Number of Citations: 0

Submitted: 13 February 2024
Accepted: 28 April 2025
Published online: 1 July, TAPS 2025, 10(3), 75-79
https://doi.org/10.29060/TAPS.2025-10-3/SC3235

Tayzar Hein¹ & Susan Somerville²

¹Department of Medical Education, Defence Services Medical Academy, Myanmar; ²University of Dundee, Scotland

Abstract

Introduction: Case-Based Learning (CBL) is increasingly used in modern medical schools to improve students’ critical thinking and problem-solving skills. While CBL is established in Western Resource-Structured (WRS) educational settings, its use in Asian-Pacific regions like Myanmar is under explored. This research studied the integration of CBL at the Defence Services Medical Academy (DSMA) in Myanmar, focusing on the perspectives of both students and faculty involved in curriculum reforms.

Methods: This study used constructivist grounded theory to gather data from 24 DSMA participants through four focus group discussions. Twelve students and twelve faculty members, were invited a subgroup of six, and after providing informed consent discussed their experiences of CBL, aiming to assess its effectiveness and relevance in their specific educational and cultural context.

Result: Analysis shows that students valued CBL for enhancing group discussions, reflecting upon real-world situations, and building critical thinking abilities. Faculty members also appreciated CBL for its capacity to create realistic applications and its support for student-centered learning and interpersonal skills development. Both groups acknowledged CBL as an effective method for simulating the complexities of medical practice.

Conclusion: This study found that CBL is well-regarded at DSMA for preparing students competence and confidence for clinical encounters. However, faculty indicated that the extensive time required in preparation of this teaching modality was a significant challenge for the wider adoption of CBL. These insights highlight the adaptability and potential challenges of implementing CBL in non-Western educational settings and suggest possible areas for development for its broader application in the Asia-Pacific region.

Keywords:           Medical Education, Case-based Learning, Perceptions, Grounded Theory, Focus Group Discussion

I. INTRODUCTION

In 2017, Defence Services Medical Academy (DSMA) in Yangon, Myanmar, introduced an outcome-based integrated curriculum incorporating Case-Based Learning (CBL) as a key pedagogical approach. This shift from teacher-centered to student-centered learning was aimed at encouraging students to take greater responsibility for their education. However, CBL’s widespread adoption across all subjects at DSMA remains uncertain, highlighting the need for further research. CBL has been established in Western Resource-Structured (WRS) medical education, where it fosters critical thinking, active learning, and problem-solving skills (Thistlethwaite et al., 2012). However, its adoption in the Asian-Pacific context, including Myanmar, has been limited. Cultural and institutional challenges such as insufficient faculty training, resource constraints, and resistance to pedagogical change present unique barriers (McLean, 2016; Yoo & Park, 2015). These challenges underline the importance of research to adapt CBL to resource-constrained settings.

At DSMA, CBL is relatively new, and while the institution can be considered an early adopter within the local context, faculty have faced challenges transitioning from traditional teaching methods due to inadequate training and support (Thistlethwaite et al., 2012). This study aimed to explore how students and faculty perceive the implementation of CBL and to assess the opportunities and challenges of CBL in a resource-constrained, Asian-Pacific context. By addressing gaps in the CBL literature, this research contributes valuable insights for adapting pedagogical practices to diverse cultural and educational settings.

This study aimed to explore:

1. How students and faculty at DSMA perceive the implementation of CBL.
2. The opportunities and challenges associated with implementing CBL in a resource-constrained, Asian-Pacific context.

 

By addressing gaps in the CBL literature, particularly in non-WRS settings, this research contributes to a better understanding of how pedagogical practices can be adapted to diverse cultural and educational contexts, offering insights for both early and late adopters within similar settings.

II. METHODS

This qualitative study used a constructivist grounded theory approach, focusing on the experiences and meanings constructed by participants engaged with CBL in the DSMA integrated curriculum.

A. Sampling and Focus Group Composition

Purposive sampling (Patton, 2014) was used to select participants with direct involvement in CBL activities, either as facilitators or active learners. The study included 24 participants, evenly split between 12 students and 12 faculty members. Four focus groups, each containing six participants, were conducted. To reduce power dynamics, the focus groups were divided by role, with separate groups for students and faculty.

B. Participant Demographics

Table 1 below shows the demographic breakdown of participants is for understanding the responses and receptivity to CBL.

Table 1. Participant demographic

C. Theoretical Framework

The constructivist grounded theory approach guided both data collection and analysis. This approach emphasises the co-construction of knowledge, meaning participants not only shared their experiences but actively engaged in interpreting them. The analysis followed a constant comparative method (Patton, 2014), allowing key themes to emerge from the data.

D. Data Analysis

Data were analysed using MAXQDA software, and the constant comparative method was applied to identify recurring themes and refine categories as new insights developed.

E. Ethical Considerations

Ethical approval was granted by the DSMA Ethical Review Board. Informed consent was obtained from all participants, ensuring they were aware of the study’s aims and their rights. Confidentiality and anonymity were maintained throughout the study, and all focus group discussions were audio-recorded with consent.

III. RESULTS

The core category identified in the study was that CBL is a student-centered approach that develops critical thinking, simulates discussion about real-world scenarios, and enhances interpersonal skills, making it a key facet of modern medical education. These findings emphasise the role of CBL in bridging theoretical knowledge with practical application and supporting the development of essential skills for clinical encounters. Both students and faculty members offered different but aligned perspectives, providing valuable insights into the opportunities and challenges associated with CBL.

A. Students’ Perceptions of CBL

1) Theme 1: CBL as group discussion: Students welcomed the collaborative nature of CBL, emphasising the shared learning experience it offers. One student stated, “It’s like a team effort where we learn from each other while solving problems.” This highlights the significance of peer interaction in CBL, which is consistent with research indicating that collaborative learning enhances problem-solving skills.

2) Theme 2: Real-World Relevance: Students appreciated the practical aspects of CBL, particularly its similarity to real-life clinical scenarios. A participant remarked, “It feels like we are preparing for actual hospital situations.” This theme aligns with studies showing how CBL effectively bridges the gap between theoretical knowledge and clinical practice, preparing students for real-world medical challenges.

3) Theme 3: Fostering Critical Thinking: Students frequently mentioned the role of CBL in promoting deeper analytical skills. One student shared, “CBL makes us analyse why things happen instead of just memorising.” This observation reflects the literature that highlights critical thinking as a fundamental outcome of CBL, encouraging students to engage more deeply with the material.

B. Faculty Perceptions of CBL

1) Theme 1: Preparation for Clinical Practice: Faculty members emphasised the effectiveness of CBL in preparing students for real-world medical contexts. One faculty member noted, “CBL allows students to apply their knowledge in realistic medical contexts.” This highlights the need for carefully designed scenarios that accurately mimic clinical challenges, supporting students in applying theoretical knowledge.

2) Theme 2: The Role of Facilitator: Faculty highlighted the critical role of facilitators in guiding effective CBL sessions. A faculty member stated, “Guiding discussions and asking the right questions is key to effective CBL sessions.” This underscores the importance of facilitator training, as their competence significantly impacts the success of CBL in achieving its objectives.

3) Theme 3: Development of Personal Skills: Faculty also emphasised the role of CBL in cultivating essential personal skills for medical practice, such as communication and empathy. One faculty member remarked, “CBL is instrumental in teaching students how to communicate effectively and empathise with patients, which are essential skills in medicine.” This theme reflects a structured focus on skill development, complementing students’ emphasis on the experiential aspects of learning.

IV. DISCUSSION

This study identified both the opportunities and challenges of adopting CBL in a resource-constrained, Asian-Pacific context. Students recognised CBL’s role in fostering teamwork and critical thinking, consistent with previous research (Ferguson & Lee, 2012; Thistlethwaite et al., 2012). Faculty highlighted its effectiveness in preparing students for clinical practice and developing essential interpersonal skills. However, both groups noted challenges, such as the time-intensive nature of CBL and the varying levels of facilitator preparedness.

A. Student Perspectives

Students appreciated the collaborative nature of CBL, noting that it enhanced communication and problem-solving skills. They also valued its practical relevance, which bridged the gap between theory and clinical practice. However, challenges related to the time commitment and inconsistent preparation for case studies were identified.

B. Faculty Perspectives

Faculty acknowledged the value of CBL in preparing students for real-world challenges but emphasised the importance of facilitator training. Inconsistent facilitation was cited as a barrier to effective implementation, suggesting the need for structured training programs focusing on communication and group management skills.

C. Adapting CBL for the Asian-Pacific Context

Cultural dynamics at DSMA, including hierarchical relationships, were seen as barriers to open dialogue and peer-led activities. Strategies such as peer-led activities and anonymous feedback could help mitigate these issues, creating a more inclusive and collaborative environment. Although hierarchical relationships are common across educational settings, these challenges may be viewed as institutional factors rather than unique cultural issues. Thus, the solutions proposed peer-led activities and feedback are relevant for various contexts beyond Asian-Pacific.

D. Core Category and Future Directions

The findings underscore the need for ongoing research to explore facilitation models and cultural adaptations that can optimise CBL in diverse settings. Future studies should examine how CBL can be further refined to address institutional factors like hierarchical relationships, and how these adaptations can be applied in resource-limited settings.

V. CONCLUSION

This study highlights both the strengths and challenges of implementing CBL at DSMA. Students valued CBL for its relevance to clinical scenarios and its emphasis on clinical reasoning, while faculty recognised its potential in fostering interpersonal skills. However, challenges such as inconsistent facilitation, insufficient faculty training, and the lack of localised case studies were identified. Moving forward, DSMA should focus on enhancing faculty development, particularly in facilitation skills, and integrate case studies that reflect local clinical realities. Additionally, leveraging technology to support CBL in resource-limited settings could improve access and engagement.

For the broader health education community, this study underscores the importance of adapting CBL to local contexts, considering cultural dynamics and institutional constraints. Successful implementation of CBL in resource-constrained settings requires flexibility in adapting global pedagogical methods to meet the needs of local learners and educators. Expanding CBL at DSMA, with a focus on faculty training, case study development, and the use of technology, will better prepare students for the challenges of medical practice. This study contributes to the growing body of literature on CBL and provides actionable recommendations for institutions in similar settings.

Notes on Contributors

Dr. Tayzar Hein contributed significantly to the manuscript’s conception, design, and writing, leveraging his expertise to shape its content.

Dr. Susan Somerville provided essential support during the research process, particularly in data collection and analysis, contributing to the manuscript’s presentation.

Ethical Approval

Ethics approval was granted by the Ethical Review Committee of the DSMA, Ethical Review Board (2/ ERB/ 2022).

Data Availability

The data that support the findings of this study are openly available in https://doi.org/10.6084/m9.figshare.26550262.v1.

Acknowledgement

The author would like to express sincere gratitude to their supervisor, Dr Susan Somerville, for her thoughtful guidance throughout the research project. Dr Susan Somerville provided invaluable suggestions, constant encouragement, and generously dedicated her time during video chats, despite being on the other side of the world. The support of the Ethical Review Committee at DSMA is also deeply appreciated. Their rigorous adherence to ethical standards ensured that the study met the highest research ethics guidelines, which is essential to both advancing medical knowledge and protecting human subjects.

Special thanks are extended to the Phase II medical students and faculty members who participated in interviews and provided honest, insightful discussions that significantly contributed to the research. Phase II students, typically in the years of medical education, engage in more clinical-based learning and were crucial in offering perspectives on applying Case-Based Learning (CBL) to real-world medical scenarios. Faculty members from both basic science and clinical practice domains also played an integral role in facilitating these discussions. The assistance of the Medical Education Department faculty in facilitating these interviews was also instrumental, and their support is gratefully acknowledged.

Finally, the author wishes to express heartfelt thanks to his wife and son for their unwavering support and encouragement throughout the academic journey. Without their constant love and understanding, this research project would not have been possible.

Funding

This research is entirely self-funded, as there is currently no external financial support available for the project, necessitating the coverage of all expenses independently.

Declaration of Interest

The author conducted original research and wrote this dissertation, which was not previously submitted for a degree. The author has the copyright to the dissertation according to UK Copyright Acts and University of Dundee’s rules. Any use of material from this thesis should be acknowledged.

References

Ferguson, A., & Lee, E. (2012). Desperately seeking… relevant assessment? A case study on the potential for using online simulated group based learning to create sustainable assessment practices. Legal Education Review, 22(1), Article 6. https:/​/​doi.org/​10.53300/​001c.6258

McLean, S. F. (2016). Case-based learning and its application in medical and health-care fields: A review of worldwide literature. Journal of Medical Education and Curricular Development, 3, S20377. 

Patton, M. Q. (2014). Qualitative research & evaluation methods: Integrating theory and practice (4^th ed.). SAGE Publications.

Thistlethwaite, J. E., Davies, D., Ekeocha, S., Kidd, J. M., MacDougall, C., Matthews, P., Purkis, J., & Clay, D. J. (2012). The effectiveness of case-based learning in health professional education. A BEME systematic review: BEME Guide No. 23. Medical Teacher, 34(6), e421-e444. https://doi.org/10.3109/0142159X.2012.680939

Yoo, M. S., & Park, H. R. (2015). Effects of case‐based learning on communication skills, problem‐solving ability, and learning motivation in nursing students. Nursing & Health Sciences, 17(2), 166-172. https://doi.org/10.1111/nhs.12151

*Tayzar Hein
Defence Services Medical Academy,
Pyay Road, Mingalardon Township,
Yangon, Myanmar
+9595188093
Email: dr.tayzarhein@gmail.com