Original Article

Effectiveness of CBL Pak Armed Forces Med J 2014; 64 (4):564-8

STUDENTS’ OPINION ON EFFECTIVENESS OF CBL IN ARMY MEDICAL COLLEGE,

RAWALPINDI, PAKISTAN
Shoaib Bin Aleem, Kamil Asghar Imam, Muhammad Hammad
Army Medical College, National University of Sciences and Technology (NUST), Islamabad

ABSTRACT
Objectives: To assess students’ opinion regarding group working, quality of learning and assessment in newly
introduced case based learning at Army Medical College, Pakistan.
Study Design: Descriptive study
Place and Duration of Study: Army Medical College, 03 months.
Subjects and Methods: In this study, students from the second year MBBS class at Army Medical College were
given a questionnaire on completion of their second year of medical school (2012) regarding their opinion about
CBL. The questionnaire used in this study consisted of 18 statements with Likert-type responses ranging from
Strongly Agree (1) to Strongly Disagree (5). Statements were grouped using 3 categories: Group working, Quality
of Learning and Assessment.
Results:Process of learning through group work and problem solving as a learning tool was appreciated by
>80%of students.Also, >84%acknowledged that CBL has prompted them to come well prepared in the session
and has helped them in improving their understanding of key concepts.>83% students opine that their efforts in
CBL discussions are being evaluated fairly.
Conclusion: Feedback from the students clearly asserts superiority of CBL in imparting knowledge, cultivating
the habit of self-learning and inculcating skills of group discussions which is in consistence with the published
literature. At the same time, weak points highlighted by the students need rectification.
Keywords: Assessment, CBL, Group working, Quality of learning, Students’ opinion.

INTRODUCTION clinical casesto generate discussion among the

Undergraduate teaching in medical students for active acquisition and integration of
collegesis Lecture-based, Case/Problem-based or new knowledge5. CBL promotes optimal learning
a combination of Lecture and Case/Problem- in three ways. First, it provides an opportunity
basedlearning. Lecture-based learning (LBL) has where the student actively participates and
been at the core of medical education in most of contributes in group discussion while receiving
the medical colleges. However, as medical feedback from other students and the instructor6.
educators recognized the importance of active Second, the student receives knowledge,
learning strategies, the effectiveness of LBL was guidance and support from other members of the
questioned as it is a passive form of learning1,2. group. Students consult library and search
Seeing that, various methods of active learning internet to acquire relevant knowledge.Thus,
were evolved and introduced in various medical learning becomes multidirectional instead of
schools around the world. One of these methods being uni-directional i.e. teacher to student7.
is case based learning (CBL) in which written case Third, the learning is based on solving a clinical
histories are provided to the students who study problem which leads to acquisition of applied
and then discuss these casesas smallgroups3,4. aspects in addition to basic mechanisms and the
process of learning occurs through the multiple
CBL is based on the principle of using
interactions within the learning environment8.
Correspondence: Dr Shoaib Bin Aleem, Army CBL increases the ability of students to work
Medical College, Rawalpindi together to identify and analyze case histories,
Email: shoaib.phy@gmail.com and/or generate solutions which promotes
Received: 19 Jun 2013; Accepted: 22 Nov2013
physician competencies, especially in the social

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Effectiveness of CBL Pak Armed Forces Med J 2014; 64 (4):564-8

and cognitive dimensions9.Acquisition of potential harm to participants, the anonymity of

retrievable knowledge, integration of basic and participants is guaranteed and the informed
clinical sciences, self-directed learning skills, consent of participants was obtained. Data was
clinical reasoning skills, awareness of the compiled using Microsoft Excel 2007 and results
limitations of one’s knowledge, communication presented as percentages.
skills and motivation are among the advantages RESULTS
associated with the CBL10-12.
Questionnaire proforma was distributed
Keeping in view the benefits of CBL, it had among 200 students out of which 172 (86%)
been implementedat Army Medical College, returned it. Of the 172 participants, 81 (47%) were
Pakistan since 2008. It is vital for the success and male and 91 (53%) were female. >80%students
continuity of this recently introduced approach expressed an overall satisfaction with the CBL
that students view it positively.The purpose of (Table-2). Process of learning through group
this study was to determine how medical work and problem as a learning tool was
students of 2nd year MBBS view the effectiveness appreciated by majority of students as expressed.
of CBL as a tool of acquiring knowledge while >84% acknowledged that CBL has prompted
working as a group. them to come well prepared in the session and
SUBJECTS AND METHODS has helped them in improving their
This descriptive study was carried out using understanding of key concepts. >83% mentioned
non-probability, purposive sampling technique. that their efforts in CBL discussion are fairly
Two hundred students from the 2nd year MBBS evaluated.
class at Army Medical College, Pakistan were DISCUSSION
given a questionnaire on completion of their
CBL is based on adult learning principles
second year of medical school (2012) regarding
and since learning is contextual, closer the
their opinion about CBL in a classroom setting
resemblance between problem and real life
and during class time. During the two years of
situation, better would be the performance of the
their academic training, the traditional
students13.Various studies conducted previously
curriculum was horizontally integrated for
have shown results which support superiority of
teaching these students. CBL sessions were of
CBL over traditional learning strategies. Students
two hours each and carried out twice a week.
acknowledged that CBL is a better way of
Each group was facilitated by randomly assigned
learning and are mostly satisfied with the way it
faculty members who were trained through
is being conducted8-11.
workshops.
An effective CBL group should be
The questionnaire used in this study
organized, motivated, mutually encouraging,
consisted of 18 statements with Likert-type
clearly understand and energetically pursue the
responses ranging from Strongly Agree (1) to
tasks outlined in the given problem14.Most of the
Strongly Disagree (5). Statements were grouped
students in present study agreed that they have a
using 3 categories: Group working, Quality of
meaningful interaction in an environment where
Learning and Assessment (Table-1). The
students discuss the problem in respectable
questionnaire was used to conduct a pilot test
manner andthe instructor does not overshadow
with 15 male and 15 female second year students.
problem solving (70-80% either agree or strongly
Cronbach alpha coefficient was used to test the
agree). This promotes student’s interpersonal
reliability of the questionnairewhich was found
skills and ability to work as team members10. In
to be 0.87. The work was carried out in
study carried out at Rawalpindi Medical College
accordance with the Declaration of Helsinki,
(RMC),80-89% students endorsed that CBL was
including, but not limited to there being no

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Effectiveness of CBL Pak Armed Forces Med J 2014; 64 (4):564-8

productive and the facilitatorcreated a supportive discussion while 44.4% disagreed and 5.6%
Table-1: Questionnaire used to assess student satisfaction with the process of CBL.
Group working
I usually have a meaningful interaction with the group.
There are students in my group who hesitate to participate but there percentage is low.
Most of the time, some students dominate the discussion preventing others from participating.
CBL session mostly becomes a tutorial in which teacher keeps asking questions which students
have to answer.
Most of the time students only repeat bookish knowledge.
Most of the time students over-rely on teachers for generating discussion and solving problems.
All students in my group respect each other and do not ridicule any one during discussion.
Quality of learning
CBL is a better way to learn course contents than lectures.
Group discussions help me improve my concepts of various medical concepts better than
lectures.
Group discussions help me in retention of key facts about the topic under discussion.
Most of the time, I prepare the topic to be discussed before the session which has improved my
understanding of the subject.
Most of the time, I take help of various books present in college library to prepare the topic.
Most of the time, I take help of material available on internet to prepare the topic.
Most of the students come well prepared and generate a discussion which elaborates various
aspects of the problem under discussion.
Assessment
Assessment of my contribution in the discussion is done fairly.
Quiz tests are relevant to the problem and marked fairly.
As the CBL session is assessed, it motivates me to prepare well and participate enthusiastically.
All teachers assess according to the same criteria so it does not matter which teacher is
supervising the session.

environment without dominating the discussion remained neutral15. To avoid this predicament, it
and kept them focused on the task15. In Dow is suggested that instructors should intervene in a
Medical College, students evaluated PBL was positive manner to ensure maximum active
significantly higher than LBL (p<0.05) in terms participation of all the students. Second, a few
of interest in method of learning and stimulation students tend to memorize the bookish
for further study as a result of productive group knowledge and just repeat the same (72.08%
discussions. However, there was no significant either agree or strongly agree). If quality of
difference (p>0.05) in perception of the problem given to the students is improved
instructor’s role in either PBL or LBL16. further, it will stimulate the students to discover
The weak points identified by our students basic scientific and clinical mechanisms, think
include domination of the discussion by some critically, evaluate ideas and share pertinent
students (72.67% either agree or strongly agree) information.This will enhance the problem
while a few others are hesitant to participate solving skills of the students and drift them away
(76.74% either agree or strongly agree). In the from traditional approach of memorizing
study done in RMC, 50% of the students reported things.**
equal participation of all students in group

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Majority of our students (66.27% either agree Students at RMC highly appreciated PBL as
or strongly agree) think that CBL is a better way a learning tool which facilitated their
of learning as compared to the lectures. It helps understanding of the subject (78% either agree or
Table-2: Students’ response to the questionnaire.
A. Group working
Question no. Strongly agree Agree Confused Disagree Strongly disagree
1 39 (22.67%) 98 (56.97%) 10 (5.81%) 11 (6.39%) 14 (8.13%)
2 52 (30.23%) 80 (46.51%) 11 (6.39%) 23 (13.37%) 6 (3.48%)
3 3(1.74%) 27 (15.69%) 17 (9.88%) 79 (45.93%) 46 (26.74%)
4 5 (2.90%) 39 (22.67%) 12 (6.97%) 53 (30.81%) 63 (36.62%)
5 1 (0.58%) 39 (22.67%) 8 (4.6%) 75 (43.60%) 49 (28.48%)
6 9 (5.23%) 33 (19.18%) 11 (6.39%) 81 (47.09%) 38 (22.09%)
7 41 (23.83%) 94 (54.65%) 10 (5.81%) 8 (4.6%) 19 (11.04%)
B. Quality of learning
Question no. Strongly agree Agree Confused Disagree Strongly disagree
1 62 (36.04%) 52 (30.23%) 28 (16.27%) 17 (9.88%) 13 (7.55%)
2 78 (45.34%) 25 (14.53%) 27 (15.69%) 30 (17.44%) 6 (3.48%)
3 40 (23.25%) 91 (52.90%) 6 (3.48%) 23 (13.37%) 12 (6.97%)
4 46 (26.74%) 87 (50.58%) 1 (0.58%) 28 (16.27%) 10 (5.81%)
5 22 (12.79%) 34 (19.76%) 17 (9.88%) 69 (40.11%) 30 (17.44%)
6 45 (26.16%) 74 (43.02%) 5 (2.90%) 24 (13.95%) 24 (13.95%)
7 23 (13.37%) 98 (56.97%) 12 (6.97%) 29 (16.86%) 10 (5.81%)
C. Assessment
Question no. Strongly agree Agree Confused Disagree Strongly disagree
1 18 (10.46%) 114 (66.27%) 2 (1.16%) 31 (18.02%) 7 (4.06%)
2 31 (18.02%) 120 (69.76%) 11 (6.39%) 10 (5.81%) Nil
3 46 (26.74%) 78 (45.34%) 20 (11.62%) 16 (9.30%) 12 (6.97%)
4 40 (23.25%) 100 (58.13%) 15 (8.72%) 12 (6.97%) 5 (2.90%)

them to understand the topic in better way and strongly agree). However, in contrast to our
retain the key facts. Most of our students (77.32% study, students relying on non-electronic library
either agree or strongly agree) come prepared in sources slightly dominated the internet users
the CBL session which shows their interest to (52.3% and 49.9% respectively)15. Students of
actively participate in the discussion and Dow Medical College also favoured PBL against
contribute positively to the process of learning. LBL (p<0.05) regardingtime spent in self-study,
This aspect is mostly missing in the lecture based number of books consulted, time spent on
teaching and is therefore one of the biggest internet search, time spent in library, amount of
advantages of CBL. Students rely more on the group discussion and depth of knowledge
internet (69.18% either agree or strongly agree) as gained16. Similar comparison made in Isra
compared to the books (32.55% either agree or University depicted greater autonomy and in-
strongly agree) which underlines the need for depth approach of learning as compared to
ready access to library and computer facility for traditional curriculum (p<0.001). Majority of
effective CBL as stressed by Pelzer and co- students (p<0.001) rated the experience of CBL as
workers17. Also, the students must be guided excellent due todemocraticlearning environment
beforehand about the internet sites with reliable while traditional learning was dubbed as
scientific medical information. boring18. While evaluating CBL, students at

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