Introduction
Modern medical education is continuously reorganizing the performance-based curriculum to train doctors required by the future society and expanding the application of learner-centered teaching and learning methods. Among them, case-based learning (CBL) is a learner-centered teaching and learning method in which learning occurs through the process of analyzing and discussing real-life cases [1]. CBL has emerged as an alternative to problem-based learning because it can strengthen students’ motivation to learn by analyzing cases, which leads to more active participation in learning activities [2,3]. Modern medical education is increasingly focusing on integrating basic and clinical sciences to better prepare future physicians for patient care. It is particularly important to align clinical and basic science education in pharmacology, where understanding drug mechanisms is directly applied to clinical scenarios. Woodman et al. [4] found that integrating clinical cases into pharmacology courses, especially through CBL, significantly improved students’ ability to apply theoretical knowledge to practical situations. This approach enhances learning outcomes and clinical competence, highlighting the practical benefits of CBL in pharmacology education. Additionally, Eissa et al. [5] reported that the large-scale implementation of CBL in medical biochemistry education proved to be both feasible and effective. The study demonstrated significant improvements in student performance and comprehension. Both students and faculty perceived CBL positively, highlighting its impact on enhancing problem-solving abilities and critical thinking skills [5].
Meanwhile, the Context, Input, Process, and Product (CIPP) evaluation model has been adopted and utilized for educational evaluation in the field of medical education in Korea and abroad [6]. This is because the CIPP evaluation model has the strength of being able to effectively improve programs by evaluating them from a systematic and comprehensive perspective in four aspects: context evaluation, input evaluation, process evaluation, and product evaluation [7]. Furthermore, CIPP evaluation model was used to assess an integrated basic science curriculum, positively impacting medical students’ participation, course quality, and need for ongoing improvement [8]. Therefore, it is meaningful that by customizing each component of the CIPP evaluation model to fit the specific context, inputs, processes, and desired outcomes of different programs, medical schools can effectively assess and enhance their educational programs.
In this study, we introduced a CBL class using blended learning, which is based on the existing lecture-based class, while converting the pharmacology curriculum into an integrated form of education. In addition, for an in-depth evaluation of the 7-hour clinical-basic CBL program, we developed class evaluation questions based on the CIPP evaluation model instead of class evaluation questions optimized for the existing lecture-based class. The purpose of this study is to systematically evaluate the effectiveness and implementation of the CBL program within a basic-clinical integrated educational framework by applying the CIPP evaluation model at the subject level.
Methods
1. Participants
In 2022, there were 54 students enrolled in Pharmacology and Practice and 52 students enrolled in the Integrated Pharmacology-Clinical Case Practicum course. These students were in their first year of medical school, and four of the 54 were repeat students.
2. Running a clinical-basic aligned CBL program
The application of CBL was determined to be 1 week out of the total 10 weeks, and a clinical-based CBL program class was designed and taught to 52 students who took pharmacology and practice courses in the second semester of 2022. As a pre-learning, online activities provided guidance on the methodology, evaluation method, and presentation materials; offline, the class was held for 7 hours using three clinical-basic cases; and as a post-learning, feedback on the presentation was provided by both clinical and basic professors in the field (Fig. 1).
3. Data collection and analysis
Considering the educational situation of the medical school, evaluation questions were developed for each evaluation stage according to the CIPP model, and based on this, a survey was conducted for the students after the 7-hour CBL class. There were 20 male students (54.1%) and 17 female students (45.9%), totaling 37 questionnaires. The questionnaire asked about the demands, resources, operations, and outcomes of the class, which were organized into four categories: situation, input, process, and output. Responses were assessed using a 5-point Likert scale (1=very dissatisfied, 3=adequate, 5=very satisfied) and open-ended questions. Briefly, the questionnaire was developed by the researcher by referring to previous studies [9,10], and the questionnaire was developed in consultation with two educational evaluation experts with experience in planning and conducting medical education. To identify and supplement the appropriateness and validity of the questions, two medical education experts were reviewed and revised the measurement tool and constructed it to evaluate CBL based on the CIPP model. The “Context” area assessed the extent to which the program effectively integrates foundational medical knowledge with clinical practice and whether it cultivates evidence-based thinking and critical reasoning skills. The “Input” area focused on assessing the adequacy of resources, including educational facilities, online platforms, and faculty support, and evaluating the appropriateness and alignment of the cases provided with the program’s educational goals. The “Process” area examined the effectiveness of the program’s planning and implementation in achieving its educational objectives, and the responsiveness and guidance provided by faculty within the program. Finally, the “Product” area assessed the program’s impact on enhancing students’ clinical skills, application of knowledge, professionalism, and overall achievement of the educational objectives.
To enhance the reliability and validity of variables, factor analysis was conducted using the varimax rotation method with Kaiser normalization, focusing on eigenvalues > 1. Through seven rounds of factor analyses, the initial 28 items were reduced to 18 items across four factors. Additionally, variables with a measure of sampling adequacy value of the inverse-image correlation coefficient or a commonality value below the 0.50 threshold were considered for removal. Consequently, the Kaiser-Meyer-Olkin measure of sample adequacy for the final items was 0.822, exceeding the 0.50 cutoff, indicating the suitability of the correlation matrix for factor analysis. Bartlett’s test of sphericity yielded a valid result of 743.235 (153 degrees of freedom, p<0.001). For the validity and reliability, the Cronbach α scores were calculated for the adopted questionnaires.
Results
Learners’ satisfaction with the CBL program based on the CIPP model (on a 5-point scale) showed an overall average of 4.17, as shown in Table 1, indicating that learners were satisfied with the CBL program that linked basic and clinical. Specifically, the mean score for the situation evaluation was 4.18, the mean score for the input evaluation was 4.11, the mean score for the process evaluation was 4.31, and the mean score for the output evaluation was 4.09, with the process evaluation showing the highest satisfaction score and the output evaluation showing the lowest satisfaction score. When looking at the detailed evaluation questions, “Feedback from clinical professors during presentations helps me understand the case” in the course evaluation had the highest satisfaction score with an average of 4.50, and “Practicing cases improves my ability to see patients” in the output evaluation had the lowest satisfaction score with an average of 4.0, but all questions had an average satisfaction score above 4.0, indicating that learners were satisfied with the program overall. The Cronbach’s α for the questionnaire used in this study was over 0.85, indicating a high level of internal consistency.
Discussion
This study aimed to systematically evaluate the effectiveness of a clinical-basic aligned CBL program within a pharmacology course using the CIPP model. The findings are particularly significant as they contribute to the existing body of evidence supporting the integration of basic and clinical sciences in medical education, specifically through CBL.
Consistent with previous research, this study demonstrated that incorporating clinical cases into pharmacology education enhances students’ ability to apply theoretical knowledge to practical clinical scenarios. Woodman et al. [4] found that integrating clinical cases within a pharmacology curriculum significantly improved students’ clinical competence by providing practical applications of drug mechanisms and pharmacological principles. Similarly, the results of this study indicate that students who participated in the CBL program expressed high satisfaction, particularly regarding their ability to understand and apply pharmacological concepts in clinical contexts.
Furthermore, in the educational operation section of the course evaluation, learners’ satisfaction with the CBL program, particularly in conjunction with clinical practice, was notably high. The highest satisfaction score, 4.5, was recorded for the item “Feedback from clinical professors during presentations helps me understand the cases.” This was further supported by qualitative feedback, where students highlighted the value of clinical professors’ input, stating, “The feedback from the clinical professor was good and made it more interesting,” and “The feedback from the psychiatry professor related to the actual clinical was constructive.” This emphasis on the role of clinical feedback aligns with the positive impact of CBL on problem-solving skills and critical thinking observed in previous studies, such as Eissa et al. [5], who implemented a large-scale CBL program in medical biochemistry.
Additionally, learners’ satisfaction with the educational outcomes of the CBL program was highest in the “Product” evaluation category, with a score of 4.16. Students reported that the CBL approach enabled them to think critically and apply theoretical knowledge to actual cases, as evidenced by comments like, “I was able to think in various ways and consider various factors in the process of applying the theory I learned by simple memorization to real cases,” and “I was able to become more familiar with drug names by exploring cases and applying them directly to clinical practice.” These findings suggest that CBL enhances theoretical understanding and facilitates the practical application of knowledge, which is crucial in medical education.
The application of the CIPP model in this study also corresponds with previous evaluations of integrated medical curricula [8]. In the present study, the CIPP model proved to be a robust framework for evaluating the multifaceted components of the CBL program, from context to product, thereby providing a comprehensive and reassuring understanding of its effectiveness.
Overall, this study not only corroborates prior research findings but also extends the application of CBL and the CIPP evaluation model to pharmacology education. The positive product suggests that this teaching model could be effectively implemented in other medical school courses that aim to bridge the gap between basic and clinical medical education. However, the study’s limitations, including small number of participants, the absence of a control group and the single-institution context, may limit the generalizability of the results. Future research should consider these factors and explore the long-term impacts of CBL in various educational settings.
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