Like many teaching techniques, vicarious learning has been a standard in the teaching repertoire. Vicarious learning, or learning through imagined participation, has been around just long enough that most teachers who employ the technique are not really sure how it works! The most comon example of vicarious learning in health professional teaching is the case study.
A case study is defined as a presentation of a single instance or example of a particular disease or problem. In the hands of a skilled teacher the case study can provide a clear, stable, organized body of knowledge that enhances a learner's capacity to understand the essential elements and implications of the concepts being taught. The "vicarious learning" experienced by the learner is attained through the learner's involvement in the problem-solving activities built into the case study.
The expectation is that the learner will apply recently acquired knowledge or past experiences in his or her attempt to solve the problem(s) identified in the case study. And, if successful, will retain the "solution" as part of his or her armamentarium of problem-solving solutions for future use.
A case study can be presented orally or through other forms. It continues to be popular in lectures and most recently has become a standard in computer-assisted problem solving. In this article the case study will be reviewed by identifying the essential components that go into creating a good case study. In addition, one theory on how learners learn from the technique also will be discussed.
The Essential Components
In any form of communication, it is essential that the sender (or the source of the information ) be as clear and accurate as possible to reduce the opportunity for the information to be misinterpreted. Aristotle is credited with saying that in any communication there are three primary elements: the sender, the topic (the subject matter), and the receiver. In the end, he said, it is the receiver who determines the results (Bettinghaus, I960). Aristotle felt that the secondary qualities, as credited by the receiver to the sender and to the topic, determine the results of the communication.
A case study is basically a form of communication. One purpose for presenting information in the form of a case study is to place in perspective the essential elements of an area of content (or several areas of content). An example would be, after three hours of lecture in which the essential components of how to treat a serious burn in the Emergency Department are enumerated, a case study is presented which describes the arrival of a burned person in the ED. During the case study presentation all the essential points presented in the three hours of lecture are restated within the context of the case study.
There are four essential components of a good case study. They are:
1. Clarity of Purpose: The instructor's purpose in selecting and presenting a particular case is clear to the instructor and learner. All of the nonessential components have been stripped away, leaving ample opportunity for the learner to focus on the essential elements.
2. Proper Sequence: The essential elements are presented in their order of occurrence, if there is a proper sequence. In some teaching situations it may not be essential that the elements occur in a certain order. In this case the instructor should present the elements in a logical order. In teaching, a logical order is usually from small to large.
3. Concrete Applications of Concepts and Theory: The case study must take the abstract information elements presented to the learner earlier and apply them to concrete actions in the case study. (This point is explained further on under "Placement of the Case Study.") An example of this action is a situation where a formula for calculating the dosage of a particular drug was part of the information explained to a learner. In the case study the formula is restated, values are drawn from the case (patient) by the learner and/or teacher and inserted into the formula, and the results calculated.
4. Discussion of Results: The results are reported and discussed very soon after the learner has had the opportunity to apply his or her skill at reaching a solution.
Some instructors who utilize the case study technique believe the story line is an essential element. The story or background information serves only as a vehicle to "transport" the essential information.
While not considered essential, the story can be detrimental to the learner if it wanders and rambles on aimlessly. The story should be succinct and focused. One technique is to establish one individual or family of individuals, that is always used as the case study. 'Always used" means the person or persons in the case study do not change if the case study format is used throughout a series of lectures. Instead, the age, degree of injury, reaction to treatments, etc., change. This saves a lot of time for the presenter and avoids reintroducing the specifics that surround the case study.
The placement of, the case study in a presentation, or teaching plan, will affect the role that the information plays. When the case study is presented at the beginning of the class or lecture it can be used to help the learner organize the new information that follows and to anchor new ideas. This can be particularly helpful when the concepts presented by the instructor need to be solidified as soon as they are presented (Ausubel, 1967).
When the case study is presented within the class or lecture, the learner is able to focus the new information on to a specific example. Presenting the case study at the end of the new information provides an opportunity for learners to apply their problem-solving and decision-making skills. When to present a case study should be part of the teaching plan designed by the instructor earlier in the class preparation.
How Does Learning Occur?
To the teacher presenting the case study the information contained in the narrative is already understood; but to the learner, the information appears very new. In order to appreciate the learning process that is occurring in the learner, a person must understand something about how the human organism senses and perceives information.
Sensing means to become aware of the world around us. We are constantly bombarded by sounds, feelings, images, etc., that act upon our many sense organs. When the amount of energy in a particular element reaches a point that attracts our attention, that element has an advantage over the other elements. Those that are particularly helpful to the case study stimuli are: 1) the novelty of the stimuli (i.e., a situation not encountered before); 2) the narrative (story line ) that serves to sharpen the clarity of the information being presented; and 3) the relevance of the information to the learner's work environment. These factors vary in their effectiveness and are dependent upon the learner's interest and experience (Murphy, 1951).
As the case study unfolds, the learner passes through three stages of perception: diffusion, differentiation, and interpretation (Murphy, 1951). In the diffusion stage, the information is perceived as blurred. The essential elements are not clear. As the learner searches the information he or she begins to differentiate among the elements. This stage is particularly dependent upon experience. The greater the experiences of the learner, the better the analysis (differentiation). This stage is also dependent on the organization of the original information presented in lecture to the learner. In stage three, integration, the components of the information are more sharply defined and coherent.
The learner is capable of identifying several characteristics in the case study that he or she understands and can use this information to explain or respond to questions about the case study. The time required for each stage cannot be accurately predicted. As noted, there are several factors that can affect the length of time required by the learner: the learner's motivation to search in stage one; the organization of the initial presentation and the experiences of the learner in stage two; the detail of the questions asked in stage three. Understanding the stages that learners pass through when learning from a case study provides the teacher with the opportunity to design a better teaching tool.
Designing a Case Study
In this era of rapidly increasing knowledge, learners have difficulty comprehending and sifting through information. It is important that the educators find ways to help learners organize and store new information by reducing the elements to a manageable size (Greenblat and Duke, 1975). The case study is one way of achieving this. These are seven steps to designing a good case study:
1. The purpose and objectives (expected behavioral outcomes of the learners) must be clearly stated and understood by the instructor. Each objective must be written out and not just mentally stated. It is important to actually see and read the statements that define the intent of the case study.
2. The story line used to create the case study should be developed from one (or more) cases that the instructor is familiar with. A good story Une will keep the learner's interest. However, don't make the story too long. Remember, the learner is in the diffusion stage and is searching the information for relevant details. The more irrelevant information woven into the case study, the more difficult the search process.
3. Organize the case study into a proper sequence and introduce it slowly. Pause periodically to help the learner differentiate among the components presented.
4. Use the opportunity to prod the learners into thinking. Ask questions about upcoming details or ask them questions about information already provided.
5. Design the case study to address no more than three or four objectives at one time. The learner will have difficulty organizing more than this in the differentiation stage.
6. The inclusion of imagery can be helpful to the learner only if the pictures or illustrations complement the information presented and do not conflict with it.
7. Present thought-provoking questions to the learners about the case study by stimulating them to draw on some of the new information to produce a new response. One technique is to ask what would change in the results if the patient used in the case study was older/ younger/malnourished/overweight, etc. This questioning technique can be really useful when an instructor is trying to see if the learners are simply recalling facts presented earlier.
Learners are members of the fast growing society where information increases at a remarkable rate. The case study is a teaching technique whereby large quantities of information can be introduced and collapsed to a manageable size to enable the learner to develop an appreciation of the whole. The technique of using a case study provides motivation to a learner by involving him or her in the learning process and enables the teacher to provide prompt feedback on the learner's success and errors. All of this begins, however, with a well-designed case study.
- Ausübe!, O.P. (1967). A Cognitive-structure theory of school learning. In LL. Siege! (Ed.), Instruction: Some contemporary viewpoints. San Francisco: Chandler.
- Bettinghaus, E.P. (1960). Communication Models in the Department of Audio Visual Instruction. National Education Association's publication of Visual communications: Research, principals and practice, pp. 16-28.
- Greenblat, C.S. & Duke, R.D. (1975). Gamingsimulation: Rationale, design and applications. New York: J. Wiley and Sons, 1975.
- Murphy, G. (1951 ). An Introduction to Psychology. Westport, CT: Greenwood Press.