study’s results, comparisons were made between students from different countries, different high schools, and different genders. Most of the students either agreed or strongly agreed that the CBL approach was well prepared and has helped them academically in various ways. This perception was not gender-dependent, neither was it dependent on the type of pre-university education or cultural differences arising from difference in nationality or area of residence. The majority of students agreed that this approach has been effective in advancing their meaningful learning in biochemistry. This agrees with previous studies (Harden 2000 ; Williams et al. 2018 ), which showed the value of CBL for the students’ perception and gaining the required knowledge both immediate and on relatively long-term basis.

Our students were given the chance to work in a team during the sessions. Team learning has already been proved in different medical sciences to be beneficial for better learning and memorization (Chung et al. 2009 ; Mcinerney and Fink 2003 ; Rigby et al. 2012 ; Sisk 2011 ; Vasan et al. 2011 ; Zgheib et al. 2011 ). The discussion in our sessions ran in an interactive way, with the textbooks and Internet access available for the students to get the answers themselves. This active learning engages students in the topic and allows them to develop their critical thinking skills. The positive responses to the first eight items of section 1 in the student’s questionnaire demonstrate clearly these beneficial aspects of CBL (Figs.  2 and 3 ). In addition, the positive responses to the staff questionnaire (Fig.  4 ) emphasize on the successful use of CBL for better students’ understanding, retention, and application of biochemical concepts. Moreover, favorable perception of CBL method by both students and staff has led them to strongly recommend its application to all biochemistry topics and also to other courses. In agreement with our results, several reports showed that active/interactive learning is one of the most common educational approaches promoting student-centered learning with a focus on critical thinking and problem solving (Michael 2006 ; Popil 2010 ; Shanley 2007 ; Zgheib et al. 2011 ).

The participating staff members strongly agree that CBL is a better method of teaching/learning than the didactic one. In accordance with our results, it has been shown that CBL is superior to the traditional lecture approach (Eissa and Sabbour 2016 ). Based on the significant improvement in the students’ scores in the posttest as compared to the pretest in our study, CBL seems to be an effective method of learning for the students. This implies that the students grasped the knowledge and were inspired to concentrate on biochemical concepts.

Preparing the faculty members to play the role of expert facilitators, as a specific aim of this study, was achieved by the departmental workshops and by engaging them in designing the cases. The success of CBL approach measured by the students’ performance and opinion in this study implies a success of the facilitators. This can be nicely illustrated by the presence of a significant difference between the 2 years regarding item 5 of the students’ questionnaire. The students’ response is better in the second academic year (2017–2018) than the first one (2016–2017). This would imply that the staff members have gained more experience in conducting CBL classes in the second academic year. In addition, the students of the second batch could have obtained some sort of positive feedback from their peers of the first batch. Overall, the participating staff provided positive and encouraging responses, whether to the closed or open-ended questions as stated above. This reflects the staff members’ common belief that the new approach has improved teacher–student relationship and has benefited them scientifically and professionally, increasing their “teaching competence.” Moreover, they found that CBL method for teaching biochemistry was an enjoyable experience. A critical issue about the staff of basic sciences is that they may not be currently involved in patient-related clinical services; they may be shifted more toward the basic science research. We inquired about the staff’s clinical experience in the questionnaire. However, we could not make conclusions about this issue due to the small number of staff participating in this study.

Encouraging results were also reported by adopting CBL approach in teaching of other basic science courses: pharmacology (Kamat et al. 2012 ; Gupta et al. 2014 ), physiology (Gade and Chari 2013 ), microbiology (Ciraj et al., 2010 ; Singhal 2017 ), and pathology (Dubey and Dubey 2017 ). Although the facilitators of CBL sessions in pathology in the latter report felt positively, they recommended using this CBL method for selected topics because of its inherent extra time and effort for preparation and conduction. This opinion certainly applies to students who come at a large number like ours. Some of our staff already shared this opinion and suggested to use the help of clinicians in preparing the cases to cut down the time and effort. Nonetheless, a lot of published reports emphasize the usefulness of this teaching modality for the preclinical education (Ghosh 2007 ; Malau-Aduli et al. 2013 ; McLean 2016 ).

The current work has several strength points and certain limitations. Strength points include the application of CBL to a large number of students on two consecutive academic years. Our number of students per an academic year may be the highest to be reported till now. Another strength point is the engagement of different levels of academic/professional staff members in preparing the clinical cases and conducting the CBL sessions. The assessment of CBL experiment by both students and facilitators is another point of strength, since it will allow for applying more effective future modification to improve the outcomes. In addition, the use of pre- and posttest serves as an internal control and an objective method to assess the short-term retention of knowledge and the ability of the facilitators to reinforce the core concepts of biochemistry.

Limitations of this study that should be considered include the small number of participating staff members. Not all biochemistry staff would accept this new process of teaching either due to lack of clinical experience, lack of proper training, or both. Conduction of CBL orientation seminars and more hands-on CBL training workshops throughout the academic year would be helpful to overcome limitation of trained staff. The number of students included in each subgroup (~ 25 students) is a relative limitation, since small-group discussions are preferably managed with a lower number, up to 15 students for best outcomes (Thistlethwaite et al. 2012 ). Increasing the number of well-trained staff members will allow for dividing the students in the future into smaller subgroups. Furthermore, while the current work assessed the short-term retention of knowledge (same session pre- and posttest scores), it did not test the long-term retention. Future study is needed where the impact of CBL on the students’ performance at the end-of-block examination would be assessed. Another limitation of the current work is the absence of a control group for whom traditional teaching methods for the same topics are used with no CBL implementation. However, such design would be hard to implement. One way to partially overcome this limitation is to design a future study where we assess the students’ performance in topics that are taught using both didactic and CBL and compare it to their performance in topics taught without CBL sessions in the same block.

The system-based integrated medical curriculum has just started in our medical school. More studies are warranted to find out the best approach for teaching the concepts of medical biochemistry and other basic sciences into the context of this new curriculum.

In conclusion, by filtering out unneeded theoretical details and concentrating on what is relevant to medicine, the introduction of CBL in the current work had positive outcomes. Example of such outcomes includes strengthening critical skills of medical students, such as problem solving, critical thinking, teamwork, time management, and best use of resources. Such outcomes have increased the medical students’ awareness of the relevance of biochemistry to the practice of medicine and are expected to ease the abrupt transition from academic textbooks to real-life practice of medicine.

Last but not least, the answer is “yes” to the question of feasibility of adopting CBL in medical biochemistry with a large number of students. It is not only feasible, but also efficient as evidenced by the students’ performance. It is positively perceived by both students and teaching staff. This could not have been achieved without the good preparation of the learning environment, the topic cases, and the session facilitators. However, future work is needed to solve certain challenges such as increasing work load on the faculty members and the time-consuming nature of preparing CBL sessions, and to test the impact of this teaching modality on long-term retention of knowledge.

Availability of data and materials

The datasets used during the current study are available upon request from the corresponding author.

Abbreviations

Ain Shams University

• Case-based learning

CBL scientific committee

Extended Modular Program

Intended learning objectives (outcomes)

Multiple-choice question

Problem-based learning

Working group

Abraham, R., Ramnarayan, K., & Kamath, A. (2008). Validating the effectiveness of Clinically Oriented Physiology Teaching (COPT) in undergraduate physiology curriculum. BMC Medical Education, 8, 40.

Article   Google Scholar  

Afshar, M., & Han, Z. (2014). Teaching and learning medical biochemistry: Perspectives from a student and an educator. Medical Science Educator, 24, 339–341.

Bandiera, G., Boucher, A., Neville, A., Kuper, A., & Hodges, B. (2013). Integration and timing of basic and clinical sciences education. Medical Teacher, 35, 381–387.

Boyer, R. (2000). The new biochemistry: Blending the traditional with the other. Biochemistry & Moecularl Biology Education, 28, 292–296.

Chung, E. K., Rhee, J. A., & Baik, Y. H. (2009). The effect of team-based learning in medical ethics education. Medical Teacher, 31, 1013–1017.

Ciraj, A. M., Vinod, P., & Ramnarayan, K. (2010). Enhancing active learning in microbiology through case based learning: Experiences from an Indian medical school. Indian Journal of Pathology and Microbiology, 53, 729–733.

Costa, M., & Magalhaes, E. (2009). What should the student-centered teacher of biochemistry and molecular biology be aware of? Biochemistry & Molecular Biology Education, 37, 268–270.

D’Souza, J. M. P., Raghavendra, U., D’Souza, D. H., & D’Souza, N. D. R. (2013). Teaching Learning of Biochemistry in undergraduate medical curriculum: Perceptions and opinions of medical students. Education in Medical Journal, 5, e45–e53.

Google Scholar  

Davis, M. H., & Harden, R. M. (2003). Planning and implementing an undergraduate medical curriculum: The lessons learned. Medical Teacher, 25, 596–608.

D’Eon, M. F. (2006). Knowledge loss of medical students on first year basic science courses at the University of Saskatchewan. BMC Medical Education, 6, 5.

Dornan, T., & Bundy, C. (2004). What can experience add to early medical education? Consensus survey. British Medical Journal, 329, 834–839.

Dornan, T., Littlewood, S., Margolis, S. A., Scherpber, A., Spencer, J., & Ypinazar, V. (2006). How can experience in clinical and community settings contribute to early medical education? A BEME systematic review. Medical Teacher, 28, 3–18.

Dubey, S., & Dubey, A. K. (2017). Promotion of higher order of cognition in undergraduate medical students using case-based approach. Journal of Education & Health Promotion, 6, 75.

Dyrbye, L. N., Harris, I., & Rohren, C. H. (2007). Early clinical experiences from students’ perspectives: A qualitative study of narratives. Academic Medicine, 82, 979–988.

Eissa, S., & Sabbour, A. (2016). Case based metabolic unit (CBMU): A model for better understanding of metabolic pathways in the second year extended modular program medical students. Journal of Biochemistry Education, 14, 23–30.

Gade, S., & Chari, S. (2013). Case-based learning in endocrine physiology: An approach toward self-directed learning and the development of soft skills in medical students. Advances in Physiology Education, 37, 356–360.

Ghosh, S. (2007). Combination of didactic lectures and case oriented problem solving tutorials toward better learning: Perceptions of students from a conventional medical curriculum. Advances in Physiology Education, 31, 193–197.

Gupta, K., Arora, S., & Kaushal, S. (2014). Modified case based learning: Our experience with a new module for pharmacology undergraduate teaching. International Journal of Applied Basic Medical Research, 4, 90–94.

Harden, R. M. (2000). The integration ladder: A tool for curriculum planning and evaluation. Medical Education, 34, 551–557.

Harden, R. M. (2002). Learning outcomes and instructional objectives: Is there a difference? Medical Teacher, 24, 151–155.

Hartfield, P. (2010). Reinforcing constructivist teaching in advanced level Biochemistry through the introduction of case-based learning activities. Journal of Learning Design, 3, 20–31.

Hermes-Lima, M., Muniz, K. C., & Coutinho, I. S. (2002). The relevance of student seminars on clinically related subjects in a biochemistry course for medical and nutrition students. Biochemistry & Moecularl Biology Education, 30, 30–34.

Jabaut, J. M., Dudum, R., Margulies, S. L., Mehta, A., & Han, Z. (2016). Teaching and learning of medical biochemistry according to clinical realities: A case study. Biochemistry & Moecularl Biology Education, 44, 95–98.

Joshi, K. B., Nilawar, A. N., & Thorat, A. P. (2014). Effect of case based learning in understanding clinical biochemistry. International Journal of Biomedical & Advance Research, 5, 516–518.

Kamat, S. K., Marathe, P. A., Patel, T. C., Shetty, Y. C., & Rege, N. N. (2012). Introduction of case based teaching to impart rational pharmacotherapy skills in undergraduate medical students. Indian Journal of Pharmacology, 44, 634–638.

Lee, Y. M., Karen, V., & Blye, W. M. (2010). What drives student’s self-directed learning in a hybrid PBL curriculum. Advances in Health Sciences Education, 15, 425–437.

Leinster, S. (2002). Medical education and the changing face of health care delivery. Medical Teacher, 24, 13–15.

Ling, Y., Swanson, D. B., Holtzman, K., & Bucak, S. D. (2008). Retention of basic science information by senior medical students. Academic Medicine, 83 (Suppl), 82–85.

Malau-Aduli, B. S., Lee, A. Y. S., Cooling, N., Catchpole, M., Jose, M., & Turner, R. (2013). Retention of knowledge and perceived relevance of basic sciences in an integrated case-based learning (CBL) curriculum. BMC Medical Education, 13, 1–8.

Mcinerney, M. J., & Fink, L. D. (2003). Team-based learning enhances long-term retention and critical thinking in an undergraduate microbial physiology course. Microbiology Education, 4, 3–12.

McLean, S. (2016). Case-based learning and its application in medical and health-care fields: A review of worldwide literature. Journal of Medical Education & Curriculum Development, 3, 39–49.

McRae, M. P. (2012). Using clinical case studies to teach biochemistry in a doctoral program: A descriptive paper. Scientific Research, 3, 1173–1176.

Michael, J. (2006). Where’s the evidence that active learning works? Advances in Physiology Education, 30, 159–167.

Michalec, B. (2012). Clinical experiences during preclinical training: The function of modeled behavior and the evidence of professionalism principles. International Journal of Medical Education, 3, 37–45.

Nair, S. P., Shah, T., Seth, S., Pandit, N., & Shah, G. V. (2013). Case based learning: A method for better understanding of biochemistry in medical students. Journal of Clinical & Diagnostic Research, 7, 1576–1578.

Popil, I. (2010). Promotion of critical thinking by using case studies as teaching method. Nurse Education Today, 31, 204–207.

Prideaux, D. (2003). ABC of learning and teaching in medicine curriculum design. British Medical Journal, 326, 268–270.

Ramasamy, R., Gopal, N., Srinivasan, A. R., & Murugaiyan, S. B. (2013). Planning an objective and need based curriculum: The logistics with reference to the undergraduate medical education in biochemistry. Journal of Clinical & Diagnostic Research, 7, 589–594.

Rigby, L., Wilson, I., Baker, J., Walton, T., Price, O., Dunne, K., et al. (2012). The development and evaluation of a ‘blended’ enquiry based learning model for mental health nursing students: “Making your experience count”. Nurse Education Today, 32, 303–308.

Rybarczyk, B. J., Baines, A. T., McVey, M., Thompson, J. T., & Wilkins, H. (2007). A case-based approach increases student learning outcomes and comprehension of cellular respiration concepts. Biochemistry and Molecular Biology Education, 35, 181–186.

Sathishkumar, S., Thomas, N., Tharion, E., Neelakantan, N., & Vyas, R. (2007). Attitude of medical students towards: Early Clinical Exposure in learning endocrine physiology. BMC Medical Education, 7, 30.

Sé, A. B., Passos, R. M., Ono, A. H., & Hermes-Lima, M. (2008). The use of multiple tools for teaching medical biochemistry. Advances in Physiology Education, 32, 38–46.

Shanley, P. F. (2007). Viewpoint: Leaving the “empty glass” of problem-based learning behind: New assumptions and a revised model for case study in preclinical medical education. Academic Medicine, 82, 479–485.

Singhal, A. (2017). Case-based learning in microbiology: Observations from a North West Indian Medical College. International Journal of Applied Medical Research, Suppl, 1, S47–S51.

Sisk, R. J. (2011). Team-based learning: Systematic research review. Journal of Nursing Education, 50, 665–669.

Srinivasan, M., Wilkes, M., Stevenson, F., Nguyen, T., & Slavin, S. (2007). Comparing problem-based learning with case-based learning: Effects of a major curricular shift at two institutions. Academic Medicine, 82, 74–82.

Surapaneni, K. M., & Tekian, A. (2013). Concept mapping enhances learning of biochemistry. Medical Education Online, 18, 1–4.

Tavakol, M., & Dennick, R. (2011). Making sense of Cronbach’s alpha. International Journal of Medical Education, 2, 53–55.

Thistlethwaite, J. E., Davies, D., Ekeocha, S., Kidd, J., MacDougall, C., & Matthews, P. (2012). The effectiveness of case-based learning in health professional education. A BEME systematic review: BEME Guide No. 23. Medical Teacher, 34, e421–e444.

Varghese, J., Faith, M., & Jacob, M. (2012). Impact of e-resources on learning in biochemistry: First-year medical students’ perceptions. BMC Medical Education, 12, 21.

Vasan, N. S., De Fouw, D. O., & Compton, S. (2011). Team-based learning in anatomy: An efficient, effective, and economical strategy. Anatomical Sciences Education, 4, 333–339.

Watmough, S., O’Sullivan, H., & Taylor, D. (2009). Graduates from a traditional medical curriculum evaluate the effectiveness of their medical curriculum through interviews. BMC Medical Education, 9, 64–70.

Wilhelmsson, N., Bolander-Laksov, K., Dahlgren, L. O., Hult, H., Nilsson, G., Ponzer, S., et al. (2013). Long-term understanding of basic science knowledge in senior medical students. International Journal of Medical Education, 4, 193–197.

Williams, A. (2003). How to write and analyse a questionnaire. Journal of Orthodontology, 30, 245–252.

Williams, C., Perlis, S., Gaughan, J., & Phadtare, S. (2018). Creation and implementation of a flipped jigsaw activity to stimulate interest in biochemistry among medical students. Biochemistry and Molecular Biology Education, 46, 343–353.

Wood, E. J. (1990). Biochemistry is a difficult subject for both student and teacher. Biochemical Education, 18, 170–172.

Zgheib, N. K., Simaan, J. A., & Sabra, R. (2011). Using team-based learning to teach clinical pharmacology in medical school: Student satisfaction and improved performance. Journal of Clinical Pharmacology, 51, 1101–1111.

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Acknowledgements

The authors sincerely thank the second-year medical students for their participation in this study. Our thanks extend to the junior staff members of the Medical Biochemistry Department for their help in preparation, distributing, collecting, and entry of the data of the used assessment tools. We also thank the ASU Faculty of Medicine’s administration for their support and guidance.

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Sanaa Eissa, Reem M. Sallam, Amr S. Moustafa & Abdelrahman M. A. Hammouda

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All authors, SE, RS, AM, and AH, shared in planning, conducting, analyzing the results, and writing the manuscript of this work. All authors read and approved the final manuscript.

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Correspondence to Sanaa Eissa .

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This CBL approach was approved by the department’s undergraduate medical education committee, by the Faculty of Medicine Vice-deanship for Students Affairs, and by the ASU Faculty of Medicine Ethical Committee, proposal 2016/88.

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Appendix 1: CBL case

Appendix 2: Students’ Questionnaire

Appendix 3: Staff’s Questionnaire

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Eissa, S., Sallam, R.M., Moustafa, A.S. et al. Large-scale application of case-based learning for teaching medical biochemistry: a challenging experience with positive impacts. Innov Educ 2 , 1 (2020). https://doi.org/10.1186/s42862-020-0006-9

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Received : 01 July 2019

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Published : 18 February 2020

DOI : https://doi.org/10.1186/s42862-020-0006-9

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