A pilot study investigating the efficacy of technology enhanced case based learning (CBL) in small group teaching

Participants

The study consisted of an experimental group (n = 10) of year two undergraduate medical students, who participated in the technology-based (TEL) case-based learning (CBL) pilot that ran over the spring semester (January to May), and a control CBL group (n = 10) of year two undergraduate medical students who received conventional CBL over the same period. Ethical approval was sought and provided by the Cardiff University School of Medicine Research Ethics Committee (SoMREC). All protocols were approved, the pilot was conducted in accordance with the school’s guidelines and regulations, and consent was provided by participants. Both groups were matched in relation to key criteria that included: year 1 academic performance, year 2 progress test performance, number of graduate entry students in each group, age, and years of experience of the group facilitator/tutor. Table 1 below contains for more information about the TEL CBL group and the control CBL group:

Apparatus and procedure

Both groups of students were assigned identical teaching sessions for each unit of study throughout the course of the spring semester. Specifically, each group attended the same lectures, practical tutorials, clinical skills sessions, community clinical learning, and small group teaching sessions. Each group was assigned an experienced CBL tutor, with both tutors being senior members of staff who have been CBL tutors since the CBL-based curriculum was introduced at Cardiff University’s School of Medicine eleven years ago. Both tutors have a research background in clinical science, are members of the undergraduate medicine curriculum team, and alongside small group tutorials also deliver lectures and units of study throughout the pre-clinical phase of the programme. The two tutors facilitated their respective groups independently and as per the study protocol. The tutor assigned to the conventional CBL group adhered to the curriculum’s well-established small group learning practices (i.e., no difference in delivery, lesson plan and structure of CBL). Whilst the TEL CBL tutor covered the identical material and adhered to the same CBL structure (e.g., 3 small group sessions per case, with two scenarios for students to work through), the lesson plan and delivery of the sessions differed by integrating the use of new and emerging technologies. This included access to a 5.5 × 5.5 m immersive learning suite, 3D anatomy software, asynchronous e-learning and virtual patient cases, a GenAI simulated virtual patient platform, and VR headsets equipped with immersive anatomy software. Both groups were allocated the same amount of time per CBL session, with the conventional CBL group exploring case content during group discussion, making use of the whiteboards to recap prior knowledge and to brainstorm. The TEL CBL group integrated the use of the technological tools at their disposal to recap prior knowledge, brainstorm, and to explore case content in further detail.

The immersive learning suite consists of projectors and sensors that transform the walls surrounding the space into an immersive environment whereby images and/or 360° videos can be projected onto the walls. The sensors also enable students to interact with contact projected onto the walls through the ‘touch’ feature. The suite was used to create immersive 3D anatomy sessions that were introduced to enhance students’ learning, with peer-teaching and teamwork activities (e.g., group quizzes) included in the lesson plan. The suite was also used to transform the space into a move ambulance so that students could practice key clinical skills in an immersive environment during an emergency simulation.

The 3D anatomy software used in the immersive learning suite, as well as embedded within asynchronous e-learning resources available to all year two students, was BioDigital Human (n.d.)¹⁶ and Complete Anatomy (n.d.)¹⁷. The pilot ChatGPT-based AI platform containing virtual patient scenarios was provided by SimPat (n.d.)¹⁸, who are a group of medical students developing generative AI (GenA1)-based virtual patient simulations that enable medical students to practice history taking and communication skills in their spare time. There were 12 Meta Quest 2 128GB VR headsets available for the 10 TEL CBL students, each containing the Virtual Medicine software (n.d.)¹⁹ that enabled students to explore human anatomy and physiology in a virtual and immersive learning environment. A snapshot of a few of the immersive resources and facilities used during this pilot are presented in Fig. 1.

A sample of tools, technologies and facilities that were embedded within the TEL CBL pilot. These included (A) immersive virtual environments that could be explored on students’ individual devices, (B) a physical immersive learning suite that could accommodate the group of 10 TEL CBL students, (C) 3D anatomy software that was accessible using VR headsets as well (D) and interactive virtual patient clinical scenarios.

During the spring semester, the year two students considered four units of study that explored various areas of clinical science and medicine. This included cardiology, neurology, orthopaedics, and gastrointestinal (upper) medicine. A blend of teaching activities was delivered during each unit, which included three small group teaching sessions. The TEL CBL group had access to the aforementioned technological tools and platforms during each of these three small group sessions. The use of the technology and platforms was included as a means of enhancing learning during these sessions, as opposed to replacing any element of the sessions specifically. Each small group session was facilitated by an experienced tutor, with an equally experienced tutor facilitating the control CBL group’s small group sessions. During the third and final session during each unit, a 20-item quiz was administered to both groups as a means of assessing knowledge acquisition and retention during the unit. The quizzes (4 in total, each consisting of 20 multiple-choice items) contained questions that aligned to the teaching activities that both groups of students engaged in (i.e., lectures, practical tutorial, community and clinical learning), with an emphasis on basic science questions (anatomy, physiology and histology where relevant). Students were also administered a survey that included Likert scale items, as well as open-ended questions in relation to the learning experience during the unit and confidence in their scientific knowledge and clinical competence. Specifically, students were asked to rate their experience of using the various technologies, tools and platforms, as well as to rate the extent to which these enhanced their learning and confidence. Engagement with the tools, platforms, devices and e-learning resources was also monitored by the group tutor.

Data analysis

Quiz performance and engagement was analysed using an independent samples t-test in IBM SPSS (version 27). Student experience and confidence as reported by the TEL CBL group were captured in the form of quantitative descriptive statistics, with responses to the open-ended items being explored using content analysis, which has been reported as a well-suited approach to analysing qualitative health education data^2,20.