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The Effect of Instruction on Learning- Case Based Versus Lecture Based

By David Griffin

The primary role of the educator is to impart knowledge to their students. From the perspective of the student, it is abundantly clear that the manner in which knowledge is imparted has a great effect on its acquisition. Simply put, how we learn has a major impact on what we learn. Consequently, for a university to produce competent professionals, it is vital that teaching practices are optimised. This ensures that students are given the greatest possible opportunity to mature into competent, capable professionals over the course of their studies. With this in mind, a study at the American University of Beirut sought to explore different models of knowledge acquisition for a cohort of nursing students (Kantar & Sailian, 2018). Nursing, as one of the foundation stones of healthcare systems worldwide, depends on individuals with adequate knowledge and judgement skills. The actions and decisions of nurses have serious and immediate consequences for those in their care. As a result, the instruction of nursing students is a subject under constant scrutiny.

The researchers sought to compare the long-term efficacy of two distinct teaching models. The first can be described as the traditional Lecture-Based Learning (LBL) model, in which lectures form the core of the students’ tuition. Within nursing programmes, this model has received criticism, with some research suggesting that it leads to students recording knowledge gained as disparate and disjointed concepts, ill-suited to the nursing profession. The second model, Case-Based Learning (CBL), uses real-world scenarios as a basis for discussion within the lecture theatre. Students are required to decipher the relevant facts and form conclusions from them, before presenting their conclusions to their peers (Nilson, 2010).

The researchers chose to carry out this study with their university’s Nursing Care of Adults course within their three-year nursing programme. This course aims to provide students with the relevant knowledge and knowledge-application skills to care for patients experiencing or at risk of developing acute or chronic surgical or medical issues. A single cohort of 47 nursing students was divided in two, with the first group receiving tuition through the LBL model and the second through the CBL model.

Eight months after the course, these students were asked to complete a 65-question multiple-choice questionnaire, with a single best answer listed for each question. The questions in this questionnaire were divided into categories based on the four recognised clinical judgement dimensions. These are Noticing, Interpreting, Responding and Reflecting, each of which represents a phase in the nurse’s thinking practice during care provision (Tanner, 2006).

  • Noticing – Predominantly describes knowledge and skills involved in situation and patient assessment.
  • Interpreting – Describes skills involved in reasoning, including analysis, intuition and situation narration.
  • Responding – Describes the action taken by the nurse in a given situation.
  • Reflection – Involves reflecting on the appropriateness of an action taken after the fact.

While the LBL and CBL groups showed no significant difference in overall knowledge gained and retained over the course, the CBL group had significantly higher scores for questions in the Reflection dimension than the LBL group. According to Tanner (2006), this dimension of knowledge acquisition leads to further clinical maturity and learning in healthcare professionals. CBL forces students to consider their own experiences, reflect on those of their peers and reach a conclusion. According to Kantar (2016), this encourages students to become emotionally and intellectually invested in the material, which in turn aids their knowledge retention.

The number of participants used in this study was modest, leading the authors to conclude that it should be replicated with a larger sample size in the future. However, this work builds on others (Nilson, 2010; Kantar, 2016) to suggest that immersive, case-based teaching is an effective alternative to the traditional lecture model. Case-based learning could find potential application in a broad range of subjects, from mathematics and engineering-based problem solving, to business and resource management. A goal of educators is to help their students mature into competent and capable professionals. Case-based learning may act as another tool to enable students engage with the material, helping this goal become a reality.


Nilson, L. B. (2010). Teaching at its best: A research-based resource for college instructors (3rd ed.). Jossey-Bass: A Wiley Imprint.
ISBN: 978-1-119-09632-0

Tanner, C. A. (2006). Thinking like a nurse: A research-based model of clinical judgment in nursing. Journal of Nursing Education, 45(6), 204–211.
DOI: 10.3928/01484834-20060601-04

Kantar, L. (2016). Context-based pedagogy: A framework from experience. Journal of Nursing Education, 55(7), 391–395.
DOI: 10.3928/01484834-20160615-06

Kantar, L. & Sailian, S. (2018). The effect of instruction on learning: Case based versus lecture based. Teaching and Learning in Nursing, 13 (2018), 207-211
DOI: 10.1016/j.teln.2018.05.002

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