Impact of case-based learning on self-reflection and academic achievement in clinical hematology education

Abstract

Case-Based Learning (CBL) is a widely used educational approach that encourages active learning and critical thinking. According to situated cognition learning theory, learning occurs more effectively when students engage in real-world scenarios. While CBL has been extensively used in medical education, its impact on self-reflection and academic performance in specific hematology topics, such as anemia and bleeding disorders, remains unclear. This study aims to evaluate the effects of CBL on self-reflection and academic performance among fourth-year medical students, focusing on anemia and coagulation disorders. This randomized controlled trial (RCT) included 70 fourth-year medical students, divided into a CBL group and a Lecture-Based Learning (LBL) group. Both groups completed pre-tests, post-tests, and submitted two self-reflection reports. The study covered two topics: (1) Anemia and Thalassemia and (2) The Bleeding Disorders and Snake bite. The self-reflection process was assessed using a rubric score. Results: found that students in the CBL group demonstrated significantly higher levels of self-reflection than those in the LBL group (p=0.002), particularly in areas such as integrating new knowledge with prior understanding, evaluating clinical decision-making, and synthesizing case-based information. In contrast, students in the LBL group more likely to remember contents than LBL group. Regarding academic performance, the LBL group achieved higher post-test scores than the CBL group, especially in topics requiring in-depth understanding of thalassemia and the clinical evaluation of snakebite envenomation (p=0.014 and p=0.044, respectively). These topics involve recognizing specific hematological conditions and applying standard treatment guidelines. In conclusion, this study highlights the importance of CBL in enhancing self-reflection and analytical skills in medical students. However, LBL may be more effective for content requiring memorization and structured learning. A combined approach incorporating both CBL and LBL could maximize learning outcomes.