need and importance of case study in education

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In This Article Expand or collapse the "in this article" section Case Study in Education Research

Introduction, general overview and foundational texts of the late 20th century.

• Conceptualisations and Definitions of Case Study
• Case Study and Theoretical Grounding
• Choosing Cases
• Methodology, Method, Genre, or Approach
• Case Study: Quality and Generalizability
• Multiple Case Studies
• Exemplary Case Studies and Example Case Studies
• Criticism, Defense, and Debate around Case Study

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Case Study in Education Research by Lorna Hamilton LAST REVIEWED: 27 June 2018 LAST MODIFIED: 27 June 2018 DOI: 10.1093/obo/9780199756810-0201

It is important to distinguish between case study as a teaching methodology and case study as an approach, genre, or method in educational research. The use of case study as teaching method highlights the ways in which the essential qualities of the case—richness of real-world data and lived experiences—can help learners gain insights into a different world and can bring learning to life. The use of case study in this way has been around for about a hundred years or more. Case study use in educational research, meanwhile, emerged particularly strongly in the 1970s and 1980s in the United Kingdom and the United States as a means of harnessing the richness and depth of understanding of individuals, groups, and institutions; their beliefs and perceptions; their interactions; and their challenges and issues. Writers, such as Lawrence Stenhouse, advocated the use of case study as a form that teacher-researchers could use as they focused on the richness and intensity of their own practices. In addition, academic writers and postgraduate students embraced case study as a means of providing structure and depth to educational projects. However, as educational research has developed, so has debate on the quality and usefulness of case study as well as the problems surrounding the lack of generalizability when dealing with single or even multiple cases. The question of how to define and support case study work has formed the basis for innumerable books and discursive articles, starting with Robert Yin’s original book on case study ( Yin 1984 , cited under General Overview and Foundational Texts of the Late 20th Century ) to the myriad authors who attempt to bring something new to the realm of case study in educational research in the 21st century.

This section briefly considers the ways in which case study research has developed over the last forty to fifty years in educational research usage and reflects on whether the field has finally come of age, respected by creators and consumers of research. Case study has its roots in anthropological studies in which a strong ethnographic approach to the study of peoples and culture encouraged researchers to identify and investigate key individuals and groups by trying to understand the lived world of such people from their points of view. Although ethnography has emphasized the role of researcher as immersive and engaged with the lived world of participants via participant observation, evolving approaches to case study in education has been about the richness and depth of understanding that can be gained through involvement in the case by drawing on diverse perspectives and diverse forms of data collection. Embracing case study as a means of entering these lived worlds in educational research projects, was encouraged in the 1970s and 1980s by researchers, such as Lawrence Stenhouse, who provided a helpful impetus for case study work in education ( Stenhouse 1980 ). Stenhouse wrestled with the use of case study as ethnography because ethnographers traditionally had been unfamiliar with the peoples they were investigating, whereas educational researchers often worked in situations that were inherently familiar. Stenhouse also emphasized the need for evidence of rigorous processes and decisions in order to encourage robust practice and accountability to the wider field by allowing others to judge the quality of work through transparency of processes. Yin 1984 , the first book focused wholly on case study in research, gave a brief and basic outline of case study and associated practices. Various authors followed this approach, striving to engage more deeply in the significance of case study in the social sciences. Key among these are Merriam 1988 and Stake 1995 , along with Yin 1984 , who established powerful groundings for case study work. Additionally, evidence of the increasing popularity of case study can be found in a broad range of generic research methods texts, but these often do not have much scope for the extensive discussion of case study found in case study–specific books. Yin’s books and numerous editions provide a developing or evolving notion of case study with more detailed accounts of the possible purposes of case study, followed by Merriam 1988 and Stake 1995 who wrestled with alternative ways of looking at purposes and the positioning of case study within potential disciplinary modes. The authors referenced in this section are often characterized as the foundational authors on this subject and may have published various editions of their work, cited elsewhere in this article, based on their shifting ideas or emphases.

Merriam, S. B. 1988. Case study research in education: A qualitative approach . San Francisco: Jossey-Bass.

This is Merriam’s initial text on case study and is eminently accessible. The author establishes and reinforces various key features of case study; demonstrates support for positioning the case within a subject domain, e.g., psychology, sociology, etc.; and further shapes the case according to its purpose or intent.

Stake, R. E. 1995. The art of case study research . Thousand Oaks, CA: SAGE.

Stake is a very readable author, accessible and yet engaging with complex topics. The author establishes his key forms of case study: intrinsic, instrumental, and collective. Stake brings the reader through the process of conceptualizing the case, carrying it out, and analyzing the data. The author uses authentic examples to help readers understand and appreciate the nuances of an interpretive approach to case study.

Stenhouse, L. 1980. The study of samples and the study of cases. British Educational Research Journal 6:1–6.

DOI: 10.1080/0141192800060101

A key article in which Stenhouse sets out his stand on case study work. Those interested in the evolution of case study use in educational research should consider this article and the insights given.

Yin, R. K. 1984. Case Study Research: Design and Methods . Beverley Hills, CA: SAGE.

This preliminary text from Yin was very basic. However, it may be of interest in comparison with later books because Yin shows the ways in which case study as an approach or method in research has evolved in relation to detailed discussions of purpose, as well as the practicalities of working through the research process.

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Making Learning Relevant With Case Studies

The open-ended problems presented in case studies give students work that feels connected to their lives.

To prepare students for jobs that haven’t been created yet, we need to teach them how to be great problem solvers so that they’ll be ready for anything. One way to do this is by teaching content and skills using real-world case studies, a learning model that’s focused on reflection during the problem-solving process. It’s similar to project-based learning, but PBL is more focused on students creating a product.

Case studies have been used for years by businesses, law and medical schools, physicians on rounds, and artists critiquing work. Like other forms of problem-based learning, case studies can be accessible for every age group, both in one subject and in interdisciplinary work.

You can get started with case studies by tackling relatable questions like these with your students:

• How can we limit food waste in the cafeteria?
• How can we get our school to recycle and compost waste? (Or, if you want to be more complex, how can our school reduce its carbon footprint?)
• How can we improve school attendance?
• How can we reduce the number of people who get sick at school during cold and flu season?

Addressing questions like these leads students to identify topics they need to learn more about. In researching the first question, for example, students may see that they need to research food chains and nutrition. Students often ask, reasonably, why they need to learn something, or when they’ll use their knowledge in the future. Learning is most successful for students when the content and skills they’re studying are relevant, and case studies offer one way to create that sense of relevance.

Teaching With Case Studies

Ultimately, a case study is simply an interesting problem with many correct answers. What does case study work look like in classrooms? Teachers generally start by having students read the case or watch a video that summarizes the case. Students then work in small groups or individually to solve the case study. Teachers set milestones defining what students should accomplish to help them manage their time.

During the case study learning process, student assessment of learning should be focused on reflection. Arthur L. Costa and Bena Kallick’s Learning and Leading With Habits of Mind gives several examples of what this reflection can look like in a classroom: 

Journaling: At the end of each work period, have students write an entry summarizing what they worked on, what worked well, what didn’t, and why. Sentence starters and clear rubrics or guidelines will help students be successful. At the end of a case study project, as Costa and Kallick write, it’s helpful to have students “select significant learnings, envision how they could apply these learnings to future situations, and commit to an action plan to consciously modify their behaviors.”

Interviews: While working on a case study, students can interview each other about their progress and learning. Teachers can interview students individually or in small groups to assess their learning process and their progress.

Student discussion: Discussions can be unstructured—students can talk about what they worked on that day in a think-pair-share or as a full class—or structured, using Socratic seminars or fishbowl discussions. If your class is tackling a case study in small groups, create a second set of small groups with a representative from each of the case study groups so that the groups can share their learning.

4 Tips for Setting Up a Case Study

1. Identify a problem to investigate: This should be something accessible and relevant to students’ lives. The problem should also be challenging and complex enough to yield multiple solutions with many layers.

2. Give context: Think of this step as a movie preview or book summary. Hook the learners to help them understand just enough about the problem to want to learn more.

3. Have a clear rubric: Giving structure to your definition of quality group work and products will lead to stronger end products. You may be able to have your learners help build these definitions.

4. Provide structures for presenting solutions: The amount of scaffolding you build in depends on your students’ skill level and development. A case study product can be something like several pieces of evidence of students collaborating to solve the case study, and ultimately presenting their solution with a detailed slide deck or an essay—you can scaffold this by providing specified headings for the sections of the essay.

Problem-Based Teaching Resources

There are many high-quality, peer-reviewed resources that are open source and easily accessible online.

• The National Center for Case Study Teaching in Science at the University at Buffalo built an online collection of more than 800 cases that cover topics ranging from biochemistry to economics. There are resources for middle and high school students.
• Models of Excellence , a project maintained by EL Education and the Harvard Graduate School of Education, has examples of great problem- and project-based tasks—and corresponding exemplary student work—for grades pre-K to 12.
• The Interdisciplinary Journal of Problem-Based Learning at Purdue University is an open-source journal that publishes examples of problem-based learning in K–12 and post-secondary classrooms.
• The Tech Edvocate has a list of websites and tools related to problem-based learning.

In their book Problems as Possibilities , Linda Torp and Sara Sage write that at the elementary school level, students particularly appreciate how they feel that they are taken seriously when solving case studies. At the middle school level, “researchers stress the importance of relating middle school curriculum to issues of student concern and interest.” And high schoolers, they write, find the case study method “beneficial in preparing them for their future.”

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Using Case Study in Education Research

• Lorna Hamilton - University of Edinburgh, UK
• Connie Corbett-Whittier - Friends University, Topeka, Kansas
• Description

This book provides an accessible introduction to using case studies. It makes sense of literature in this area, and shows how to generate collaborations and communicate findings.

The authors bring together the practical and the theoretical, enabling readers to build expertise on the principles and practice of case study research, as well as engaging with possible theoretical frameworks. They also highlight the place of case study as a key component of educational research.

With the help of this book, graduate students, teacher educators and practitioner researchers will gain the confidence and skills needed to design and conduct a high quality case study.

See what’s new to this edition by selecting the Features tab on this page. Should you need additional information or have questions regarding the HEOA information provided for this title, including what is new to this edition, please email [email protected] . Please include your name, contact information, and the name of the title for which you would like more information. For information on the HEOA, please go to http://ed.gov/policy/highered/leg/hea08/index.html .

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'Drawing on a wide range of their own and others' experiences, the authors offer a comprehensive and convincing account of the value of case study in educational research. What comes across - quite passionately - is the way in which a case study approach can bring to life some of the complexities, challenges and contradictions inherent in educational settings. The book is written in a clear and lively manner and should be an invaluable resource for those teachers and students who are incorporating a case study dimension into their research work' - Ian Menter, Professor of Teacher Education, University of Oxford

'This book is comprehensive in its coverage, yet detailed in its exposition of case study research. It is a highly interactive text with a critical edge and is a useful tool for teaching. It is of particular relevance to practitioner researchers, providing accessible guidance for reflective practice. It covers key matters such as: purposes, ethics, data analysis, technology, dissemination and communities for research. And it is a good read!' - Professor Anne Campbell, formerly of Leeds Metropolitan University

'This excellent book is a principled and theoretically informed guide to case study research design and methods for the collection, analysis and presentation of evidence' -Professor Andrew Pollard, Institute of Educaiton, University of London

This publication provides easy text, giving differing viewpoints to establish definitions for case study research. This book has been recommended to the Fd students to support projects of action research.

This has again been recommended for students on the Foundation Degree and Degree programmes as it is an easy text, providing differing viewpoints to establish definitions for case study research. Additionally recommended on the reading list for the BA programmes to provide a clearer insight into using Case Studies in preschool and school environments.

This is an excellent book - very clear

This text clearly discusses the case study approach and would be useful for both undergraduate and post graduate learners.

An easily accessible text, giving alternative points of view on what case study research actually is and how it might be interpreted at doctoral level.

This is a pleasant read with a number of useful group and individual tasks for students to engage with as they think through designing and doing a project. These tasks for useful not just for case studies but can be adapted as students consider other research designs.

Offers a good understanding of case study research in a clear and accessible manner. A perfect starting point for the researcher new to the case study method and will also offer the experienced researcher some useful tips and insights.

This text is clearly written and argues strongly for using case study in educational research, despite the challenges this approach faces in the dynamic world of shifting research paradigms. Step-by-step guidance from initial ideas through to the reality of undertaking case study in educational research is helpful

The book is written in a practical way, which gives a clear guide for undergraduate students especially for those who are using case study in education research. I will definitely add this book to recommended reading lists.

Preview this book

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Activity 6.12 Observation 1 p98

Activity 6.12 Observation 2 p98

Activity 6.12 Observation 3 p98

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Activity 6.18 Interview schedule 1

Activity 6.19 and 6.20 Questionnaire P110

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Research Guides

Case Studies

Dee Degner; Amani Gashan; and Natalia Ramirez Casalvolone

Description

Creswell and Poth (2018) define case study as a strategy that involves the study of an issue explored through one or more cases within a bounded system (i.e., a setting or a context), a methodology, a type of design in qualitative research, or an object of study, as well as a product of the inquiry.

Flyvbjerg (2011) defines case study as an intensive analysis of an individual unit (as a person or community) stressing developmental factors in relation to the environment. Case study methodology aims to describe one or more cases in depth. It examines how something may be occurring in a given case or cases and typically uses multiple data sources to gather information. Creswell and Poth also argue that the use of different sources of information is to provide depth to the case description. Case study methodology aims to describe one or more cases in depth. It examines how something may be occurring in a given case or cases and typically uses multiple data sources to gather the information. This is the first step of data analysis in a qualitative case study. Following this, researchers must decide whether there is a case study to analyze, determine the boundaries of their case study and its context, decide whether they wish to use single or multiple case studies, and explore approaches to analyzing themes and articulating findings. Creswell and Poth (2018) are an ideal resource for defining case study, learning about its parts, and executing case study methodology.

Creswell, J. W., & Poth, C. N. (2018). Qualitative inquiry & research: choosing among five approaches (4th ed.) . Thousand Oaks, CA: Sage.

Flyvbjerg, B. (2011). Case study. In N. K. Denzin, & Y.S. Lincoln (Eds.), The Sage handbook of qualitative research (pp. 301-316 ). Thousand Oaks, CA: Sage.

Key Research Books and Articles on Case Study Methodology

Ashley, L. D. (2017). Case study research. In R. Coe, M. Waring, L. Hedges & J. Arthur (Eds), Research methods & methodologies in education (2nd ed., pp. 114-121). Thousand Oaks, CA: Sage.

This edited text discusses several research methods in education. Dr. Laura Day Ashley, a professor at the University of Birmingham in the United Kingdom, contributes a chapter on case study research. Using research on how private and public schools impact education in developing countries, she describes case studies and gives an example.

Baxter, P., & Jack, S. (2008). Qualitative case study methodology: Study design and implementation for novice researchers. Qualitative Report, 13 (4), 544-559.  http://nsuworks.nova.edu/cgi/viewcontent.cgi?article=1573&context=tqr

The authors of this study presented an account of the qualitative case study methodology that can provide beneficial tools for researchers to explore any phenomenon under study within its context. The aim of this study was to guide novice researchers in understanding the required information for the design and implementation of any qualitative case study research project. This paper offers an account of the types of case study designs along with practical recommendations to determine the case under study, write the research questions, develop propositions, and bind the case. It also includes a discussion of data resources and the triangulation procedure in case study research.

Creswell, J. W. & Poth, C. N. (2018). Qualitative inquiry & research: choosing among five approaches (4th ed.) . Los Angeles, CA: SAGE.

The authors are both recognized academics in the field of qualitative research; Dr. Creswell has authored many articles and 26 books on topics such as mixed-methods research, qualitative research, and research design, and Dr. Poth has written more than 30 peer reviewed journal articles and was a guest co-editor at the International Journal of Qualitative Methods. The book thoroughly reviews and compares five qualitative and inquiry designs, including research, phenomenological research, grounded theory research, ethnographic research, and case study research. Chapter 4, which is titled Five Qualitative Approaches, gives a thorough description and explanation of what a case study research contemplates. It discusses its definition and origins, its features, the types of case study procedures to follow when doing a case study, and the challenges faced during case study development. In the appendix, on page 119, the authors offer an example of a case study and a question that can be used for discussion. The entire book has pertinent information for both novice and experienced researchers in qualitative research. It covers all parts of the research process, from posing a framework to data collection, data analysis, and writing up.

Yin, R. K. (2016). Qualitative research from start to finish . New York, NY: The Guilford Press.

Yin is the CEO of an applied research firm. He has authored numerous articles in many fields, including education. He also authored Case Study Research, which is now in its Sixth Edition. This book uses three approaches (practical, inductive, and adaptive) to highlight many important aspects of Qualitative Research. He provides a definition of case study and references how case study differs from other types of research.

Recent Dissertations Using Case Study Methodology

Clapp, F. N. (2017). Teachers’ and researchers’ beliefs of learning and the use of learning progressions (Doctoral dissertation). Retrieved from ProQuest Dissertations & Theses Global. (Order Number 10261732)

This study from Colorado State University was designed to identify the beliefs and discourse that both the Learning Progressions (LP) developers and the intended LP implementers held around student learning, teaching, and learning progressions. The study’s research questions were examined through the use of an instrumental case study. The researchers were deliberate in applying theory and study phenomena in their context, as it investigated teachers’ practices in the context of their respective classrooms.

Applying theory to the study phenomena, this study provided insight into the relationship between LP models and teachers’ perceptions about how students learn content in a particular context. The data was collected using interviews with teachers who participated in a year-long teacher-in-residence program. Researchers and content experts who conceptualized the LP were also interviewed to study the impact that it had on participants’ perceptions of the LP and any teacher reported changes in their respective classrooms. The findings of this study inform literature on both science teacher professional development and LP’s theory to practice.

Ruiz, A. M. (2011). Teachers and English language learners experiencing the secondary mainstream classroom: A case study (Doctoral Dissertation). Retrieved from ProQuest Dissertations & Theses Global. (Order Number 3471646)

This study from Georgia State University answered the following questions: 1) How does a secondary mainstream teacher experience the phenomenon of the inclusion of ELLs in a mainstream content area classroom? 2) How do ELLs experience the phenomenon of inclusion within the secondary mainstream content area classrooms? 3) How do the points of interaction between the secondary mainstream teacher, the English language learners, the content and the context shape the experiences of the inclusive classroom?

To comprehend the socio-constructivist learning theory which guided the design of this study, one must begin with understanding the epistemological stance of constructionism. Constructionism is seated within an interpretivist paradigm which asserts that reality does exist outside the realm of human interpretation; rather, it is human interpretation which makes meaning of this reality. The researcher applied Denzin and Lincoln’s (2004) bricoleur approach to this study, as it offered them the opportunity “to piece together a set of representations that is fitted to the specifics of this complex situation in an overlapping series of events” (p. 4). The researcher stated that his worldview shaped his research questions which called for a single case study research design.

Smith, P. H. (2000). Community as resource for minority language learning: A case study of Spanish-English dual-language schooling (Doctoral dissertation). Retrieved from ProQuest Dissertations & Theses Global. (Order Number 304578045)

The author studied a school where a dual language (Spanish- English) program was being developed. He focused on the role of the community and the students’ acquisition of Spanish. Through a case study design, his theoretical framework was contemplated under the fields of language planning, language revitalization, and funds of knowledge. The author believed that minority language (Spanish) acquisition could be supported by incorporating local language resources, and in this way undermine the strong influence of the English language. To analyze his data, he went through a triangulation process of participant observation in classrooms, literacy instruction, teacher, parent and community interviews, and document and archival analysis. Findings showed that minority language resources are less often incorporated in the curriculum than those of the language majority. Thus the study suggested that these types of programs should include the funds of knowledge and available resources of the language minority communities.

Internet Resources

Graham R Gibbs. (2012, October 24). Types of Case Study. Parts 1-3 on Case Studies .

This series of videos by Graham R. Gibbs at the University of Huddersfield effectively explains case studies. Some of Gibbs’ books on qualitative research include Qualitative Data Analysis: Explorations with NVivo (2002) and Analyzing Qualitative Data (2018).

Graham R Gibbs. (2012, October 24). Types of Case Study. Part 1 on Case Studies . Retrieved from https://youtu.be/gQfoq7c4UE4

The first part of this series is an attempt to define case studies. Dr. Gibbs argued that it is a contemporary study of one person, one event, or one company. This contemporary phenomenon cab be studied in its social life context by using multiple sources of evidence.

When completing a case study, we either examine what affects our case and what effect it has on others, or we study the relationship between “the case” and between the other factors. In a typical case study approach,  you choose one site to do your work and then you collect information by talking to people, using observations, interviews, or focus groups at that location. Case study is typically descriptive, meaning “you write what you see”, but it could also be exploratory or explanatory.

Types of Case Study:

• Individual case study: One single person
• Set of individual case studies: Looking at three single practices
• Community studies: Many people in one community
• Social group studies: The case representing social phenomenon “how something is defined in a social position”
• Studies of organizations and institutions: The study of “election, ford, or fielding”
• Studies of events, roles, and relationships: Family relationships

Graham R Gibbs. (2012, October 24). Planning a case study. Part 2 on Case Studies . Retrieved from https://youtu.be/o1JEtXkFAr4

The second part of this series explains how to plan a case study. Dr. Gibbs argues that when planning to conduct a case study, we should think about the conceptual framework, research questions, research design, sampling/replication strategy, methods and instruments, and analysis of data.

For any type of research, a good source of inspiration could be either from personal experiences or from talking with people about a certain topic that we can adopt.

The Conceptual Framework: Displays the important features of a case study; shows the relationships between the features; makes assumptions explicit; is selective, iterative, and based on theory; takes account of previous research; includes personal orientations, and includes overlap and inconsistency.

Research questions should:

• Be consistent with your conceptual framework.
• Cover conceptual framework.
• Be structured and focused.
• Be answerable.
• Form a basis for data collection.

Graham R Gibbs. (2012, October 24). Replication or Single Cases. Part 3 of 3 on Case Studies . https://youtu.be/b5CYZRyOlys

In the final part of the three videos of case study, Dr. Gibbs examines case study designs and variations that are possible. He also discusses replication strategies which help give the studies reliability and test to see if they can be generalized. Dr. Gibbs highlights the methods and instruments used, how to analyze the data, and concludes with problems of validity you may encounter and common pitfalls of case study research. In summary, case studies can involve gathering a lot of data and you can start analyzing the data while collecting and going through it.

shirlanne84. (2014). Different types of case study </. Retrieved from https://youtu.be/tWsnvYs9Brs

In this short video (1.49 min.), three kinds of case studies (exploratory, descriptive, and explanatory) are described, as well as rationales for using them. These rationales are as follows:

• Exploratory: If you know nothing about the case.
• Descriptive: When you write what you see, you are describing the situation.
• Explanatory: When you try to understand why things are happening, then you explain them.

Shuttleworth, M. (2008, Apr. 1). Case study research design [website]. Retrieved Feb 20, 2018 from https://explorable.com/case-study-research-design

This is a useful website that provides a guide to almost all of the research methods. It offers a clear explanation about what a case study is, the argument for and against the case study research design, how to design and conduct a case study, and how to analyze the results. This source provides a journey from the introduction of case study until the analysis of your data.

Case Studies Copyright © 2019 by Dee Degner; Amani Gashan; and Natalia Ramirez Casalvolone is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License , except where otherwise noted.

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Resources for research

Case studies in educational research

31 Mar 2011

Dr Lorna Hamilton

To cite this reference: Hamilton, L. (2011) Case studies in educational research, British Educational Research Association on-line resource. Available on-line at [INSERT WEB PAGE ADDRESS HERE] Last accessed [insert date here]

Case study is often seen as a means of gathering together data and giving coherence and limit to what is being sought. But how can we define case study effectively and ensure that it is thoughtfully and rigorously constructed?  This resource shares some key definitions of case study and identifies important choices and decisions around the creation of studies. It is for those with little or no experience of case study in education research and provides an introduction to some of the key aspects of this approach: from the all important question of what exactly is case study, to the key decisions around case study work and possible approaches to dealing with the data collected. At the end of the resource, key references and resources are identified which provide the reader with further guidance.

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What the Case Study Method Really Teaches

• Nitin Nohria

Seven meta-skills that stick even if the cases fade from memory.

It’s been 100 years since Harvard Business School began using the case study method. Beyond teaching specific subject matter, the case study method excels in instilling meta-skills in students. This article explains the importance of seven such skills: preparation, discernment, bias recognition, judgement, collaboration, curiosity, and self-confidence.

During my decade as dean of Harvard Business School, I spent hundreds of hours talking with our alumni. To enliven these conversations, I relied on a favorite question: “What was the most important thing you learned from your time in our MBA program?”

• Nitin Nohria is the George F. Baker Jr. Professor at Harvard Business School and the former dean of HBS.

Partner Center

Case-Study Instruction in Educational Psychology: Implications for Teacher Preparation

• First Online: 01 January 2014

Cite this chapter

• Alyssa R. Gonzalez-DeHass 6 &
• Patricia P. Willems 6  

Part of the book series: New Frontiers of Educational Research ((NFER))

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3 Citations

Case-study instruction has become increasingly popular as a way for preprofessional teachers to actively engage in problem-solving for real-life classroom situations. Case-study activity allows for social dialog and exploration in an atmosphere of shared learning among peers and instructor, and it also affords prospective teachers the opportunity to see how a teacher works jointly with other stakeholders such as the school principal, guidance counselor, and students and their parents in order to assist a student’s academic learning. Benefits associated with this method of teaching include preservice teachers gaining an appreciation for the complexities involved in teaching, opportunities for scaffolding of critical thinking skills, students being involved in authentic learning experiences in teacher decision-making, and student motivation to learn academic content. The chapter also includes suggestions for instructors in teacher preparation programs wishing to successfully incorporate case-study instruction into their classrooms.

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Gonzalez-DeHass, A.R., Willems, P.P. (2015). Case-Study Instruction in Educational Psychology: Implications for Teacher Preparation. In: Li, M., Zhao, Y. (eds) Exploring Learning & Teaching in Higher Education. New Frontiers of Educational Research. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-55352-3_4

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Case studies.

Print Version

Case studies are stories that are used as a teaching tool to show the application of a theory or concept to real situations. Dependent on the goal they are meant to fulfill, cases can be fact-driven and deductive where there is a correct answer, or they can be context driven where multiple solutions are possible. Various disciplines have employed case studies, including humanities, social sciences, sciences, engineering, law, business, and medicine. Good cases generally have the following features: they tell a good story, are recent, include dialogue, create empathy with the main characters, are relevant to the reader, serve a teaching function, require a dilemma to be solved, and have generality.

Instructors can create their own cases or can find cases that already exist. The following are some things to keep in mind when creating a case:

• What do you want students to learn from the discussion of the case?
• What do they already know that applies to the case?
• What are the issues that may be raised in discussion?
• How will the case and discussion be introduced?
• What preparation is expected of students? (Do they need to read the case ahead of time? Do research? Write anything?)
• What directions do you need to provide students regarding what they are supposed to do and accomplish?
• Do you need to divide students into groups or will they discuss as the whole class?
• Are you going to use role-playing or facilitators or record keepers? If so, how?
• What are the opening questions?
• How much time is needed for students to discuss the case?
• What concepts are to be applied/extracted during the discussion?
• How will you evaluate students?

To find other cases that already exist, try the following websites:

• The National Center for Case Study Teaching in Science , University of Buffalo. SUNY-Buffalo maintains this set of links to other case studies on the web in disciplines ranging from engineering and ethics to sociology and business
• A Journal of Teaching Cases in Public Administration and Public Policy , University of Washington

For more information:

• World Association for Case Method Research and Application

Book Review :  Teaching and the Case Method , 3rd ed., vols. 1 and 2, by Louis Barnes, C. Roland (Chris) Christensen, and Abby Hansen. Harvard Business School Press, 1994; 333 pp. (vol 1), 412 pp. (vol 2).

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• J Undergrad Neurosci Educ
• v.19(2); Spring 2021

Effective Use of Student-Created Case Studies as Assessment in an Undergraduate Neuroscience Course

Dianna m. bindelli.

1 Neuroscience Department, Carthage College, Kenosha, WI 53140

Shannon A.M. Kafura

Alyssa laci, nicole a. losurdo, denise r. cook-snyder.

2 Department of Physiology, Medical College of Wisconsin, Milwaukee WI 53226

Case studies and student-led learning activities are both effective active learning methods for increasing student engagement, promoting student learning, and improving student performance. Here, we describe combining these instructional methods to use student-created case studies as assessment for an online neurovirology module in a neuroanatomy and physiology course. First, students learned about neurovirology in a flipped classroom format using free, open-access virology resources. Then, students used iterative writing practices to write an interrupted case study incorporating a patient narrative and primary literature data on the neurovirulent virus of their choice, which was graded as a writing assessment. Finally, students exchanged case studies with their peers, and both taught and completed the case studies as low-stakes assessment. Student performance and evaluations support the efficacy of case studies as assessment, where iterative writing improved student performance, and students reported increased knowledge and confidence in the corresponding learning objectives. Overall, we believe that using student-created case studies as assessment is a valuable, student-led extension of effective case study pedagogy, and has wide applicability to a variety of undergraduate courses.

It is well established that active learning increases student engagement, promotes student learning, and improves student performance compared to traditional lecture ( Armbruster et al., 2009 ; Haak et al., 2011 ; Freeman et al., 2014 ). Moreover, active learning is a critical component of inclusive pedagogy that is effective for all students, and decreases the achievement gap for persons excluded because of their ethnicity or race (PEERs; Haak et al., 2011 ; Ballen et al., 2017 ; Penner, 2018 ; Theobald et al., 2020 ; Asai, 2020 ). Frequent student-led learning activities are an important component of an active learning classroom, where students engage with course content and work collaboratively with their peers to increase their own and each other’s learning. Student-led learning techniques range from short, cooperative activities like think-pair-share and the jigsaw method ( Faust and Paulson, 1998 ; Lom, 2012 ; Lang, 2016 ), to full collaborative learning courses where students prepare and lead most classes ( Casteel and Bridges, 2007 ; Davidson and Major, 2014 ; Kurczek and Johnson, 2014 ). Case studies are also an effective active learning method that uses narratives to engage students in higher-level learning objectives within Bloom’s Taxonomy ( Anderson and Krathwohl, 2001 ; Handelsman et al., 2004 ; Herreid et al., 2012 ; Wiertelak et al., 2016 ). As one example, case studies have been incorporated into introductory and upper-level neuroscience courses to promote student analysis and evaluation of primary literature ( Cook-Snyder, 2017 ; Sawyer and Frenzel, 2018 ; Rollins, 2020 ). Typically, student-led learning activities and case studies are both used as in-class practice before a separate, larger assessment, like an exam testing similar content ( Freeman et al., 2014 ; Cook-Snyder, 2017 ; Sawyer and Frenzel, 2018 ). Here, we describe using the case study itself as the assessment, where students work collaboratively to write a case study that demonstrates and applies their neurovirology knowledge and requires analysis and evaluation of the primary literature. In turn, students lead their peers in discussion of their case to promote their own and each other’s learning.

As described here, we used student-created case studies as assessment in a four-week, online neurovirology module in an upper-level neuroanatomy and physiology course. Neurovirology is the interdisciplinary study of viruses that affect the central nervous system ( Nath and Berger, 2020 ) and students voted to learn more about neurovirology during the SARS-CoV-2 (COVID-19) pandemic in the spring 2020 semester. Accordingly, student-created case studies focused on neurovirulent viruses, or viruses that can cause disease of nervous tissue ( Racaniello, 2020a ). Students used iterative writing practices to write their case studies, which were graded as writing assignments. Then, students exchanged case studies with their peers, and both taught and completed the cases in small groups as low-stakes assessment. Student performance data and self-reported evaluations support the success of the neurovirology module and case study assignment in meeting the content and skills learning objectives listed below. Case studies are highly effective tools in undergraduate education ( Handelsman et al., 2004 ; Herreid et al., 2012 ; Wiertelak et al., 2016 ), and we believe that using student-created case studies as assessment is a valuable extension of established case study pedagogy.

Learning Objectives

Content objectives.

After this module, students should be able to:

• ○ Viral properties and classification
• ○ Viral pathogenesis, including infection and immune response
• ○ CNS barriers, including the blood-brain barrier
• ○ Mechanisms of neurotoxicity and neuronal death

Skills Objectives

Additionally, students will increase their skills in:

• Applying virology and neuroscience principles to neurovirulent viruses and neurologic disorders
• Using resources from the neurovirology module to learn more about virology
• Analyzing and evaluating primary literature
• Collaborating to write original case studies
• Leading peers in analysis and evaluation of case studies

MATERIALS AND METHODS

Neurovirology module.

The neurovirology module was developed for a one-semester, neuroanatomy and physiology lecture and laboratory course for junior and senior neuroscience majors at a small liberal arts college (Neuroscience 4100, Carthage College). Enrollment for the course is typically 25–30 students, with greater than 60% of students reporting clinically focused health care career goals. The most common career goals are physician (M.D. or D.O.), physician assistant, physical or occupational therapist, and clinical psychologist, consistent with the hypothesis that students believe a neuroscience major will better prepare them for health care careers ( Prichard, 2015 ; Ramos et al., 2016a , 2016b ).

The neurovirology module was developed as a substitution for in-person labs when remote instruction was implemented in the spring 2020 semester due to the COVID-19 pandemic. Student survey data was collected using Google Forms at the beginning of remote instruction, and 96% of students voted in favor of using lab time to learn more about virology and infectious disease, with an emphasis on neurovirology ( n = 26 enrolled students; 24/26 students for, 0/26 students against, 2/26 students abstained). Accordingly, the neurovirology module was administered over Zoom ( https://zoom.us/ ) during weekly 3-hour lab periods for a total of four weeks (Week 1 to Week 4; 12 hours total; see Supplementary Material Appendix A , Appendix B ). Students received instruction in using Zoom prior to the neurovirology module, including joining a Zoom class, providing verbal and non-verbal feedback to the instructor, and joining breakout rooms to work with peers.

The neurovirology module followed a flipped classroom format, in which students gained familiarity with neurovirology content before class, and used class time for active learning strategies ( Mazur, 2009 ; Brame, 2013 ). Appendix A provides details on before class readings, videos, and assignments, and in-class activites for the neurovirology module. Briefly, in Week 1, students learned basic principles of virology using recorded lectures and readings from a free, online, open-access virology course ( https://www.virology.ws/course/ ) and blog ( https://www.virology.ws/virology-101/ ) courtesy of Vincent Racaniello at Columbia University ( Racaniello, 2004 ; Racaniello, 2009a , 2009b , 2009c , 2009d , 2009e , 2009f , 2009g ; Racaniello, 2020a , 2020b , 2020c ). These materials were supplemented with textbook readings on the immune system ( Widmaier et al., 2014 ). Week 1 materials were chosen to provide students with enough background on viral properties, classification, and pathogenesis that they could apply their knowledge to neurovirulent viruses and neurologic disorders in Week 2. Accordingly, in Week 2, students read about central nervous system barriers in the course textbook ( Kandel et al., 2013 ), and watched a brief, recorded lecture summarizing major mechanisms of neurotoxicity and neuronal death ( Appendix A ; Fink and Cookson, 2005 ; Jellinger, 2010 ; Fan et al., 2017 ; full lecture available from the corresponding author by request). After completing these additional background readings, students read a neurovirology review article describing mechanisms of invasion and disease for specific neurovirulent viruses ( Swanson and McGavern, 2015 ).

Before class assignments for Week 1 and Week 2 included short, online comprehension quizzes, and collaborative “neurovirology dictionary” assignments, where students were responsible for adding new terms and definitions to create a shared “neurovirology dictionary” from the before class readings and videos ( Appendix A ). Both of these graded assignments incentivized student preparation before class and provided checks of student understanding, which are key elements of a flipped classroom ( Brame, 2013 ).

Week 1 and Week 2 class time used cooperative, student-led learning, where students worked together to complete questions based on the before class content ( Davidson and Major, 2014 ). Specifically, students were randomly assigned to groups of 3–4 using the breakout room function in Zoom. Each group was assigned a different set of instructor-created questions to discuss and complete in a shared Google Slides document, and the instructor circulated between groups to check understanding. Then, each group presented their answers to the full class. This format provided structure for students to create their own study guide summarizing neurovirology content, and provided additional practice in cooperative, student-led learning ( Davidson and Major, 2014 ).

Case Study Assignment

Weeks 3–4 of the neurovirology module were used for the case study assignment. Broadly defined, case studies use narratives to engage students and meet learning objectives ( Herreid, 2007 ). The case study assignment was worth 6% of the final course grade, and Appendix B provides details on assignment requirements and a grading rubric. Briefly, students worked in self-selected groups of 2–3 to write their case study on any neurovirulent virus of their choosing. Case studies were required to follow an interrupted, literature-based format ( Herreid et al., 2012 ; Prud’homme-Généreux, 2016 ; Cook-Snyder, 2017 ), where the first part of the case study used a patient narrative or primary literature data and asked questions on the epidemiology and/or symptoms and diagnosis of the virus. The second part of the case study was required to use primary literature data and ask questions on the pathogenesis and/or treatment of the virus. Students included answers to their own questions, and the answers were required to be clearly supported by the course materials and by their case study. Supplementary Material Appendices C and D provide example student-created case studies on rabies virus and enterovirus 71, respectively.

Students followed an iterative writing practice to create their case studies, which sought to couple goal-directed practice with targeted feedback ( Ambrose et al., 2010 ). Specifically, students submitted the first draft of their co-authored case study in Week 3, which was graded by the instructor using a holistic rubric that included a grading scale, comments, and specific examples from the students’ draft ( Appendix B ; Allen and Tanner, 2006 ). The first draft was worth 10% of the students’ final grade on the assignment, which incentivized student performance on the draft while still serving as a low-stakes assesment and providing formative feedback ( Birol et al., 2013 ; Brownell et al., 2013 ; Cotner and Ballen, 2017 ; Cyr, 2017 ). Then, students revised and submitted the final draft of their case study in Week 4, which was graded by the instructor using the same rubric as the first draft to provide summative feedback, and was worth 90% of the students’ final grade. Students were asked to write new or edited text on the final draft in a different color, so the instructor could more easily identify the students’ improvements from the first draft and incorporation of first draft feedback.

Students also shared their case study final draft with one other student group, and the case study authors led their peers through their case studies following a previously described classroom management strategy ( Cook-Snyder, 2017 ). This classroom management strategy is consistent with effective student-led discussion practices, including students working in teams to create and disseminate discussion questions before leading class discussion ( Casteel and Bridges, 2007 ; Kurczek and Johnson, 2014 ). Briefly, in Week 4, peers completed the student authors’ case study questions as homework before class, and class time was used to discuss their answers. Discussion was facilitated by the student authors, and emphasized that there can be multiple "correct" answers where the best answers are accurate and well-supported. Well-supported answers cited the case study itself, the neurovirology module, previous course content, and/or the primary literature as needed. This approach encourages students to apply course knowledge and conduct targeted literature searches to increase their knowledge. Peers edited their answers based on the discussion, and these edits were factored into a pass/fail grade from the instructor. Each case study was allotted 30 minutes for discussion; at the end of 30 minutes, the peers and students authors switched roles and discussed the peers’ case study. Appendix B provides a table illustrating this format for a three-hour class period. Overall, each student received three grades on the case study assignment: a grade on the first draft and a grade on the final draft of the case study they wrote, and a pass/fail grade on the case study they completed ( Appendix B ). Additionally, each student had the opportunity to teach their case study to their peers as a student-led learning activity. By implementing the case study assignment workflow outlined here, students both created original work and led their peers in analysis and evaluation of their work, consistent with higher-level learning objectives from Bloom’s Taxonomy ( Anderson and Krathwohl, 2001 ).

Assessment of Learning Objectives

Learning objectives for the neurovirology module and case study assignment were assessed directly and indirectly using student performance data and self-reported evaluations, respectively ( Muir, 2015 ). Data and evaluations were collected in accordance with federal guidelines for research in education settings, and with approval from the Institutional Review Board at Carthage College. All statistical analyses were performed in GraphPad Prism 8 for macOS (San Diego, CA) with a significance level of p <0.05.

Analyzed student performance data included student grades on the first draft and final draft of the case study assignment ( Figure 1 ). Comparison of first draft and final draft case study grades was analyzed using a parametric paired t -test.

Student performance improved with iterative writing practice and low-stakes assessment. Student group grades for the first draft and final draft of the case study are shown as a percentage of the total possible points for the draft (grey circles). Lines connect the first draft and final draft grades from the same student group ( n = 12 student groups; paired t -test, **** p <0.001).

De-identified student self-reported evaluations were collected using Google Forms after Week 4 of the neurovirology module and case study assignment. Quantitative evaluations used a Likert scale with the following responses: 5-Strongly Agree; 4- Agree; 3- Neutral; 2- Disagree; 1- Strongly Disagree ( Figures 2 ​ 2 – 4 ). All questions included a “prefer not to respond” option for student response, although no students chose this option for the questions reported here. Student responses were analyzed using a nonparametric one-sample Wilcoxon signed-rank test, with a hypothetical median of 3- Neutral. If the responses were significantly different from 3- Neutral, we concluded that the students agreed/strongly agreed (4–5) or disagreed/strongly disagreed (1–2) with the question. This analysis method is consistent with previous research analyzing student-led learning activities ( Stavnezer and Lom, 2019 ).

Students self-reported familiarity with neurovirology ( A ), increased knowledge in content learning objectives ( B ), and activities contributing to knowledge ( C ). Evaluations used a Likert scale: 5-Strongly Agree; 4- Agree; 3- Neutral; 2- Disagree; 1- Strongly Disagree. Scatter plots show individual student responses (grey circles) and the median response (black bar) for each question ( n = 23–24 students; one-sample Wilcoxon signed rank test to a hypothesized median of 3- Neutral (dotted line); ** p <0.01, **** p <0.0001).

Students self-reported increased confidence in skills learning objectives. Evaluations used a Likert scale: 5-Strongly Agree; 4- Agree; 3- Neutral; 2- Disagree; 1- Strongly Disagree. Scatter plots show individual student responses (grey circles) and the median response (black bar) for each question ( n = 23–24 students; one-sample Wilcoxon signed rank test to a hypothesized median of 3- Neutral (dotted line); **** p <0.0001).

Students self-reported satisfaction with the neurovirology module and case study assignment. Evaluations used a Likert scale: 5-Strongly Agree; 4- Agree; 3- Neutral; 2- Disagree; 1- Strongly Disagree. Scatter plots show individual student responses (grey circles) and the median response (black bar) for each question ( n = 24 students; one-sample Wilcoxon signed rank test to a hypothesized median of 3- Neutral (dotted line); *** p <0.001, **** p <0.0001).

De-identified qualitative evaluations included three open-ended questions: (1) What will you take away from the neurovirology module?; (2) What aspects of the neurovirology module were most valuable?; (3) What suggestions do you have for how Dr. Cook-Snyder (i.e., instructor and corresponding author) can improve the neurovirology module? The corresponding author categorized student responses to align with the content and skills learning objectives, or with the neurovirology module materials ( Appendix A ) and case study assignment ( Appendix B ; Figure 5 ). Some student responses contained module/case study assignment category. Additionally, some student responses (31.03% of responses) did not contain a suggestion for improvement, and were omitted from analysis. Accordingly, qualitative evaluation sample sizes vary from course enrollment because one response can contain zero or multiple categories, consistent with analysis methods from previous studies ( Stavnezer and Lom, 2019 ).

Students self-reported content and skills learning objective takeaways, and provided strengths and areas for improvement for the neurovirology module and case study assignment. Qualitative evaluations used open-ended questions to assess takeaways ( A ), strengths ( B ), and areas for improvement ( C ). ( A ) Students responses on takeaways were aligned with content learning objectives (above dotted line) or skills learning objectives (below dotted line), and the percentage of total responses for each learning objective is shown ( n = 38 responses). ( B, C ) Student responses on strengths ( B ) and areas for improvement ( C ) were aligned with neurovirology module materials (above dotted line) or the case study assignment (below dotted line), and the percentage of total responses for each category is shown ( B : n = 39 responses; C : n = 20 responses)

Student Performance

Student learning in the neurovirology module ( Supplementary Material Appendix A ) was primarily assessed with the case study assignment ( Supplementary Material Appendix B ). As examples, two student-created case studies on neurovirulent viruses are included in Supplementary Material Appendices C and D . Student authors (DMB, SAMK, AL, NAL) had substantial familiarity with interrupted, literature-based case studies before writing their own case study in this format. Indeed, almost all students who wrote case studies (25 out of 26 students) had previously completed 13 interrupted, literature-based case studies over two semesters in the corresponding author’s courses ( Cook-Snyder, 2017 ). In Appendix C , the student-created case study on rabies virus applies content from the neurovirology module with detailed analysis of primary literature data on rabies virus, blood-brain barrier permeability, and vaccine efficacy ( Long et al., 2020 ). In Appendix D , the student-created case study on enterovirus 71 also applies neurovirology content to investigate vaccine efficacy ( Li et al., 2008 ; Zhang et al., 2012 ). Additionally, this case study reviews cerebellar and pontine structure and function, which were previously discussed in the course, in relation to viral pathogenesis ( Huang et al., 1999 ; Shen et al., 1999 ; Jain et al., 2014 ). In both case studies, student authors successfully met the skills learning objectives of the neurovirology module and case study assignment by applying their knowledge of neurovirology and analyzing and evaluating primary literature.

The case study assignment used an iterative writing process and low-stakes assessment, where the first draft of the case study was worth 10% of the students’ final grade on the assignment, and the final draft was worth 90%. Iterative writing practices and low-stakes assessment have been shown to improve student performance and confidence within a course ( Freestone, 2009 ; Brownell et al., 2013 ; Cyr, 2017 ). Therefore, we compared student grades on the first draft and final draft of the case study, and consistent with previous literature, our results show that every student group increased their grade from the first draft to the final draft ( Figure 1 ). These results further support that iterative writing practices and low-stakes assessment can improve student performance.

Student Evaluations

For quantitative evaluations, students used a Likert scale to self-report their knowledge of content learning objectives and confidence in skills learning objectives after completion of the neurovirology module and case study assignment. Our results show that the majority of students had not studied neurovirology in a previous college course, and that they reported increased knowledge of content learning objectives after completing the neurovirology module and case study assignment ( Figure 2A, 2B ). Moreover, students reported that writing, teaching, and completing a neurovirology case study all increased their neurovirology knowledge, with writing (median = 5- Strongly Agree) ranking higher than teaching or completing (median = 4- Agree; Figure 2C ). Additionally, students reported increased confidence in skills learning objectives ( Figure 3 ), and agreed that if they took the course again, they would want the neurovirology module included, and to write more case studies ( Figure 4 ). Taken together, these data suggest that the neurovirology module and case study assignment were largely successful in meeting content and skills learning objectives and student satisfaction.

For qualitative evaluations, students answered open-ended questions on takeaways, strengths, and areas for improvement after completion of the neurovirology module and case study assignment. When asked what they will take away from the neurovirology module, student responses spanned the module’s learning objectives but reported more content than skills takeaways ( Figure 5A ; 55.3% of responses for content learning objectives; 44.7% of response for skills learning objectives). Additionally, students emphasized the importance of the module as a foundation for further exploration, as exemplified by the following responses:

“I will take away how much I loved learning about neurovirology. I was always interested in infectious diseases and loved neuroscience so tying them together has been fantastic… I am definitely more confident in reading primary literature on the topic due to this section and that will hopefully carry me through any future education.” “I thought the material was interesting and relevant and I appreciated that I could take the information and neurovirology definitions we were learning about and begin to apply them to literature being published now about COVID-19….”

When asked about the most valuable aspects of the neurovirology module, students identified before class readings and videos, and in-class active learning strategies in Weeks 1–2 of the module ( Appendix A ), and writing and teaching their case studies in Weeks 3–4 of the case study assignment ( Appendix B ; Figure 5B ; 56.4% of responses for the neurovirology module, 43.6% of responses for the case study assignment). Writing the case study was the most commonly identified valuable aspect of the class (33% of responses; Figure 5B ), as exemplified by the following responses:

“I found the case study we created to be most helpful. It pushed me to go through the neurovirology material learned in the lectures, readings, and videos and truly understand the topic I had to eventually write and teach about. I felt that it allowed for more active learning in which I had to think about the topic from multiple angles-researching a virus, creating the prompt, writing questions and answers...” “I really enjoyed having the challenge of writing our case study. It made me think more like a scientist and a physician regarding viruses and how they can affect the nervous system. It is very interesting to apply the theory to what we could see in real life on a patient undergoing a viral infection.” “I think the aspect that was most valuable was the creation of the case study. I thought it was beyond inspiring to have crafted our very own case study that seemed so professional and to teach it to our peers was very meaningful.”

When asked for suggestions for improving the neurovirology module, student feedback spanned the module and the case study assignment ( Figure 5C ; 55% of responses for the neurovirology module, 45% of responses for the case study assignment). The most common areas for improvement were adding more content, especially clinical symptoms and diagnosis (30% of responses) and completing more case studies (30% of responses). Interestingly, adding more content was also the most common area for improvement for students that reported neutral or disagree with knowledge of content learning objectives ( Figure 2B ) or confidence in skills learning objectives ( Figure 3 ; 57% of responses from these students). As two students wrote:

“Discussing more symptoms and how you would classify a disease based on the symptoms presented [is an area of improvement]…learning how to diagnose/differentiate these types of diseases would be helpful.” “…I think it would be interesting if we all got to do or at least listen in on everyone's case study. This would allow us to learn about different neuroviruses.”

Interestingly, some students also identified providing more instruction on teaching the case study as an area for improvement ( Figure 5C ; 15% of responses). As one student wrote:

“While I did think that creating our own case study was very valuable, I did think that some of the expectations on how it was going to be presented were unclear. I wish there was a little more format to that portion of the project. Other than that I really did enjoy this module and I hope that you can find a way to integrate it into the class material in the future.”

Taken together, qualitative student evaluations suggest that student takeaways aligned with content and skills learning objectives, and that students valued the structure of the neurovirology module and case study assignment, although important improvements to content and instruction are needed.

In this article, we describe using student-created case studies as assessment for a neurovirology module. Our results suggest that the neurovirology module and the case study assignment met their intended content and skills learning objectives by improving student performance and increasing students’ self-reported knowledge and confidence. We believe our approach is a valuable extension of case study pedagogy with broad applicability to a variety of undergraduate courses.

As described in this article, students followed iterative writing practices to create their case studies, which have been shown to improve student performance and confidence within a course ( Freestone, 2009 ; Brownell et al., 2013 ; Cyr, 2017 ). Our data was consistent with the previous literature, showing improved student grades from the first draft to the final draft of the case study assignment ( Figure 1 ). Previous studies also suggest that iterative writing practice coupled with calibrated peer review may be particularly effective in improving performance for the lowest-performing students ( Birol et al., 2013 ). Future version of the case study assignment could repeat the iterative writing practices described here and included calibrated peer review for the first draft, then measure improvement from the first draft to the final draft for high- and low-performing students. Moreover, additional studies suggest that iterative writing practices may not improve student writing performance across all domains or in subsequent courses ( Rayner et al., 2014 ; Holstein et al., 2015 ). Further analysis would be necessary to determine if students show longitudinal improvements in writing performance across multiple writing assignments and courses after completion of the case study assignment described here.

Quantitative and qualitative student self-report evaluations support that the neurovirology module and case study assignment promoted content and skills learning objectives in understanding, applying, analyzing, evaluating, and creating ( Anderson and Krathwohl, 2001 ), and that students valued the structure of the neurovirology module and case study assignment ( Figures 2 ​ 2 ​ – 5 ). Importantly, student self-report evaluations of active learning may underestimate the amount of actual student learning ( Deslauriers et al., 2019 ), so the high student evaluations of learning objectives are notable. However, students also offered important areas for improvement, including adding more content on clinical symptoms and diagnosis on neurovirulent disorders ( Figure 5C ). To address this, future iterations of the neurovirology module should include clinical textbook readings and primary literature ( Bookstaver et al., 2017 ; Nath and Berger, 2020 ) coupled with public health resources on symptoms and diagnosis ( Centers for Disease Control and Prevention, 2020 ; National Institute of Allergy and Infectious Disease, 2020 ; National Institute of Neurological Disorders and Stroke, 2020 ). Encouraging students to read scientific articles written for the general public prior to or concurrent with reading primary literature on the same topic improves student understand of complex or unfamiliar literature ( Gottesman and Hoskins, 2013 ; Bodnar et al., 2016 ; Kararo and McCartney, 2019 ). Additionally, students suggested providing more instruction on teaching case studies and completing more case studies ( Figure 5C ). This area for improvement is consistent with quantitative evaluations, where students reported that writing, teaching, and completing a neurovirology case study all increased their neurovirology knowledge, but writing ranked higher than teaching or completing ( Figure 2C ). To address this, future iterations of the case study assignment will include teaching guidelines in the assignment requirements ( Appendix B ) based on nine facilitator strategies for student-led discussion ( Rees, 1998 ; Soranno, 2010 ). Students will be asked to reflect on these strategies and write a short paragraph at the end of their first draft on how they will work as a team to teach their case study using these strategies. Additionally, students will share their case study final draft with at least two other student groups to increase the number of case studies each student completes. Quantitative and qualitative evaluations should be repeated to determine if these interventions address students’ areas for improvement.

Students had considerable familiarity with interrupted, literature-based case studies before writing their own cases. Indeed, almost all students who wrote case studies (25 out of 26 students) had previously completed 13 interrupted, literature-based case studies over two semesters in the corresponding author’s courses ( Cook-Snyder, 2017 ). This is consistent with active learning pedagogy, which emphasizes students practicing the skills necessary to succeed in assessment before they are assessed ( Armbruster et al., 2009 ; Haak et al., 2011 ; Freeman et al., 2014 ). However, previous research suggests that more limited practice with case studies prior to writing a case study may still be effective. For example, research on collaborative learning courses describe instructor modeling of good discussion practices “several” times before students prepared and led classroom discussions ( Casteel and Bridges, 2007 ; Kurczek and Johnson, 2014 ). Therefore, we suggest that students complete several (two to four) instructor-provided and -taught case studies following the structure and classroom management of the case study assignment before writing and leading their own case.

Active learning is a critical component of inclusive pedagogy that is effective for all students, and decreases the achievement gap for PEERs ( Haak et al., 2011 ; Ballen et al., 2017 ; Penner, 2018 ; Theobald et al., 2020 ; Asai, 2020 ). Studies suggest that active learning may be particularly effective for PEERs because active learning helps students identify as scientists, and science identity is critical for persistence in STEM ( Graham et al., 2013 ; Trujillo and Tanner, 2014 ; Theobald et al., 2020 ). Case studies are important components of active learning ( Handelsman et al., 2004 ; Herreid et al., 2012 ; Wiertelak et al., 2016 ), and some qualitative student evaluations suggest that the case study assignment promoted scientific identity, where students described thinking “more like a scientist and a physician,” and that writing a case study “seemed so professional.” However, direct questions on students’ science identities are needed for future iterations of the case study assignment to determine if the assignment promoted science identity ( Trujillo and Tanner, 2014 ). Likewise, further studies are needed to determine if the case study assignment promoted persistence in STEM. In this article, the case study assignment was used in a spring semester course for junior and senior neuroscience majors at Carthage College, where nearly 100% of junior and senior neuroscience majors graduate from Carthage with a neuroscience degree (data not shown). This is consistent with previous research, which estimates that STEM attrition rates peak in students’ first and second academic year, and plateau in third and fourth year ( Aulck et al., 2017 ; Chen et al., 2018 ). However, if the case study assignment was used in first or second year neuroscience courses, when STEM attrition rates are higher, measuring subsequent retention of students in a STEM major could be particularly valuable metric.

We believe that using student-created case studies as assessment has wide applicability to undergraduate education because case studies themselves have wide applicability. Case studies have been used effectively in introductory and advanced neuroscience courses with small and large student enrollments to address a variety of content and skills learning objectives ( Herreid et al., 2012 ; Brielmaier, 2016 ; Ogilvie and Ribbens, 2016 ; Roesch and Frenzel, 2016 ; Wiertelak et al., 2016 ; Lemons, 2017 ; Nagel and Nicholas, 2017 ; Sawyer and Frenzel, 2018 ; Mitrano, 2019 ; Ogilvie, 2019 ; Watson, 2019 ; Rollins, 2020 ). Case studies are also effective active learning methods for synchronous and asynchronous online and hybrid teaching ( Brooke, 2006 ; Schiano and Anderson, 2014 ). Accordingly, we believe that the case study assignment described here could be adapted to follow any of these existing methods of case study writing and teaching. Additionally, we encourage instructors to adapt our neurovirology module to their students’ needs and interests, taking advantage of the free virology resources available online ( https://www.virology.ws/course/ ; https://www.virology.ws/virology-101/ ). Moreover, we believe the module format and case study assignment described here could be duplicated for other important neuroscience topics that are highly relevant to students but not always discussed in the neuroscience curriculum, like social neuroscience or neuroethics ( Flint and Dorr, 2010 ; Abu-Odeh et al., 2015 ; Wiertelak et al., 2018 ). Overall, we believe that using student-created case studies as assessment is a valuable, student-led extension of effective case study pedagogy, and has wide applicability to a variety of undergraduate courses.

Acknowledgements

This work was supported by the Neuroscience Case Network (NeuroCaseNet; NSF-RCN-UBE Grant #1624104). The authors thank the students in Neuroscience 4100 at Carthage College for their participation and feedback, and Dr. Kristen Frenzel for editing the manuscript.

APPENDIX 1. NEUROVIROLOGY MODULE MATERIALS

Before class readings and videos.

Instructions for students: Please read and watch the following in order. Note that most of these are short readings and videos, but Infection Basics is an hour-long lecture.

• What is a virus?: https://www.virology.ws/2004/07/28/what-is-a-virus/
• How viruses are classified: https://www.virology.ws/2009/08/07/how-viruses-are-classified/
• Simplifying virus classification: The Baltimore system: https://www.virology.ws/2009/08/12/simplifying-virus-classification-the-baltimore-system/
• Recorded lecture: https://www.youtube.com/watch?v=fBJ0vcOlS7I&feature=youtu.be
• Slides: https://virology2020.s3.amazonaws.com/012_4310_20.pdf
• Please watch the entire lecture
• pg. 652 – 656
• pg. 662- adaptive immune responses overview
• These pages define immune cell types and cytokines, and give overviews of the innate immune response and adaptive immune response
• The rest of the chapter is for your reference
• Innate immune defenses: https://www.virology.ws/2009/06/03/innate-immune-defenses/
• The inflammatory response: https://www.virology.ws/2009/07/01/the-inflammatory-response/
• Adaptive immune defenses: https://www.virology.ws/2009/07/03/adaptive-immune-defenses/
• Adaptive immune defenses: Antibodies: https://www.virology.ws/2009/07/22/adaptive-immune-defenses-antibodies/
• Immunopathology: Too much of a good thing: https://www.virology.ws/2009/01/23/immunopathology-too-much-of-a-good-thing/
• Recorded lecture: https://www.youtube.com/watch?v=TQkg0mID-w8&feature=youtu.be
• Slides: https://virology2020.s3.amazonaws.com/016_4310_20.pdf
• Please watch until 8:00 (slide 7) of this lecture. The rest of the lecture is posted for your reference.
• Recorded lecture: https://www.youtube.com/watch?v=oWRynTL8NI4&feature=youtu.be
• Slides: https://virology2020.s3.amazonaws.com/017_4310_20.pdf
• Please watch until 5:30 (slide 6) of this video. The rest of the lecture is posted for your reference

Before Class Assignments

Instructions for students.

• Quiz ( Instructor note: Figure A1 provides sample quiz questions ).
• Neurovirology dictionary ( Instructor note: Figure A2 provides example neurovirology dictionary entries ). Neurovirology has so many terms that we’re going to create our own neurovirology dictionary. You are responsible for adding two new definitions to the dictionary this week. Your two definitions should be unique- they should not have already been defined by your classmates. I’ve included a few definitions to get us started. Your neurovirology dictionary definitions are worth 5 points, and you will receive full credit for being thoughtful, thorough, and on time.

In Class: Zoom lecture

• Study questions will be distributed at the beginning of class. You'll have the first part of class to work on the study questions in groups, and we'll discuss the answers to the study questions during the second part of class.
• At the end the end of class, please submit your study questions to the assignment posted below ( Instructor note: this course uses Schoology as learning management software ). Your study questions are worth 5 points, and you will receive full credit for being thoughtful, thorough, and on time.

Please read and watch the following in order.

• Kandel, Appendix D , The Blood-Brain Barrier, Choroid Plexus, and Cerebrospinal Fluid: pgs. 1565–1575.
• Mechanism of neurotoxicity and neuronal death ( Instructor note: this is a brief, recorded lecture focusing on key definitions, including apoptosis, autophagy, necrosis, inflammation, excitotoxicity, trophic factor withdrawal, oxidative stress, mitochondrial dysfunction, protein misfolding and aggregation, and axonal transport dysfunction ).
• Swanson and McGavern, 2015 - Viral Diseases of the Central Nervous System ( Instructor note: key concepts from this review include viral spread, CNS entry, viral cytopathology, and immunopathology).
• Quiz ( Instructor note: Figure A3 provides sample quiz questions ).
• At the end of class, please submit your study questions to the assignment posted below ( Instructor note: this course uses Schoology as learning management software ). Your study questions are worth 5 points, and you will receive full credit for being thoughtful, thorough, and on time.

Sample quiz questions for Week 1 neurovirology module.

Example student-created neurovirology dictionary entries for Week 1 and Week 2 neurovirology module. Student names have been redacted.

Sample quiz questions for Week 2 neurovirology module.

APPENDIX 2. CASE STUDY ASSIGNMENT REQUIREMENTS AND RUBRIC

What is a neurovirology case study.

We’ve used case studies to practice applying our knowledge from lecture to solve biomedically-relevant problems. By now, you all are experts in answering case studies questions- now it’s your turn to work in groups to write your own case study, similar to the case studies we’ve completed in class, and teach it to your peers.

What should you include in your neurovirology case study?

You should work with your lab group to write a neurovirology case study on any neurovirulent virus of your choosing. Your virus can also be neurotropic and/or neuroinvasive, but this is not required. ( Instructor note: neurovirulent viruses cause disease of nervous tissue. Neurotropic viruses infect neural cells; infection may occur by neural or hematogenous spread from a peripheral site. Neuroinvasive viruses enter the CNS after infection of a peripheral site ).

Your neurovirology case study should have two parts:

• Part #1 of your case study should investigate your neurovirulent virus using a patient narrative and/or primary literature data. You are encouraged to refer back to our previous case studies as examples.
• Based on your patient narrative and/or primary literature data, you should write a minimum of two questions, with answers, which address the epidemiology and/or symptoms and diagnosis of your virus.
• Part #2 of your case study should continue to investigate your neurovirulent virus using primary literature data. You are encouraged to refer back to our previous case studies as examples- nearly all of our case studies include questions based on primary literature data.
• Based on your primary literature data, you should write a minimum of three questions, with answers, which address the pathogenesis and/or treatment of your virus.
• Answers to your questions should be clearly supported by previous readings, videos, and lectures from class, and by the case study itself. You are encouraged to use any material from class as needed- you are not limited to just our neurovirology readings, videos and lectures.
• Remember, your peers are going to read your case study and answer your questions. So, your peers should be able to answer your questions based on material from class, plus any additional information you provide for them in the case study. Your peers should have to do minimal additional research to answer your questions correctly.

Your neurovirology case study should also have two versions:

• The answers to your questions
• In-text citations for all parts of your case study, especially your patient narrative/primary literature data and the answers to your questions.
• A list of references on the last page.
• You will write a 1st draft and a final draft of your Answer Key- see the Submission requirements and Grading and Feedback sections below for details
• This is the version you will share with your peers, so they can read your case study and answer your questions. This version should be identical to your Answer Key final draft, but not include the answers to your questions, in-text citations, or your list of references at the end.

How will you teach your neurovirology case study to your peers?

During Week 4, you will be leading your peers in a discussion of your case study, similar to our class discussions of case studies ( Instructor note: see Cook-Snyder, 2017 for a detailed classroom management strategy for case studies ).

• You will share your Neurovirology Case Study- Without Answer with your peers
• Your peers will read your case study, answer the questions, and submit their answers to Schoology before class.
• Then, in class, you will lead your peers in a discussion of your case study, and your peers will submit their original answers plus annotations to Schoology after class

Submission requirements

• ○ Your 1st draft is due Tuesday, May 5th, before your lab section starts (Instructor note: this is Week 3).
• ○ Your final draft is due Monday, May 11th, 10:30am (Instructor note: this is Week 4).
• ○ Even though you’re writing one case study per lab group, all group members should submit the case study to Schoology. This will ensure that all group members receive their case study grades.
• Your Neurovirology Case Study- Without Answers should be emailed to your peers by Monday, May 11th, 10:30am (Instructor note: this is Week 4).

Grading and Feedback

You will be graded according to the Neurovirology Case Study Grading Rubric posted below. Note that 10% of your case study grade will be earned on your 1st draft, and 90% will be earned on your final draft.

I will provide feedback electronically on all drafts (1st and final). My feedback will summarize the strengths, areas for improvement, and specific actions you can take to improve. IMPORTANT: I will provide a maximum of two comments per rubric section. This doesn’t mean that there aren’t any additional areas for improvement, or that if you only address these comments that you will get a 100%. But, I believe targeting your attention and effort to these top areas will make the most improvement.

Neurovirology Case Study Grading Rubric

APPENDIX 3. STUDENT-CREATED CASE STUDY- RABIES VIRUS

Instructor note: This case was written by Alyssa Laci and Nicole A. Losurdo, undergraduate students in Neuroscience 4100, Spring 2020 semester, Carthage College. In-text citations and references are in blue font. The answer key version of this case is available via request to [email protected] . The corresponding author (DRCS) has edited the case for formatting and clarity and has indicated whether each answer is supported by the case study in the neurovirology module, previous course content, and/or the primary literature in blue font.

Brian was engaging in yard work when he heard his wife yell to him.

“Brian! There is a stray dog in the yard that is acting rather strange. He is staggering and having a hard time standing upright. I think I also saw a foamy discharge coming from his eyes and mouth. I noticed him while I was in the garden because he was making this weird high-pitched noise” ( Taylor and Nel, 2015 ).

Brian walked over to his wife.

She looked concerned and asked him, “What do you think we should do about him?”

Brian replied with a similar concerned tone, “Well we better make sure he is okay and consider calling animal control. In the meantime, I’ll go take a closer look at him.”

Brian slowly moved closer to the dog, trying not to disturb or frighten him. He reached toward the dog, trying to comfort his fear. Instead, the dog lunged at his hand and bit him.

Brian pulled his hand away in pain. He glanced down at his fingers and found blood oozing from them. He stepped away from the dog and went inside to wash his hands off from the bite.

As he was washing his hands, the area around the bite tingled and itched ( CDC, 2019 ). He continued to scrub until the blood was gone, applied a bandaid and grabbed the phone to call animal control.

A week passed, and the area of Brian’s bite began to itch more excessively and he just couldn’t drum up the motivation to leave his bed because he felt so sleepy ( CDC, 2019 ). His wife entered into his bedroom, “Honey, please quit itching. You’re just going to make it worse.” She reached for his forehead, it felt warm.

Extremely irritated by her suggestion, Brian tried to keep his response low, but raised his voice at her ( CDC, 2019 ). “Don’t tell me what to do! I am a grown man! And stop coming in here to turn my light on. It’s so bright and hurts my eyes!” Shocked, his wife turned down the light and left the room, giving him time to rest.

Several more days passed. As he laid in bed, Brian began to lose feeling in his hand. He glanced down at it, noticing that it was twitching ( CDC, 2019 ). He looked up at the bedroom doorway. “Where am I?” He thought. “My mouth is so full of spit and I can hardly swallow because my throat feels so tight. Almost like its spasming.” He got out of bed and walked toward the hallway to splash his face with water. While he walked through the hallway, he noticed a creepy figure standing above him. Thinking that he may be hallucinating, Brian called to his wife. “Sweetie, please call 911.”

Part I Questions

• What are Brian’s signs and symptoms? (Answer based on case study)
• Brian was brought to the hospital after his wife called him an ambulance. Based on his symptoms, what do you think he will be diagnosed with? What diagnostic tests do you think physicians will use to achieve this diagnosis? (Answer based on case study and requires primary literature search)

After being taken to the hospital, Brian was diagnosed with rabies virus. Rabies virus enters peripheral nerves directly, and then can migrate to the central nervous system and up to the brain ( Rupprecht, 1996 ). One mechanism of entry into the peripheral nerves is through the neuromuscular junction ( Rupprecht, 1996 ). Once symptoms begin to appear, both general symptoms of fever or fatigue and neurological symptoms like hydrophobia, the disease cannot be reversed or cured ( Rupprecht, 1996 ). If the rabies vaccine is administered before the onset of symptoms, it can generally prevent or destroy the disease and the inevitable death that follows ( Long et al., 2020 ). Since Brian has already developed neurological symptoms, it is unlikely that the current rabies vaccine will be able to cure him ( Long et al., 2020 ).

The efficacy of the vaccine is reliant upon a permeable blood brain barrier (BBB) to allow immune cells to reach the virus in the brain and destroy it ( Kandel et al., 2013 ; Long et al., 2020 ). A study looked at the role of the phosphoprotein gene of the rabies virus on the permeability of the BBB ( Long et al., 2020 ). The study inoculated mice with either a wild-type (GD-SH-01), an attenuated rabies virus (HEP-Flury), or a chimeric virus that had the phosphoprotein gene of the wild-type inserted into the genome of the attenuated version (rHEP-SH-P). The rHEP-SH-P phosphoprotein gene is silenced by the placement in the attenuated genome. GD-SH-01 generally produced mild inflammation with eventual complete breakdown of the BBB, while the HEP-Flury produces high inflammation, but a more transiently permeable BBB. Figure 1 shows the data on BBB permeability (modified from Figure 1 in Long et al., 2020 ).

Part II Questions

• Is the rabies spread by hematogenous spread or neural spread? (Answer based on neurovirology module)
• Does the phosphoprotein cause a relative increase or decrease in BBB permeability? Use Figure 1 to explain your answer. (Answer based on case study)
• Would the incorporation of a phosphoprotein antagonist improve vaccine efficacy in the attenuated virus? Use Figure 1 to explain your answer. (Answer based on case study and neurovirology module)
• Centers for Disease Control and Prevention. Rabies. 2019. Available at https://www.cdc.gov/rabies/symptoms/index.html .
• Kandel ER, Schwartz JH, Jessell TM, Siegelbaum SA, Hudspeth AJ. Principles of Neural Science. 5th Ed. New York: McGraw Hill Medical; 2013. [ Google Scholar ]
• Long T, Zhang B, Fan R, Wu Y, Mo M, Luo J, Chang Y, Tian Q, Mei M, Jiang H, Luo Y, Guo X. Phosphoprotein Gene of Wild-Type Rabies Virus Plays a Role in Limiting Viral Pathogenicity and Lowering the Enhancement of BBB Permeability. Front Microbiol. 2020; 11 :109. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Racaniello VR. Immunopathology: Too much of a good thing. Virology Blog. 2009a. Jan 23, Available at https://www.virology.ws/2009/01/23/immunopathology-too-much-of-a-good-thing/
• Racaniello VR. Virology Lectures 2020 #12: Infection Basics Biology 4310: Virology. Columbia University; 2020a. Mar 8, Available at https://www.youtube.com/watch?v=fBJ0vcOlS7I&feature=youtu.be . [ Google Scholar ]
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APPENDIX 4. STUDENT-CREATED CASE STUDY- ENTEROVIRUS 71

Instructor note: This case was written by Dianna M. Bindelli and Shannon A.M. Kafura, undergraduate students in Neuroscience 4100, Spring 2020 semester, Carthage College. In-text citation and references are in blue font. The answer key version of this case is available via request to [email protected] . The corresponding author (DRCS) has edited the case for formatting and clarity and has indicated if each answer is supported by the case study the neurovirology module, previous course content, and/or the primary literature in blue font.

It was the summer of 1998 in China when Finley Chang, a 10-year-old boy, went to the orthodontist to get his braces. It was mid-July, so Finley was extremely warm on his way to the orthodontist, also he was nervous. His mom, Mrs. Chang waited for him in the waiting room and was delighted to see her little boy growing up with his new braces.

The orthodontist, Dr. Wung had noticed that Finley was visibly sweating. He asked Finley if he was feeling fine. Finley said, “just nervous”. Dr. Wung had informed Mrs. Chang that the braces were all in place and his mouth had looked good! He warned that he may have pain in his mouth for a few days while adjusting to the braces.

One morning he woke up and he complained of a stomachache. He decided that he must just be hungry and proceeded to go downstairs for breakfast. On his way down the stairs, he began to feel woozy. He felt like the room was spinning, so he hurried down the stairs to sit down.

His mom had made pancakes and had orange juice for him.

“Good morning! What’s the rush? How did you sleep?” asked his mom.

“Fine.” responded Finley.

Mrs. Chang knew something was wrong when Finley did not dive into his sugary pancakes and was sitting there with his eyes closed.

Finley really did not feel like eating. He did not want to tell his mom about his stomachache. So, he decided to stick with the juice for now. After a couple sips of juice, he got a sour face.

“What happened?” asked his mom.

Finley began to feel the inside of his mouth and responded, “I have weird cuts in my mouth”. His mom looked and saw cuts on his gums and mouth and thought it may be from the braces ( Huang et al., 1999 ). However, it has been over a month since he had them, so she decided to call the orthodontist and have the alignment checked out.

While Finley was getting ready to leave for the orthodontist, he began vomiting. Mrs. Chang thought he had the flu bug and canceled the appointment, for now.

The next morning Mrs. Chang thought Finley would be better. However, Finley woke up with sweating and vomiting, and with even more sores in his mouth ( Huang et al., 1999 ). He sat up in bed and felt even more dizzy than yesterday and had to lie down. Mrs. Chang felt his head and thought his fever was even higher ( Huang et al., 1999 ). At this point she decided to take Finley to the pediatrician.

Dr. Hu looked at Finley’s mouth sores and brought him some water. She decided to run a few tests. She set up Finley with some anti-nausea medication and ordered an IV. In the meantime, she was analyzing the tests she ran.

• What are Finley’s signs and symptoms? (Answer based on case study)
• What tests would you run based on Finley’s signs and symptoms? Hypothesize the expected results. (Answer based on neurovirology module and previous course content)

Three days after coming back from the doctor, Finley’s mother went into his room to see if he wanted dinner. “Finley, time to eat.” He was waking up from a nap. “Finley, are you okay?” she asked, concerned. “I don’t feel so good, mom,” mumbled Finley, slurring his words. She helped him sit up and felt his forehead to see if fever had returned.

“Well, you don’t seem to have a fever again. Let’s try and eat some food, maybe that will help.” She then helped him get out of bed and into the kitchen.

When Finley was eating, he kept dropping food because his hands were shaking, and he had extreme difficulty bringing his chopsticks to his mouth. He kept accidently hitting his nose or chin. “Finley, do you want me to help you?” asked his mom. When he answered, she noticed that he also couldn’t focus straight on her and instead his eyes would bounce away ( Huang et al., 1999 ; Bae et al., 2013 ; Kandel et al., 2013 ; Jain et al., 2014 ; Cook-Snyder, 2020c ). Finley’s mother knew something was wrong and brought him to the emergency room.

The ER doctor walked into the room, “Hello, my name is Dr. Chen, and you must be Finley. Can you tell me what is going on?” Finley told her, “My arms don’t seem to be working right and I don’t feel very good,” again slurring his words ( Kandel et al., 2013 ; Cook-Snyder, 2020c ).

“Okay, and according to your chart, you’ve been sick recently?” asked Dr. Chen. “Yes, he was just at the doctor three days ago and the pediatrician diagnosed him with Hand, Foot, and Mouth Disease,” replied Finley’s mother ( Rhoades et al., 2011 ; Chen, et al., 2020 ).

“I see. His blood work also shows that Finley had viremia, specifically Enterovirus 71 (EV71). Enterovirus 71 is known to cause Hand, Foot and Mouth Disease, so this is making more sense. Finley also has increased amounts of lymphocytes and monocytes in his blood. Well, before I can make a diagnosis, I would like to take an MRI.” Dr. Chen said ( Rhoades et al., 2011 ; Chen et al., 2020 ; Racaniello, 2020a ). Finley’s expected MRI results are shown in Figure 1 (modified from Figure 2A in Shen et al., 1999 ; and Figure 1B in Huang et al., 1999 ).

“Based on the expected MRI results and the viremia, it looks like Finley has rhombencephalitis. This is a pretty serious diagnosis. He’s lucky that you brought him in,” said Dr. Chen. “I’d like to admit him to the hospital for care.” She discussed the treatment plan with Finley’s mom and left the room ( Huang et al., 1999 ; Chen et al., 2007 ; Jubelt et al., 2011 ; Jain et al., 2014 ; Chen et al., 2019 ).

Dr. Chen recommended a treatment called Ribavirin, an antiviral treatment. She presented the data in Figure 2 (modified from Figure 1B in Li et al., 2008 ) and Figure 3 (modified from Figure 3B in Zhang et al., 2012 ).

• What are Finley’s new signs and symptoms? (Answer based on case study and previous course content).
• Looking at Figure 1 , what brain regions are marked by the arrows? Use full neuroanatomical descriptions to explain your answer. (Answer based on previous course content).
• Could damage to these brain areas cause the signs and symptoms seen in Finley? (Answer based on previous course content).
• Hypothesize how Finley may have developed rhombencephalitis. In other words, propose a possible mechanism of pathogenesis for how the virus infected the CNS. (Answer based on neurovirology module).
• Using Figure 2 and ​ and3, 3 , would Ribavirin be an effective treatment? Depending on your answer, either explain a possible mechanism of action for Ribavirin or possible solutions to make the drug effective. (Answer based on case study).
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What is the Impact and Importance of Case Study in Education?

Before we explain the significance of case study in education these days for high education, let us explain the first, ‘What is a case study? However, it consists of three major parts that you need to consider for writing. Starting with a problem, outline different available solutions, and offer proven results exhibits that the product or service is an optimum solution for the problem.

What is a Case Study in Education?

Well, a case study is a method of research regarding any specific questions, which allows a person to investigate why and how it happens. Based on education, a case study is that who can use the research for many purposes. It lets the student describe various factors and interaction with each other in authentic contexts. It offers multiple learning opportunities and experiences for scholars by influencing the diverse practice of theories.

Importance of Case Study in Education

It is also considered the source of valuable data regarding diversity and complexity of educational commitments and settings. It plays a vital role in putting theories into regular practice. It is always necessary for the student to realize the clarity in nature and focus of the case study. Considering the significance, Casestudyhelp.com brings the best Case Study Help Any Academic Level for students exerting for acquiring top grades.

What are the Advantages of Case Studies in Class ?

Case studies are assigned to higher classes students, which proved very beneficial to the students, especially in the classroom. Students can actively engage in the discovery of the principles by conceptualizing from the examples. Furthermore, they develop skills like

• Problem-solving
• Coping with ambiguities
• Analytical/ quantitative/qualitative tools according to the case and
• Decision making in complex situations

Method of a Writing Case Study at Casestudyhelp.com!

When teachers give students a Case Study Topic by a teacher, they have to attack each case with the following checklist or go for best and reasonable Case Study Help for Any Topic at casestudyhelp.com!

• Thoroughly read the case and formulate own opinions before sharing ideas with others in the class. You must identify the problems on your own, and offer solutions and best alternatives alongside. Before the study converses, you need to form your own outline and course of action.
• Focus on the three major parts of a case study considering the starting with a problem, outline different accessible solutions, offer predictable results that exhibit the product/service is an optimal solution for the problem.
• Prepare to engage in data collection, collecting data in the field, carry out data evaluation and analysis to write the report.

If you want to save your crucial time for in-depth academic studies, hire our  Case study research writers competent with all categories of analysis to write excellent category case studies.

Case Study Help is one of the best academic assistance providers with a team of Experts. We deliver a range of analysis help at a pocket -friendly price. For any category of writing and at any academic level, contact us now!

The Importance of Case Study Research in Educational Settings

• Şenay Ozan Leymun
• Hatice Ferhan Odabaşı
• Işıl Kabakçı Yurdakul

Case study is a research method which is used to answer how and why questions regarding an issue to be investigated, with no researcher control over variables and when the case is current. There are many factors that affect the phenomenon in the studied case, these factors and their interactions are described by the case study. It is a fact that case study can be used for many purposes in educational research because it enables the capacity to describe a lot of factors and their interact with each other in real contexts. Case studies offer an opportunity to learn from experiences and influence the practice of theories. Case studies are valuable data sources for researchers in view of the complexity and diversity of educational settings and purposes. Case study research has an important role in putting theories into practice, thus developing the practice in the field of educational sciences. In this regard, it is important that the nature and the focus of the case study is clear. The aim of this study is to explain the focus and nature of the case study research method to investigate its importance in educational settings and to offer suggestions for practice to researchers.

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5 Benefits of Learning Through the Case Study Method

• 28 Nov 2023

While several factors make HBS Online unique —including a global Community and real-world outcomes —active learning through the case study method rises to the top.

In a 2023 City Square Associates survey, 74 percent of HBS Online learners who also took a course from another provider said HBS Online’s case method and real-world examples were better by comparison.

Here’s a primer on the case method, five benefits you could gain, and how to experience it for yourself.

Access your free e-book today.

What Is the Harvard Business School Case Study Method?

The case study method , or case method , is a learning technique in which you’re presented with a real-world business challenge and asked how you’d solve it. After working through it yourself and with peers, you’re told how the scenario played out.

HBS pioneered the case method in 1922. Shortly before, in 1921, the first case was written.

“How do you go into an ambiguous situation and get to the bottom of it?” says HBS Professor Jan Rivkin, former senior associate dean and chair of HBS's master of business administration (MBA) program, in a video about the case method . “That skill—the skill of figuring out a course of inquiry to choose a course of action—that skill is as relevant today as it was in 1921.”

Originally developed for the in-person MBA classroom, HBS Online adapted the case method into an engaging, interactive online learning experience in 2014.

In HBS Online courses , you learn about each case from the business professional who experienced it. After reviewing their videos, you’re prompted to take their perspective and explain how you’d handle their situation.

You then get to read peers’ responses, “star” them, and comment to further the discussion. Afterward, you learn how the professional handled it and their key takeaways.

HBS Online’s adaptation of the case method incorporates the famed HBS “cold call,” in which you’re called on at random to make a decision without time to prepare.

“Learning came to life!” said Sheneka Balogun , chief administration officer and chief of staff at LeMoyne-Owen College, of her experience taking the Credential of Readiness (CORe) program . “The videos from the professors, the interactive cold calls where you were randomly selected to participate, and the case studies that enhanced and often captured the essence of objectives and learning goals were all embedded in each module. This made learning fun, engaging, and student-friendly.”

If you’re considering taking a course that leverages the case study method, here are five benefits you could experience.

5 Benefits of Learning Through Case Studies

1. take new perspectives.

The case method prompts you to consider a scenario from another person’s perspective. To work through the situation and come up with a solution, you must consider their circumstances, limitations, risk tolerance, stakeholders, resources, and potential consequences to assess how to respond.

Taking on new perspectives not only can help you navigate your own challenges but also others’. Putting yourself in someone else’s situation to understand their motivations and needs can go a long way when collaborating with stakeholders.

2. Hone Your Decision-Making Skills

Another skill you can build is the ability to make decisions effectively . The case study method forces you to use limited information to decide how to handle a problem—just like in the real world.

Throughout your career, you’ll need to make difficult decisions with incomplete or imperfect information—and sometimes, you won’t feel qualified to do so. Learning through the case method allows you to practice this skill in a low-stakes environment. When facing a real challenge, you’ll be better prepared to think quickly, collaborate with others, and present and defend your solution.

3. Become More Open-Minded

As you collaborate with peers on responses, it becomes clear that not everyone solves problems the same way. Exposing yourself to various approaches and perspectives can help you become a more open-minded professional.

When you’re part of a diverse group of learners from around the world, your experiences, cultures, and backgrounds contribute to a range of opinions on each case.

On the HBS Online course platform, you’re prompted to view and comment on others’ responses, and discussion is encouraged. This practice of considering others’ perspectives can make you more receptive in your career.

“You’d be surprised at how much you can learn from your peers,” said Ratnaditya Jonnalagadda , a software engineer who took CORe.

In addition to interacting with peers in the course platform, Jonnalagadda was part of the HBS Online Community , where he networked with other professionals and continued discussions sparked by course content.

“You get to understand your peers better, and students share examples of businesses implementing a concept from a module you just learned,” Jonnalagadda said. “It’s a very good way to cement the concepts in one's mind.”

4. Enhance Your Curiosity

One byproduct of taking on different perspectives is that it enables you to picture yourself in various roles, industries, and business functions.

“Each case offers an opportunity for students to see what resonates with them, what excites them, what bores them, which role they could imagine inhabiting in their careers,” says former HBS Dean Nitin Nohria in the Harvard Business Review . “Cases stimulate curiosity about the range of opportunities in the world and the many ways that students can make a difference as leaders.”

Through the case method, you can “try on” roles you may not have considered and feel more prepared to change or advance your career .

5. Build Your Self-Confidence

Finally, learning through the case study method can build your confidence. Each time you assume a business leader’s perspective, aim to solve a new challenge, and express and defend your opinions and decisions to peers, you prepare to do the same in your career.

According to a 2022 City Square Associates survey , 84 percent of HBS Online learners report feeling more confident making business decisions after taking a course.

“Self-confidence is difficult to teach or coach, but the case study method seems to instill it in people,” Nohria says in the Harvard Business Review . “There may well be other ways of learning these meta-skills, such as the repeated experience gained through practice or guidance from a gifted coach. However, under the direction of a masterful teacher, the case method can engage students and help them develop powerful meta-skills like no other form of teaching.”

How to Experience the Case Study Method

If the case method seems like a good fit for your learning style, experience it for yourself by taking an HBS Online course. Offerings span seven subject areas, including:

• Business essentials
• Leadership and management
• Entrepreneurship and innovation
• Finance and accounting
• Business in society

No matter which course or credential program you choose, you’ll examine case studies from real business professionals, work through their challenges alongside peers, and gain valuable insights to apply to your career.

Are you interested in discovering how HBS Online can help advance your career? Explore our course catalog and download our free guide —complete with interactive workbook sections—to determine if online learning is right for you and which course to take.

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Search UNICEF

Education case studies, around-the-world case studies on unicef's education programme.

Education knowledge management dashboard

Case studies

Adolescent education and skills.

Improving students' mental health in Bangladesh

Improving the quality of lower secondary through inquiry-based learning and skills development (Argentina)

An online career portal strengthens career guidance among secondary students in India and helps them plan for future educational and work opportunities (India)

Lessons on youth-led action towards climate advocacy and policy (India)

Learning, life skills and citizenship education and social cohesion through game-based sports – Nashatati Programme (Jordan)

Mental health promotion and suicide prevention in schools (Kazakhstan)

A multi-level, cross-sectoral response to improving adolescent mental health (Mongolia)

The Personal Project (Morocco)  

Improving adolescents’ learning in violence-affected areas through blended in-person and online learning opportunities - Communities in Harmony for Children and Adolescents (Mexico)

A community-based approach to support the psychosocial wellbeing of students and teachers (Nicaragua)

Flexible pathways help build the skills and competencies of vulnerable out-of-school adolescents (United Republic of Tanzania)

Climate change and education

Schools as platforms for climate action (Cambodia)

Paving the way for a climate resilient education system (India)

Youth act against climate and air pollution impacts (Mongolia)

Early childhood education

Early environments of care: Strengthening the foundation of children’s development, mental health and wellbeing (Bhutan)

Native language education paves the way for preschool readiness (Bolivia)

Developing cross-sector quality standards for children aged 0-7 (Bulgaria)

Expanding quality early learning through results-based financing (Cambodia)

Harnessing technology to promote communication, education and social inclusion for young children with developmental delays and disabilities (Croatia, Montenegro, and Serbia)

Scaling up quality early childhood education in India by investing in ongoing professional development for officials at the state, district and local levels (India)

Strengthening early childhood education in the national education plan and budget in Lesotho to help children succeed in primary and beyond (Lesotho)

Enhancing play-based learning through supportive supervision (Nigeria)

Learning social and emotional skills in pre-school creates brighter futures for children (North Macedonia)

How developing minimum standards increased access to pre-primary education (Rwanda)

Expanding access to quality early childhood education for the most excluded children (Serbia)

Advancing early learning through results-based financing (Sierra Leone)

Lessons learned from designing social impact bonds to expand preschool education (Uzbekistan)

Equity and inclusion

Inclusive education for children with disabilities.

Strengthening policies to mainstream disability inclusion in pre-primary education (Ethiopia)

National early screening and referrals are supporting more young children with disabilities to learn (Jamaica)

Ensuring inclusive education during the pandemic and beyond (Dominican Republic)

Championing inclusive practices for children with disabilities (Ghana)

Accessible digital textbooks for children in Kenya (Kenya)

Planning for inclusion (Nepal)

Harnessing the potential of inclusive digital education to improve learning (Paraguay)

Gender equality in education

Sparking adolescent girls' participation and interest in STEM (Ghana)

Non-formal education and the use of data and evidence help marginalized girls learn in Nepal (Nepal)

Getting girls back to the classroom after COVID-19 school closures (South Sudan)

Education in emergencies

Creating classrooms that are responsive to the mental health needs of learners, including refugees (Poland)

Return to school (Argentina)

Learning from the education sector’s COVID-19 response to prepare for future emergencies (Bangladesh)

Prioritising learning for Rohingya children (Bangladesh)

Prioritizing children and adolescents’ mental health and protection during school reopening (Brazil)

Learning where it is difficult to learn: Radio programmes help keep children learning in Cameroon

Reaching the final mile for all migrant children to access education (Colombia)

Supporting the learning and socio-emotional development of refugee children (Colombia)

Mission Recovery (Democratic Republic of the Congo)

The National Building the Foundations for Learning Program, CON BASE (Dominican Republic)

Mental health and psychosocial well-being services are integrated in the education system (Ecuador)

Improving access to quality education for refugee learners (Ethiopia)

The Learning Passport and non-formal education for vulnerable children and youth (Lebanon)

Accelerated Learning Programme improves children’s learning in humanitarian settings (Mozambique)

Responding to multiple emergencies – building teachers’ capacity to provide mental health and psychosocial support before, during, and after crises (Mozambique)

Teaching at the right level to improve learning in Borno State (Nigeria)

Remedial catch-up learning programmes support children with COVID-19 learning loss and inform the national foundational learning strategy (Rwanda)

Learning solutions for pastoralist and internally displaced children (Somalia)

Recovering learning at all levels (South Africa)

How radio education helped children learn during the COVID-19 pandemic and aftermath (South Sudan)

Addressing learning loss through EiE and remedial education for children in Gaza (State of Palestine)

Providing psychosocial support and promoting learning readiness during compounding crises for adolescents in Gaza (State of Palestine)

Inclusion of South Sudanese refugees into the national education system (Sudan)

Inclusion of Syrian refugee children into the national education system (Turkey)

Including refugee learners so that every child learns (Uganda)

Learning assessments

Assessment for learning (Afghanistan)

Formative assessment places student learning at the heart of teaching (Ethiopia)

Strengthening teacher capacity for formative assessment (Europe and Central Asia)

All students back to learning (India)

Strengthening the national assessment system through the new National Achievement Survey improves assessment of children’s learning outcomes (India)

A new phone-based learning assessment targets young children (Nepal)

Adapting a remote platform in innovative ways to assess learning (Nigeria)

Assessing children's reading in indigenous languages (Peru)

Southeast Asia primary learning metrics: Assessing the learning outcomes of grade 5 students (Southeast Asia)

Minimising learning gaps among early-grade learners (Sri Lanka)

Assessing early learning (West and Central Africa)

Primary education / Foundational Literacy and Numeracy

Supporting Teachers to Improve Foundational Learning for Syrian Refugee Students in Jordan

Empowering teachers in Guinea: Transformative solutions for foundational learning

Improving child and adolescent health and nutrition through policy advocacy (Argentina)

Online diagnostic testing and interactive tutoring (Bulgaria)

Supporting the socio-emotional learning and psychological wellbeing of children through a whole-school approach (China)

Engaging parents to overcome reading poverty (India)

Integrated school health and wellness ensure better learning for students (India)

Instruction tailored to students’ learning levels improves literacy (Indonesia)

A whole-school approach to improve learning, safety and wellbeing (Jamaica)

Multi-sectoral programme to improve the nutrition of school-aged adolescents (Malawi)

Parents on the frontlines of early grade reading and math (Nigeria)

Training, inspiring and motivating early grade teachers to strengthen children’s skills in literacy and numeracy (Sierra Leone) Life skills and citizenship education through Experiential Learning Objects Bank (State of Palestine)

Curriculum reform to meet the individual needs of students (Uzbekistan)

Improving early grade reading and numeracy through ‘Catch-Up,’ a remedial learning programme (Zambia)

Reimagine Education / Digital learning

Education 2.0: skills-based education and digital learning (Egypt)

Empowering adolescents through co-creation of innovative digital solutions (Indonesia)

Virtual instructional leadership course (Jamaica)

Learning Bridges accelerates learning for over 600,000 students (Jordan)

Unleashing the potential of youth through the Youth Learning Passport (Jordan)

Lessons learned from the launch of the Learning Passport Shkollat.org (Kosovo)

Opening up the frontiers of digital learning with the Learning Passport (Lao PDR)

Building teachers’ confidence and capacity to provide online learning (Maldives)

Mauritania’s first digital learning program: Akelius Digital French Course (Mauritania)

Mitigating learning loss and strengthening foundational skills through the Learning Passport (Mexico)

Expanding digital learning opportunities and connectivity for all learners (Tajikistan)

For COVID-19 education case studies, please click here and filter by area of work (Education) and type (Case Study / Field Notes).

Resources for partners

Learning at the heart of education

Key Asks 2021 - National Reviews - SDG 4 Quality Education

More from UNICEF

Transforming education in africa.

An evidence-based overview and recommendations for long-term improvements

Early Childhood Education for All

It is time for a world where all children enter school equipped with the skills they need to succeed.

A world ready to learn

Prioritizing quality early childhood education

Mission: Recovery education in humanitarian countries

Updates on UNICEF’s work to deliver education to children in crisis-affected countries, with support from the US Government

A Unified General Education Pathway

"...the transfer process is still unnecessarily complex, confusing and difficult for the majority of students to navigate." — Assembly Bill 928, The Student Transfer Achievement Reform (STAR) Act 2021

More than 50% of CSU students are transfer students, arriving primarily from the California Community Colleges system. In an effort to simplify their pathway to a four-year degree, the Student Transfer Achievement Reform Act (AB 928) creates a singular, lower-division General Education (GE) pattern for both California State University and University of California transfer admissions. This pattern, called Cal-GETC, was approved by all three higher education intersegmental partners via the Intersegmental Committee of Academic Senates in spring 2023. When Cal-GETC is implemented in fall 2025, it will become the only transfer GE pattern offered by California community colleges.

The STAR Act is meant to support student success and equity, helping to ease access, simplify advisement across segments, eliminate barriers and carve a clear path to a four-year degree across California's educational segments.

Recognizing a growing trend of first-time, first-year students arriving to the CSU with college credit, including 60% of CSU first-year applicants who have earned college credit, the Chancellor's Office has recommended a unified pathway. Historically, the CSU has had one unified GE pattern for all students—CSU GE Breadth. Changes to Title 5 California Code of Regulations ensure the CSU continues to provide one unified GE pattern whether students enroll as first-time, first-year students or transfer students.

GE Informational Webinar, April 15, 2024

An informational webinar was held on Monday, April 15, 2024 hosted by Interim Associate Vice Chancellor of Academic and Faculty Programs Laura Massa and Assistant Vice Chancellor and State University Dean Brent Foster. Questions posed in this webinar will be posted shortly.

On March 27, 2024, the CSU Board of Trustees approved proposed changes to Title 5 CSU General Education that modify CSU GE Breadth to mirror the Cal-GETC pattern and units.

The Chancellor’s Office will support campuses and faculty through the implementation processes, including through resources to support faculty release, written guidance and stipends for faculty effort during off-contract periods. Each campus will determine the application of units that are not included in Cal-GETC.

Changes to CSU General Education

The update to CSU GE removes five units from the GE pattern. It does this by:

• Including a one-unit laboratory for Biological or Physical Sciences
• Not including one of three Arts or Humanities courses (in Area C)
• Not including Area E, Lifelong Learning and Self-Development

The five units removed from GE will be returned to campuses to determine how to utilize.

About the Student Transfer Achievement Reform Act

Authored by Assemblymember Marc Berman and approved in 2021, Assembly Bill 928 consolidates two existing general education pathways for California Community College students into a single pathway to either the CSU or UC system. It also requires that community colleges place incoming students on an Associate Degree for Transfer (ADT) pathway, if one exists for their major, on or before August 1, 2024.

Key Terms and Definitions

What is Cal-GETC? Cal-GETC is a new GE pattern that will be implemented in fall 2025. As a result of its implementation, California Community Colleges will no longer offer the current CSU GE Breadth and Intersegmental General Education Transfer Curriculum (IGETC) patterns.

What is IGETC? The Intersegmental General Education Transfer Curriculum, or IGETC, is designed for the community college student who wants to be eligible to transfer to either the CSU or the UC systems. 

What is CSU GE Breadth? CSU GE Breadth is the current General Education pattern for all CSU students whether they are first-time first-year students or transfer students. Following the approval of the CSU Board of Trustees on March 27, 2024, starting in fall 2025 CSU GE will mirror Cal-GETC in areas and units.

What is an ADT? The Associate Degree for Transfer (ADT) allows California Community College students who meet the CSU's minimum eligibility requirements guaranteed priority admission to the CSU, though not necessarily to a particular campus or major. Students earn a two-year associate degree (no more than 60 units) that is fully transferrable towards a CSU bachelor's degree.

Additional Resources

GE Informational Seminar May 2023

AB 928 Bill Text

ADT Intersegmental Implementation Committee

The Intersegmental Committee of the Academic Senates (ICAS)

Frequently Asked Questions

Nevada Today

A passion for learning: ph.d. candidate reflects on the importance of growing from mistakes, lauren parker studies cellular molecular pharmacology and physiology.

Lauren Parker hopes to study female reproductive diseases that affect fertility.

As a first-generation Filipina college student, Lauren Parker has suffered from her fair share of imposter syndrome and self-doubt but chooses to use each new experience as a learning opportunity, rather than a roadblock. Her lifelong passion for learning and a desire to share knowledge led her to pursue a Ph.D. in cellular molecular pharmacology and physiology at the University of Nevada, Reno School of Medicine (UNR Med).

Currently a first-year Ph.D. student, Parker is examining how a small drug molecule affects prostate cancer metastasis. Depending on the results of this project, she intends to continue to study the effects of this drug on cervical cancer and other reproductive diseases.

As she narrows her research focus, Parker hopes to study female reproductive diseases that affect fertility as well as how to make assisted reproductive techniques less invasive and less troublesome for women.

After completing her Ph.D., Parker is interested in exploring industry research or clinical research and ultimately sees herself returning to academia to pursue teaching and a research lab.

Why did you decide to pursue research?

“I decided to pursue research because I love learning and challenging myself. From a young age, I knew that I wanted a career that involved teaching in some capacity. It wasn’t until I started college that I learned you could have a career dedicated to researching a specific area of science. When I came to the realization that I could teach and conduct research related to reproductive biology, I knew that a Ph.D. was what I needed to do so that I could one day become an academic. It is very motivating to know that I can share my knowledge in the form of teaching and in the form of contributing to the greater knowledge within scientific research.”

What is the biggest challenge you have faced in your UNR Med education and how did you overcome it?

“Being a first-generation college student and entering my Ph.D. program without a master’s has resulted in some serious imposter syndrome. It is difficult not to feel inferior when you are surrounded by classmates who have more knowledge and research experience than you. My first semester was challenging in the way that I was afraid to ask questions when it felt like I should already know the answers. I’ve come to realize that many of my classmates feel the same way as I do, we all are just really good at hiding it – and that is extremely validating.

“Additionally, all of my instructors have been very kind and even happy that I ask for help and/or clarification, which has been so relieving. Ultimately, I came to the realization that I needed to make the most of my graduate education. I acknowledge that I have so much to learn and I try my best to reframe my self-doubt by instead embracing the fact that I have an amazing opportunity to learn from my experienced peers and from the well-respected experts in my program."

What specialty or area are you most passionate about pursuing, and what draws you to this field?

"I am incredibly passionate about reproductive biology. Specifically, I am interested in studying female reproductive diseases that affect fertility and how to make assisted reproductive techniques less invasive and less troublesome for women. It sounds cheesy and simple, but what drew me to this field is the fascinating way that life is formed. It is mind-blowing to me that you can take a male and a female gamete, cells that we can’t even see with the naked eye, and when you bring them together, they hold the instructions for creating a human being."

Can you share a memorable experience during your training that has significantly impacted your journey?

“As I was getting to know everyone in my first lab rotation, I was talking with our Research Associate Professor about my past research experiences and how I felt I was not allowed to make any mistakes. He told me ‘You’re going to make some mistakes, that’s inevitable, but you learn your best when you make mistakes and fail,’ and that was so reassuring to hear.”

What advice do you have for future students interested in pursuing research?

“Always be kind and try your best to attend/participate in your program’s events – even if you think it’s not related to your research/goals or if you think it might be boring. It’s really important to show your face and to be a somewhat active member of your program. Being kind and showing up can bring you more opportunities than you might think.”

Health & Medicine

Wilderness medicine program director leads a life of adventure

Wilderness and sports medicine specialist Arthur "Tony" Islas, M.D., wields his expertise on and off the path

Graduate Program in Speech-Language Pathology receives national ranking

UNR Med is recognized by U.S. News & World Report as one of the top graduate programs in the country

Dedicated to making an impact one syllable at a time

Madelyn Montgomery shares how she found her purpose in Speech-Language Pathology

Finding her ‘why’ – one medical student’s journey

Taree Chadwick, M.D. Class of 2024, shares why she decided to switch career paths and become a doctor

Editor's Picks

Earth Month events focus on increasing campus sustainably, gardening, thrifting and more

Anthropology doctoral candidate places second in regional Three-Minute Thesis Competition

A look at careers of substance and impact

NASA astronaut Eileen Collins shares stories at Women in Space event

Center for Urban Water Conservation celebrates 30 years of research

Public invited to tours, presentations and native plant sale

Reno/Sparks selected to be part of Urban Heat Mapping Campaign

The summer 2024 effort will involve community volunteers and is supported by the National Institutes of Health, NOAA, Climate.gov and Heat Watch

College of Education and Human Development hosts awards ceremony

This year, 24 awards were given to outstanding students, faculty and staff in the College during the Spring Celebration

Join Extension to celebrate Arbor Day with a tree planting ceremony

Registered attendees will have the opportunity to learn from arborists and win a prize

Journalism school hosts 59th Scripps Dinner and Lecture, honors four students with scholarships

Steven Waldman, founder and president of Rebuild Local News, was this year’s Scripps lecturer

Grand opening of new School of Public Health building

Ribbon cutting ceremony marks the new home of the School of Public Health at the Edna S. Brigham Building

Classical Tahoe returns to the University of Nevada, Reno at Lake Tahoe

Celebrate music and the beauty of the natural landscape from July 7-August 4

Ask the Professor: Which bees will my garden attract?

A recently published article outlines the relationship between bee nutrition and flower visits

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Healthy Living with Diabetes

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On this page:

How can I plan what to eat or drink when I have diabetes?

How can physical activity help manage my diabetes, what can i do to reach or maintain a healthy weight, should i quit smoking, how can i take care of my mental health, clinical trials for healthy living with diabetes.

Healthy living is a way to manage diabetes . To have a healthy lifestyle, take steps now to plan healthy meals and snacks, do physical activities, get enough sleep, and quit smoking or using tobacco products.

Healthy living may help keep your body’s blood pressure , cholesterol , and blood glucose level, also called blood sugar level, in the range your primary health care professional recommends. Your primary health care professional may be a doctor, a physician assistant, or a nurse practitioner. Healthy living may also help prevent or delay health problems  from diabetes that can affect your heart, kidneys, eyes, brain, and other parts of your body.

Making lifestyle changes can be hard, but starting with small changes and building from there may benefit your health. You may want to get help from family, loved ones, friends, and other trusted people in your community. You can also get information from your health care professionals.

What you choose to eat, how much you eat, and when you eat are parts of a meal plan. Having healthy foods and drinks can help keep your blood glucose, blood pressure, and cholesterol levels in the ranges your health care professional recommends. If you have overweight or obesity, a healthy meal plan—along with regular physical activity, getting enough sleep, and other healthy behaviors—may help you reach and maintain a healthy weight. In some cases, health care professionals may also recommend diabetes medicines that may help you lose weight, or weight-loss surgery, also called metabolic and bariatric surgery.

Choose healthy foods and drinks

There is no right or wrong way to choose healthy foods and drinks that may help manage your diabetes. Healthy meal plans for people who have diabetes may include

• dairy or plant-based dairy products
• nonstarchy vegetables
• protein foods
• whole grains

Try to choose foods that include nutrients such as vitamins, calcium , fiber , and healthy fats . Also try to choose drinks with little or no added sugar , such as tap or bottled water, low-fat or non-fat milk, and unsweetened tea, coffee, or sparkling water.

Try to plan meals and snacks that have fewer

• foods high in saturated fat
• foods high in sodium, a mineral found in salt
• sugary foods , such as cookies and cakes, and sweet drinks, such as soda, juice, flavored coffee, and sports drinks

Your body turns carbohydrates , or carbs, from food into glucose, which can raise your blood glucose level. Some fruits, beans, and starchy vegetables—such as potatoes and corn—have more carbs than other foods. Keep carbs in mind when planning your meals.

You should also limit how much alcohol you drink. If you take insulin  or certain diabetes medicines , drinking alcohol can make your blood glucose level drop too low, which is called hypoglycemia . If you do drink alcohol, be sure to eat food when you drink and remember to check your blood glucose level after drinking. Talk with your health care team about your alcohol-drinking habits.

Find the best times to eat or drink

Talk with your health care professional or health care team about when you should eat or drink. The best time to have meals and snacks may depend on

• what medicines you take for diabetes
• what your level of physical activity or your work schedule is
• whether you have other health conditions or diseases

Ask your health care team if you should eat before, during, or after physical activity. Some diabetes medicines, such as sulfonylureas  or insulin, may make your blood glucose level drop too low during exercise or if you skip or delay a meal.

Plan how much to eat or drink

You may worry that having diabetes means giving up foods and drinks you enjoy. The good news is you can still have your favorite foods and drinks, but you might need to have them in smaller portions  or enjoy them less often.

For people who have diabetes, carb counting and the plate method are two common ways to plan how much to eat or drink. Talk with your health care professional or health care team to find a method that works for you.

Carb counting

Carbohydrate counting , or carb counting, means planning and keeping track of the amount of carbs you eat and drink in each meal or snack. Not all people with diabetes need to count carbs. However, if you take insulin, counting carbs can help you know how much insulin to take.

Plate method

The plate method helps you control portion sizes  without counting and measuring. This method divides a 9-inch plate into the following three sections to help you choose the types and amounts of foods to eat for each meal.

• Nonstarchy vegetables—such as leafy greens, peppers, carrots, or green beans—should make up half of your plate.
• Carb foods that are high in fiber—such as brown rice, whole grains, beans, or fruits—should make up one-quarter of your plate.
• Protein foods—such as lean meats, fish, dairy, or tofu or other soy products—should make up one quarter of your plate.

If you are not taking insulin, you may not need to count carbs when using the plate method.

Work with your health care team to create a meal plan that works for you. You may want to have a diabetes educator  or a registered dietitian  on your team. A registered dietitian can provide medical nutrition therapy , which includes counseling to help you create and follow a meal plan. Your health care team may be able to recommend other resources, such as a healthy lifestyle coach, to help you with making changes. Ask your health care team or your insurance company if your benefits include medical nutrition therapy or other diabetes care resources.

Talk with your health care professional before taking dietary supplements

There is no clear proof that specific foods, herbs, spices, or dietary supplements —such as vitamins or minerals—can help manage diabetes. Your health care professional may ask you to take vitamins or minerals if you can’t get enough from foods. Talk with your health care professional before you take any supplements, because some may cause side effects or affect how well your diabetes medicines work.

Research shows that regular physical activity helps people manage their diabetes and stay healthy. Benefits of physical activity may include

• lower blood glucose, blood pressure, and cholesterol levels
• better heart health
• healthier weight
• better mood and sleep
• better balance and memory

Talk with your health care professional before starting a new physical activity or changing how much physical activity you do. They may suggest types of activities based on your ability, schedule, meal plan, interests, and diabetes medicines. Your health care professional may also tell you the best times of day to be active or what to do if your blood glucose level goes out of the range recommended for you.

Do different types of physical activity

People with diabetes can be active, even if they take insulin or use technology such as insulin pumps .

Try to do different kinds of activities . While being more active may have more health benefits, any physical activity is better than none. Start slowly with activities you enjoy. You may be able to change your level of effort and try other activities over time. Having a friend or family member join you may help you stick to your routine.

The physical activities you do may need to be different if you are age 65 or older , are pregnant , or have a disability or health condition . Physical activities may also need to be different for children and teens . Ask your health care professional or health care team about activities that are safe for you.

Aerobic activities

Aerobic activities make you breathe harder and make your heart beat faster. You can try walking, dancing, wheelchair rolling, or swimming. Most adults should try to get at least 150 minutes of moderate-intensity physical activity each week. Aim to do 30 minutes a day on most days of the week. You don’t have to do all 30 minutes at one time. You can break up physical activity into small amounts during your day and still get the benefit. 1

Strength training or resistance training

Strength training or resistance training may make your muscles and bones stronger. You can try lifting weights or doing other exercises such as wall pushups or arm raises. Try to do this kind of training two times a week. 1

Balance and stretching activities

Balance and stretching activities may help you move better and have stronger muscles and bones. You may want to try standing on one leg or stretching your legs when sitting on the floor. Try to do these kinds of activities two or three times a week. 1

Some activities that need balance may be unsafe for people with nerve damage or vision problems caused by diabetes. Ask your health care professional or health care team about activities that are safe for you.

Stay safe during physical activity

Staying safe during physical activity is important. Here are some tips to keep in mind.

Drink liquids

Drinking liquids helps prevent dehydration , or the loss of too much water in your body. Drinking water is a way to stay hydrated. Sports drinks often have a lot of sugar and calories , and you don’t need them for most moderate physical activities.

Avoid low blood glucose

Check your blood glucose level before, during, and right after physical activity. Physical activity often lowers the level of glucose in your blood. Low blood glucose levels may last for hours or days after physical activity. You are most likely to have low blood glucose if you take insulin or some other diabetes medicines, such as sulfonylureas.

Ask your health care professional if you should take less insulin or eat carbs before, during, or after physical activity. Low blood glucose can be a serious medical emergency that must be treated right away. Take steps to protect yourself. You can learn how to treat low blood glucose , let other people know what to do if you need help, and use a medical alert bracelet.

Avoid high blood glucose and ketoacidosis

Taking less insulin before physical activity may help prevent low blood glucose, but it may also make you more likely to have high blood glucose. If your body does not have enough insulin, it can’t use glucose as a source of energy and will use fat instead. When your body uses fat for energy, your body makes chemicals called ketones .

High levels of ketones in your blood can lead to a condition called diabetic ketoacidosis (DKA) . DKA is a medical emergency that should be treated right away. DKA is most common in people with type 1 diabetes . Occasionally, DKA may affect people with type 2 diabetes  who have lost their ability to produce insulin. Ask your health care professional how much insulin you should take before physical activity, whether you need to test your urine for ketones, and what level of ketones is dangerous for you.

Take care of your feet

People with diabetes may have problems with their feet because high blood glucose levels can damage blood vessels and nerves. To help prevent foot problems, wear comfortable and supportive shoes and take care of your feet  before, during, and after physical activity.

If you have diabetes, managing your weight  may bring you several health benefits. Ask your health care professional or health care team if you are at a healthy weight  or if you should try to lose weight.

If you are an adult with overweight or obesity, work with your health care team to create a weight-loss plan. Losing 5% to 7% of your current weight may help you prevent or improve some health problems  and manage your blood glucose, cholesterol, and blood pressure levels. 2 If you are worried about your child’s weight  and they have diabetes, talk with their health care professional before your child starts a new weight-loss plan.

You may be able to reach and maintain a healthy weight by

• following a healthy meal plan
• consuming fewer calories
• being physically active
• getting 7 to 8 hours of sleep each night 3

If you have type 2 diabetes, your health care professional may recommend diabetes medicines that may help you lose weight.

Online tools such as the Body Weight Planner  may help you create eating and physical activity plans. You may want to talk with your health care professional about other options for managing your weight, including joining a weight-loss program  that can provide helpful information, support, and behavioral or lifestyle counseling. These options may have a cost, so make sure to check the details of the programs.

Your health care professional may recommend weight-loss surgery  if you aren’t able to reach a healthy weight with meal planning, physical activity, and taking diabetes medicines that help with weight loss.

If you are pregnant , trying to lose weight may not be healthy. However, you should ask your health care professional whether it makes sense to monitor or limit your weight gain during pregnancy.

Both diabetes and smoking —including using tobacco products and e-cigarettes—cause your blood vessels to narrow. Both diabetes and smoking increase your risk of having a heart attack or stroke , nerve damage , kidney disease , eye disease , or amputation . Secondhand smoke can also affect the health of your family or others who live with you.

If you smoke or use other tobacco products, stop. Ask for help . You don’t have to do it alone.

Feeling stressed, sad, or angry can be common for people with diabetes. Managing diabetes or learning to cope with new information about your health can be hard. People with chronic illnesses such as diabetes may develop anxiety or other mental health conditions .

Learn healthy ways to lower your stress , and ask for help from your health care team or a mental health professional. While it may be uncomfortable to talk about your feelings, finding a health care professional whom you trust and want to talk with may help you

• lower your feelings of stress, depression, or anxiety
• manage problems sleeping or remembering things
• see how diabetes affects your family, school, work, or financial situation

Ask your health care team for mental health resources for people with diabetes.

Sleeping too much or too little may raise your blood glucose levels. Your sleep habits may also affect your mental health and vice versa. People with diabetes and overweight or obesity can also have other health conditions that affect sleep, such as sleep apnea , which can raise your blood pressure and risk of heart disease.

NIDDK conducts and supports clinical trials in many diseases and conditions, including diabetes. The trials look to find new ways to prevent, detect, or treat disease and improve quality of life.

What are clinical trials for healthy living with diabetes?

Clinical trials—and other types of clinical studies —are part of medical research and involve people like you. When you volunteer to take part in a clinical study, you help health care professionals and researchers learn more about disease and improve health care for people in the future.

Researchers are studying many aspects of healthy living for people with diabetes, such as

• how changing when you eat may affect body weight and metabolism
• how less access to healthy foods may affect diabetes management, other health problems, and risk of dying
• whether low-carbohydrate meal plans can help lower blood glucose levels
• which diabetes medicines are more likely to help people lose weight

Find out if clinical trials are right for you .

Watch a video of NIDDK Director Dr. Griffin P. Rodgers explaining the importance of participating in clinical trials.

What clinical trials for healthy living with diabetes are looking for participants?

You can view a filtered list of clinical studies on healthy living with diabetes that are federally funded, open, and recruiting at www.ClinicalTrials.gov . You can expand or narrow the list to include clinical studies from industry, universities, and individuals; however, the National Institutes of Health does not review these studies and cannot ensure they are safe for you. Always talk with your primary health care professional before you participate in a clinical study.

This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health. NIDDK translates and disseminates research findings to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by NIDDK is carefully reviewed by NIDDK scientists and other experts.

NIDDK would like to thank: Elizabeth M. Venditti, Ph.D., University of Pittsburgh School of Medicine.

• Open access
• Published: 15 April 2024

Implementing spiritual care education into the teaching of palliative medicine: an outcome evaluation

• Yann-Nicolas Batzler 1 ,
• Nicola Stricker 2 , 3 ,
• Simone Bakus 4 ,
• Manuela Schallenburger 1 , 6 ,
• Jacqueline Schwartz 1 &
• Martin Neukirchen 1 , 5  

BMC Medical Education volume  24 , Article number:  411 ( 2024 ) Cite this article

217 Accesses

Metrics details

The concept of “total pain” plays an important role in palliative care; it means that pain is not solely experienced on a physical level, but also within a psychological, social and spiritual dimension. Understanding what spirituality entails, however, is a challenge for health care professionals, as is screening for the spiritual needs of patients.

This is a novel, interprofessional approach in teaching undergraduate medical students about spiritual care in the format of a seminar. The aim of this study is to assess if an increase in knowledge about spiritual care in the clinical context is achievable with this format.

In a mandatory seminar within the palliative care curriculum at our university, both a physician and a hospital chaplain teach strategies in symptom control from different perspectives (somatic domain – spiritual domain). For evaluation purposes of the content taught on the spiritual domain, we conducted a questionnaire consisting of two parts: specific outcome evaluation making use of the comparative self-assessment (CSA) gain and overall perception of the seminar using Likert scale.

In total, 52 students participated. Regarding specific outcome evaluation, the greatest gain was achieved in the ability to define total pain (84.8%) and in realizing its relevance in clinical settings (77.4%). The lowest, but still fairly high improvement was achieved in the ability to identify patients who might benefit from spiritual counselling (60.9%). The learning benefits were all significant as confirmed by confidence intervals. Overall, students were satisfied with the structure of the seminar. The content was delivered clearly and comprehensibly reaching a mean score of 4.3 on Likert scale (4 = agree). The content was perceived as overall relevant to the later work in medicine (mean 4.3). Most students do not opt for a seminar solely revolving around spiritual care (mean 2.6).

Conclusions

We conclude that implementing spiritual care education following an interprofessional approach into existing medical curricula, e.g. palliative medicine, is feasible and well perceived among medical students. Students do not wish for a seminar which solely revolves around spiritual care but prefer a close link to clinical practice and strategies.

Peer Review reports

Introduction

Education in palliative care was introduced in 2009 as a compulsory subject in German medical curricula. In the 1960s, Dame Cicely Saunders established palliative medicine and hospices as we know them today. Back then, Cicely Saunders propagated the concept of “total pain”, which means that pain or suffering in general is not solely experienced on a physical level, but also within a psychological, social and spiritual dimension (see. Fig.  1 ) [ 1 , 2 , 3 , 4 ]. Understanding the importance of spirituality in everyday clinical practice and what it entails, however, is a challenge for health care professionals (HCP) in all medical disciplines across the world [ 5 , 6 ]. Palliative care is a relatively young medical discipline which oftentimes is not sufficiently taught in medical curricula [ 1 , 7 ] and, therefore, knowledge regarding the importance of spirituality, which at many faculties is integrated into palliative care education, is scarce [ 1 , 7 ]. As a result, HCP tend to neglect the spiritual needs of patients [ 7 , 8 ]. But, if there is no fundamental knowledge in regards of spirituality and spiritual care among physicians, how can they target total pain adequately?

The European Association of palliative care (EAPC) describes spirituality as following:

“Spirituality is the dynamic dimension of human life that relates to the way persons (individual and community) experience, express and/or seek meaning, purpose and transcendence, and the way they connect to the moment, to self, to others, to nature, to the significant and/or the sacred.” [ 1 , 9 ].

It must be clear to all HCP that spirituality is a unique and subjective phenomenon that differs substantially from patient to patient [ 2 , 10 ]. Furthermore, to fully address the spiritual needs of patients, self-reflection, thorough consideration of one’s own attitude towards death, and finding meaning in life, are essential [ 8 , 9 ]. Several studies have shown the impact which the addressing of spiritual needs in the context of total pain can have on ameliorating the symptoms of patients, leading to a better quality of life and care [ 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 ]. Thus, once spiritual needs become imminent, it is necessary to engage in an interdisciplinary and multi-professional collaboration with specially trained professionals in the field of spiritual care [ 8 , 10 , 14 , 15 , 19 ]. Summing up, it is very important to raise awareness about the positive impact of spiritual care among HCPs [ 8 , 15 ]. To increase such knowledge and accrue such skills, the teaching of spiritual care in medical curricula is essential [ 20 ]. Throughout different regions in the world, in-person didactic teaching on spiritual care is the most commonly used technique [ 5 ]. Usually, the teaching is based on case studies and many include screening strategies assessing spiritual needs [ 5 ]. Often, education on spirituality and spiritual care is part of curricula in palliative care [ 5 , 21 ]. In German medical curricula, there is no compulsory subject solely revolving around spiritual care [ 22 ]. However, regarding the concept of total pain, implementing spiritual care into palliative care teaching, however, seems like a plausible proposition.

This study was conducted in order to assess the way medical students perceive the concept of implementing spiritual care into the teaching on symptom control in palliative care. Furthermore, we aimed to determine whether an actual increase of knowledge about spiritual care in the clinical context was achievable within this seminar.

Material and methods

This study is a single-centre prospective study conducted at University Hospital Duesseldorf, Germany. Ethical approval was obtained by the local ethics committee (reference number 2022–2274).

Curricular structure

At our facility, palliative care education is structured as followed: Five lectures (somatic symptoms, psychological symptoms, social symptoms and advance care planning, spiritual symptoms and end-of-life care and care for relatives, clinical ethics) and four seminars (symptom control, breaking bad news, clinical ethics I and II). Since 2022, the lecture on spiritual symptoms and end-of-life-care is held by both a physician and a hospital chaplain within the palliative care curriculum at Düsseldorf medical faculty. Beforehand, this lecture was solely held by a hospital chaplain. As internal evaluations implied, this concept was not well perceived by medical students as the relevance to daily clinical work was not apparent to them. They did not understand how spiritual care can support somatic strategies of symptom control and how both approaches are intertwined. Furthermore, they were unsure of how to assess patients’ spiritual needs. We therefore opted for the above-mentioned approach which allows lecturing relevant medical implications alongside spiritual care. As evaluations showed, this embeds spiritual care in a more clinical and tangible manner and students seem to better realize the relevance that spiritual care has in daily clinical practice. For example, students repeatedly stated that they were now able to understand the importance of ongoing collaborations for patients’ comfort care, e.g., in more sufficiently relieving anxiety or social distress.

Since this novel concept was perceived positively by medical students, we transposed it to our seminar titled “symptom control” which is now also held by a hospital chaplain and a physician. In the seminars, content from the lectures is further deepened and there is more room for discussions, e.g. concerning assessment of spiritual needs, possibilities of spiritual care, and inter-professional collaboration. There is also an emphasis on determining which patients might benefit from spiritual care making use of the SPIR tool (patient’s self-description as a S piritual person— P lace of spirituality in patient’s life – patient’s I ntegration in a spiritual community – R ole of health care professional in the domain of spirituality), which tackles different dimensions of spirituality [ 23 ].

In the seminar, a 33-year-old fictitious patient (inspired by a real patient) served as an example case. Her situation is used to address strategies for symptom control on both somatic and spiritual domains. To achieve this, a reflective question is discussed with the students followed by a joint development of possible therapeutic strategies on both the somatic and spiritual domain (see Fig.  2 ).

Case discussion in the seminar

Our approach can be described as novel, since training in spiritual care often involves the mere shadowing of chaplains [ 5 , 24 , 25 , 26 ]. An interprofessional, educational approach was mainly used with physicians or nurses in training [ 5 , 27 , 28 , 29 ], but not with medical students.

Evaluation methods

A structured, paper-based questionnaire was developed in repeated interdisciplinary and multi-professional discussions in the Interdisciplinary Centre for Palliative Care Medicine, University Hospital Düsseldorf, Germany. The basis for the questionnaire were the learning goals that are to be achieved within the seminar, as well as a didactic evaluation. The questionnaire was pretested among medical students, and unclear statements were altered. The questionnaire consists of two parts. The first part is made up of five statements regarding knowledge about total pain, assessing spiritual needs, and defining spiritual care (see Table  1 ) on both the knowledge and skills level. These statements cover the field of specific outcome evaluation. Making use of the comparative self-assessment (CSA) method to determine if a gain in knowledge was achieved, each student evaluated their knowledge before and after the seminar using the German school grading system (1 = “excellent” to 6 = “unsatisfactory”). The CSA gain is a well described and implemented method in evaluating actual knowledge gains in education [ 30 , 31 , 32 , 33 , 34 ]. This evaluation tool has the benefit of not taking into account experiences made beforehand as they are not contributing to the effect size [ 31 ]. CSA gain is calculated as followed:

Furthermore, CSA gain was calculated with a 95% confidence interval and standard error using individual learning gain (ILG) values. These values were calculated using the following formulas:

ILG = 0 if pre = post and

ILG = (pre − post)/(pre − 1) × 100 if pre > post [ 31 ].

The second part of the questionnaire consists of four questions regarding the perception of the seminar (structure, teaching spiritual care alongside symptom control in palliative care). A 5-Point-Likert scale was used for evaluation (1 = strongly disagree, 2 = disagree, 3 = neither, 4 = agree, 5 = strongly agree).

Study participation and analysis

Participation in the study was anonymous, voluntary, and could be withdrawn at any time without explanation. Eligible participants were undergraduate medical students at the beginning of their fifth year of medical education (Germany: total of min. six years), who completed the mandatory palliative care course. The purpose and content of the study were presented orally, and, furthermore, written information and consent documents were handed out. After completion of the seminar, the questionnaire was handed out making use of a post-then design in which the students were asked to retrospectively rate their knowledge before and after the seminar. There were no exclusion criteria other than refusing to participate. Due to the small number of students per seminar ( n  = 15–20), no demographic characteristics besides sex were assessed.

Data analysis was performed using Microsoft Excel 2020 (version 16.42, Microsoft Corp., Redmond, WA, USA) and IBM SPSS Statistic version 28.0.1.1 (IBM, Armonk, NY, USA).

Throughout the course of one semester in 2023, the questionnaires were rolled out in each of six separate seminars. Out of 108 eligible attending students, 52 students participated in total (48.1%). 25% ( n  = 13) of the participants were of female, 75% ( n  = 39) of male sex. Within the answered questionnaires, there was no missing data.

Regarding the specific outcome evaluation, CSA gains showed a relevant increase especially in the field of knowledge (see Table  2 and Fig.  3 ). The greatest improvement (84.8%) was achieved in the ability of defining total pain and realizing its importance in clinical settings (77.4%). After the seminar, medical students were increasingly able to name tools such as SPIR in order to engage in spiritual needs assessment (CSA gain 68,8%). A lower increase in knowledge was achieved in realizing how spiritual care itself can benefit patients’ needs (66.7%). The lowest gain was detected in actually identifying patients who might benefit from spiritual care (60.9%), which represents a skill to be learned rather than knowledge to be gained.

CSA gains for each item

Statistical analysis using 95% confidence intervals confirmed the gains in knowledge, which were significant for all items (Table  2 ).

In regard to the second part of the questionnaire, students were overall satisfied with the new structure of the seminar (Table  3 and Fig.  4 ). The content was comprehensible and delivered clearly gaining a mean score of 4.3 (median 4, SD 0.6, min. 2, max. 5). The content was perceived as overall relevant to the later work in medicine (mean 4.3, median 4, SD 0.6, min. 3, max. 5). It seems as if medical students regard the implementation of spiritual care education into the seminar “symptom control”, which focuses on alleviating symptoms on multidimensional levels, as expedient. They feel that implementing education on spiritual care into this seminar makes sense (mean 4.2, median 4, SD 0.8, min. 1, max. 5). Furthermore, most students do not opt for a seminar solely revolving around spiritual care (mean 2.6, median 2, SD 1.3, min. 1, max. 5).

Perception of the seminar, Likert scale (1 = strongly disagree, 2 = disagree, 3 = neither, 4 = agree, 5 = strongly agree)

Our data show that implementing spiritual care education into existing medical curricula, in our example palliative care, is feasible and well perceived among medical students. The timing of our seminar is in accordance to other studies that found that spiritual care should be implemented in mandatory undergraduate courses [ 6 ]. Students do not wish for a seminar solely revolving around spiritual care but prefer a connection to clinical practice and strategies in symptom management. This enables them to understand the relevance of spiritual care in a daily clinical setting.

To evaluate training programs, Kirkpatrick proposed a four-level approach (level 1: reaction, level 2: learning, level 3: behaviour, level 4: results) [ 35 ]. We followed levels 1 (reaction—satisfaction) and 2 (learning—gains in knowledge) making use of the conducted questionnaire. Level 3 (change in behaviour – acquired skills) was briefly addressed with item 5 in the first part of the questionnaire. As level 4 is an indicator of direct results of the training at an organizational level, we were not able to incorporate items on this level. A different study among undergraduate nursing students assessed the effectiveness of teaching spiritual care in mandatory classes: There was an increase in knowledge, e.g., in defining spirituality, compared to students who obtained no information on spiritual care [ 36 ]. This is comparable to our study, as there were gains in knowledge after completing the mandatory seminar. We reached higher individual learning gains on the knowledge level than on the skills level, as was also the case in a number of other studies we conducted [ 31 ]. This is mainly because, due to the format of the seminar, no bedside teaching takes place and scenarios that might occur in everyday clinical practice can only be discussed and serve as examples.

The concept of total pain is essential in palliative care; however, it should not only be taken into consideration in a palliative setting, but whenever patients experience high burdens on various dimensions such as pain, anxiety, grief or existential distress [ 2 , 4 , 17 , 37 , 38 ]. We were able to thoroughly educate students on total pain and its relevance in clinical settings. Spirituality plays an important role in a holistic approach. However, literature shows that HCP often don’t know how to implement spiritual assessments and how to deal with spiritual needs [ 1 , 5 , 6 , 8 ]. A systematic review on teaching methods found the usage of practical tools and the involvement of chaplains to be effective facilitators in the teaching of spiritual care [ 5 ]. A scoping review found that spiritual care should be taught in both mono- and multi-disciplinary educational settings [ 6 ]. With our multi-professional approach, we were able to introduce students to tools in assessing spiritual needs, such as SPIR [ 23 ]. Within this item, there was a definite gain in knowledge of these tools which make assessing spiritual needs of patients more feasible. This is in accordance with findings of a number other studies [ 5 ]. In our study, however, students are still unsure if they are fully able to determine which patients might actually benefit from spiritual care, even though this item still reached a learning gain of 60.9%. As concluded by other authors, there is need for ongoing education [ 5 ].

Even though our seminar entails many different aspects of the total pain concept (somatic symptom management, spirituality, and spiritual care) medical students found the content to be clearly structured and comprehensible. More importantly, they understood the relevance of spirituality for their future clinical work and perceived the multi-professional teaching as highly satisfactory. In sensitizing them in this, we hope that they keep in mind the importance of ongoing collaborations between different professions.

Our study has some limitations. Even though the questionnaire was pretested among medical students before the actual study, no validated questionnaire was used. The response rate of almost 50% is relatively low and it can be assumed that those who participated were mostly students who were interested in the topic. This might have led to bias as positive effects might have been overestimated. Due to the small study population and to protect the privacy of participating students, no demographic data besides sex was collected. Demographic data, however, might contribute to a better understanding of spirituality or palliative medicine beforehand such as age, professional expertise, or own spiritual resources. This also meant that adjusting for confounding factors was not possible. This study solely dealt with medical students and no patients were involved. It would be of interest to assess as to whether the content taught in this seminar ultimately impacts the wellbeing or stress levels of patients in everyday clinical practice. A study focusing on patients would complement the findings of this study, as suggested by other researchers [ 5 ]. Furthermore, the study was only performed in one centre; therefore, it can only serve as an example on how spiritual care education might be successfully implemented into medical curricula.

Spirituality plays an important role for many people and should always be taken into consideration when treating patients. This especially applies to palliative care where the addressing of spiritual needs is of crucial importance [ 18 ]. However, many HCP don’t know how to address topics revolving around spirituality which makes it hard to determine which patients might benefit from spiritual care. Therefore, education on the nature of spiritual care, on what it entails and on how it can support patients in everyday clinical practice should be thoroughly integrated into medical curricula. We opted to implement spirituality and spiritual care into an existing seminar and lecture within the medical curriculum at our faculty. This was well received among students. As a result, we found a clear increase in knowledge about total pain and about the tools one might use to assess spiritual needs. This knowledge needs to be further strengthened in practical clinical scenarios.

Availability of data and materials

All data and materials are available within this publication.

Abbreviations

Health care professional

European Association of palliative care

• Spiritual care

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Acknowledgements

We thank Dr Jessica JT Fischer for excellent English language editing.

Open Access funding enabled and organized by Projekt DEAL. This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

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Interdisciplinary Center for Palliative Care, University Hospital, Heinrich Heine University, Duesseldorf, Germany

Yann-Nicolas Batzler, Manuela Schallenburger, Jacqueline Schwartz & Martin Neukirchen

Evangelical Church in the Rhineland, Duesseldorf, Germany

Nicola Stricker

Institut Protestant de Théologie, Paris, France

Evangelical Hospital Chaplaincy (Pastoral Care), University Hospital, Heinrich Heine University, Duesseldorf, Germany

Simone Bakus

Department of Anesthesiology, University Hospital, Heinrich Heine University, Düsseldorf, Germany

Martin Neukirchen

Interdisciplinary Centre for Palliative Medicine, Medical Faculty, Heinrich Heine University Duesseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany

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Contributions

YB, NS, MS, JS, MN designed the study. YB analysed and interpreted the data. YB drafted the first version of the manuscript, which was critically revised by NS, MS, JS, and MN in several rounds of feedback. All authors have approved the submitted version and have agreed to be accountable for their contributions as well as for accuracy and integrity for any part of the work.

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Correspondence to Manuela Schallenburger .

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Batzler, YN., Stricker, N., Bakus, S. et al. Implementing spiritual care education into the teaching of palliative medicine: an outcome evaluation. BMC Med Educ 24 , 411 (2024). https://doi.org/10.1186/s12909-024-05415-0

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Key facts about Americans and guns

Guns are deeply ingrained in American society and the nation’s political debates.

The Second Amendment to the United States Constitution guarantees the right to bear arms, and about a third of U.S. adults say they personally own a gun. At the same time, in response to concerns such as rising gun death rates and  mass shootings , President Joe Biden has proposed gun policy legislation that would expand on the bipartisan gun safety bill Congress passed last year.

Here are some key findings about Americans’ views of gun ownership, gun policy and other subjects, drawn primarily from a Pew Research Center survey conducted in June 2023 .

Pew Research Center conducted this analysis to summarize key facts about Americans and guns. We used data from recent Center surveys to provide insights into Americans’ views on gun policy and how those views have changed over time, as well as to examine the proportion of adults who own guns and their reasons for doing so.

The analysis draws primarily from a survey of 5,115 U.S. adults conducted from June 5 to June 11, 2023. Everyone who took part in the surveys cited is a member of the Center’s American Trends Panel (ATP), an online survey panel that is recruited through national, random sampling of residential addresses. This way nearly all U.S. adults have a chance of selection. The survey is weighted to be representative of the U.S. adult population by gender, race, ethnicity, partisan affiliation, education and other categories. Read more about the  ATP’s methodology .

Here are the  questions used for the analysis on gun ownership , the questions used for the analysis on gun policy , and  the survey’s methodology .

Additional information about the fall 2022 survey of parents and its methodology can be found at the link in the text of this post.

Measuring gun ownership in the United States comes with unique challenges. Unlike many demographic measures, there is not a definitive data source from the government or elsewhere on how many American adults own guns.

The Pew Research Center survey conducted June 5-11, 2023, on the Center’s American Trends Panel, asks about gun ownership using two separate questions to measure personal and household ownership. About a third of adults (32%) say they own a gun, while another 10% say they do not personally own a gun but someone else in their household does. These shares have changed little from surveys conducted in 2021  and  2017 . In each of those surveys, 30% reported they owned a gun.

These numbers are largely consistent with rates of gun ownership reported by Gallup , but somewhat higher than those reported by NORC’s General Social Survey . Those surveys also find only modest changes in recent years.

The FBI maintains data on background checks on individuals attempting to purchase firearms in the United States. The FBI reported a surge in background checks in 2020 and 2021, during the coronavirus pandemic. The number of federal background checks declined in 2022 and through the first half of this year, according to FBI statistics .

About four-in-ten U.S. adults say they live in a household with a gun, including 32% who say they personally own one,  according to an August report based on our June survey. These numbers are virtually unchanged since the last time we asked this question in 2021.

There are differences in gun ownership rates by political affiliation, gender, community type and other factors.

• Republicans and Republican-leaning independents are more than twice as likely as Democrats and Democratic leaners to say they personally own a gun (45% vs. 20%).
• 40% of men say they own a gun, compared with 25% of women.
• 47% of adults living in rural areas report personally owning a firearm, as do smaller shares of those who live in suburbs (30%) or urban areas (20%).
• 38% of White Americans own a gun, compared with smaller shares of Black (24%), Hispanic (20%) and Asian (10%) Americans.

Personal protection tops the list of reasons gun owners give for owning a firearm.  About three-quarters (72%) of gun owners say that protection is a major reason they own a gun. Considerably smaller shares say that a major reason they own a gun is for hunting (32%), for sport shooting (30%), as part of a gun collection (15%) or for their job (7%). 

The reasons behind gun ownership have changed only modestly since our 2017 survey of attitudes toward gun ownership and gun policies. At that time, 67% of gun owners cited protection as a major reason they owned a firearm.

Gun owners tend to have much more positive feelings about having a gun in the house than non-owners who live with them. For instance, 71% of gun owners say they enjoy owning a gun – but far fewer non-gun owners in gun-owning households (31%) say they enjoy having one in the home. And while 81% of gun owners say owning a gun makes them feel safer, a narrower majority (57%) of non-owners in gun households say the same about having a firearm at home. Non-owners are also more likely than owners to worry about having a gun in the home (27% vs. 12%, respectively).

Feelings about gun ownership also differ by political affiliation, even among those who personally own firearms. Republican gun owners are more likely than Democratic owners to say owning a gun gives them feelings of safety and enjoyment, while Democratic owners are more likely to say they worry about having a gun in the home.

Non-gun owners are split on whether they see themselves owning a firearm in the future. About half (52%) of Americans who don’t own a gun say they could never see themselves owning one, while nearly as many (47%) could imagine themselves as gun owners in the future.

Among those who currently do not own a gun:

• 61% of Republicans and 40% of Democrats who don’t own a gun say they would consider owning one in the future.
• 56% of Black non-owners say they could see themselves owning a gun one day, compared with smaller shares of White (48%), Hispanic (40%) and Asian (38%) non-owners.

Americans are evenly split over whether gun ownership does more to increase or decrease safety. About half (49%) say it does more to increase safety by allowing law-abiding citizens to protect themselves, but an equal share say gun ownership does more to reduce safety by giving too many people access to firearms and increasing misuse.

Republicans and Democrats differ on this question: 79% of Republicans say that gun ownership does more to increase safety, while a nearly identical share of Democrats (78%) say that it does more to reduce safety.

Urban and rural Americans also have starkly different views. Among adults who live in urban areas, 64% say gun ownership reduces safety, while 34% say it does more to increase safety. Among those who live in rural areas, 65% say gun ownership increases safety, compared with 33% who say it does more to reduce safety. Those living in the suburbs are about evenly split.

Americans increasingly say that gun violence is a major problem. Six-in-ten U.S. adults say gun violence is a very big problem in the country today, up 9 percentage points from spring 2022. In the survey conducted this June, 23% say gun violence is a moderately big problem, and about two-in-ten say it is either a small problem (13%) or not a problem at all (4%).

Looking ahead, 62% of Americans say they expect the level of gun violence to increase over the next five years. This is double the share who expect it to stay the same (31%). Just 7% expect the level of gun violence to decrease.

A majority of Americans (61%) say it is too easy to legally obtain a gun in this country. Another 30% say the ease of legally obtaining a gun is about right, and 9% say it is too hard to get a gun. Non-gun owners are nearly twice as likely as gun owners to say it is too easy to legally obtain a gun (73% vs. 38%). Meanwhile, gun owners are more than twice as likely as non-owners to say the ease of obtaining a gun is about right (48% vs. 20%).

Partisan and demographic differences also exist on this question. While 86% of Democrats say it is too easy to obtain a gun legally, 34% of Republicans say the same. Most urban (72%) and suburban (63%) dwellers say it’s too easy to legally obtain a gun. Rural residents are more divided: 47% say it is too easy, 41% say it is about right and 11% say it is too hard.

About six-in-ten U.S. adults (58%) favor stricter gun laws. Another 26% say that U.S. gun laws are about right, and 15% favor less strict gun laws. The percentage who say these laws should be stricter has fluctuated a bit in recent years. In 2021, 53% favored stricter gun laws, and in 2019, 60% said laws should be stricter.

About a third (32%) of parents with K-12 students say they are very or extremely worried about a shooting ever happening at their children’s school, according to a fall 2022 Center survey of parents with at least one child younger than 18. A similar share of K-12 parents (31%) say they are not too or not at all worried about a shooting ever happening at their children’s school, while 37% of parents say they are somewhat worried.

Among all parents with children under 18, including those who are not in school, 63% see improving mental health screening and treatment as a very or extremely effective way to prevent school shootings. This is larger than the shares who say the same about having police officers or armed security in schools (49%), banning assault-style weapons (45%), or having metal detectors in schools (41%). Just 24% of parents say allowing teachers and school administrators to carry guns in school would be a very or extremely effective approach, while half say this would be not too or not at all effective.

There is broad partisan agreement on some gun policy proposals, but most are politically divisive,   the June 2023 survey found . Majorities of U.S. adults in both partisan coalitions somewhat or strongly favor two policies that would restrict gun access: preventing those with mental illnesses from purchasing guns (88% of Republicans and 89% of Democrats support this) and increasing the minimum age for buying guns to 21 years old (69% of Republicans, 90% of Democrats). Majorities in both parties also  oppose  allowing people to carry concealed firearms without a permit (60% of Republicans and 91% of Democrats oppose this).

Republicans and Democrats differ on several other proposals. While 85% of Democrats favor banning both assault-style weapons and high-capacity ammunition magazines that hold more than 10 rounds, majorities of Republicans oppose these proposals (57% and 54%, respectively).

Most Republicans, on the other hand, support allowing teachers and school officials to carry guns in K-12 schools (74%) and allowing people to carry concealed guns in more places (71%). These proposals are supported by just 27% and 19% of Democrats, respectively.

Gun ownership is linked with views on gun policies. Americans who own guns are less likely than non-owners to favor restrictions on gun ownership, with a notable exception. Nearly identical majorities of gun owners (87%) and non-owners (89%) favor preventing mentally ill people from buying guns.

Within both parties, differences between gun owners and non-owners are evident – but they are especially stark among Republicans. For example, majorities of Republicans who do not own guns support banning high-capacity ammunition magazines and assault-style weapons, compared with about three-in-ten Republican gun owners.

Among Democrats, majorities of both gun owners and non-owners favor these two proposals, though support is greater among non-owners. 

Note: This is an update of a post originally published on Jan. 5, 2016 .

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About 1 in 4 U.S. teachers say their school went into a gun-related lockdown in the last school year

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Blog The Education Hub

https://educationhub.blog.gov.uk/2024/04/09/primary-school-offer-day-2023-everything-you-need-to-know/

Primary school offer day 2024: Everything you need to know

Parents of three and four-year-olds will soon find out what primary school has offered their child a place for the next academic year.  

The majority of pupils will be offered a place at one of their preferred primary schools, while most will be offered their top choice.   

Here, we explain everything you need to know about primary school offer day, from when you can expect to find out, to how to appeal a decision.  

When is primary school offer day and what time are school places released?   

Parents will find out which primary school has offered their child a place for September 2024 on  Tuesday 16 April.

The decision will be sent by the local council by either letter or email. Some councils allow parents to view their results through the admissions portal or system. Exactly what time the offers will be released varies by council.

How likely am I to get my first-choice primary school?  

We want parents to feel reassured when it comes to getting one of their top choice primary schools.

In 2023, 92.5% of families received an offer from their first choice of primary school and 98.3% received an offer from one of their top three choices.

At the same time, over 1 million additional school places have been created between May 2010 and May 2023, with many more in the pipeline.

What happens after I receive an offer of a school place?  

A parent or carer must formally accept the offer by the given deadline. This is usually set through the local authority’s admissions portal or system. You’ll receive details of next steps with the offer.  

Can I appeal a primary school placement decision?  

If you’re not offered your first-choice school, you can appeal the decision . However, even if you're appealing a decision, we recommend accepting the offer your child did receive so that they have a school place if the appeal is unsuccessful. Accepting another offer won’t affect your appeal or limit other options available to you.  

Parents or carers who want to appeal a decision should first contact the school’s admission authority, which is responsible for organising the appeal panel. Parents and carers can find their school’s admission authority by visiting their local council website:  Find your local council - GOV.UK (www.gov.uk) .  

The panel is independent and will look at the case presented by both the admission authority and the parent before coming to a decision.  

The decision of the appeal panel is binding – if the appeal is upheld, the admission authority must offer your child a place at the school.  

Admission authorities and appeal panels must comply with the statutory School Admission Appeals Code, which is available  here . Guidance for parents on the admission appeals process can also be found  here .  

How are primary school places decided?  

All schools have admission criteria to decide which children get places. This criteria is set by the school or local council.  

While all state-funded schools must give top priority to admitting children who are in care or have been in care, admission criteria is  different for each school. They may choose to give priority to children:  

• who live close to the school  
• who have a brother or sister at the school already  
• from a particular religion (for faith schools)  
• who are eligible for the pupil premium   
• whose parent has worked at the school for two years or more  

Your  local council  can give you information about a school’s criteria.  

Why has my child not been offered a place at one of their preferred schools?  

Some schools will receive more applications than places it has available and unfortunately not every parent will be successful. Priority must be given to those who most closely meet the school’s specific admission arrangements.  

If the local authority is unable to offer a place at one of the parents’ preferred schools, it must offer a place at another school.  

In the unlikely event that a parent does not receive an offer of a place on 17 April, parents should contact their local authority for further advice.  

Can I join a waiting list for my top-choice primary school?  

You can add your child’s name to the waiting list for any school that you’ve applied for. You should still accept the offer you received and this won’t affect where you stand in the waiting list.  

Schools must keep a waiting list for at least one term. The waiting list will be ordered by the school’s oversubscription criteria.   

In some areas, your child will be automatically added to the waiting lists of the schools you ranked more highly. In others, you must ask to be put on the waiting list. Check the school admissions section of your local authority website to find out how it works in your area.  

You may also be interested in:

• Can I appeal a primary school offer
• How we are growing our 30 hours free childcare offer
• Everything you need to know about childcare support

Tags: free school places , National Offer Day , national offer day 2023 , primary school , primary school offer day , primary schools , school admissions , schools , when is primary school offer day

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