Pharmacology is a core subject in the undergraduate medical curriculum, yet it is often perceived by students as difficult due to the vast amount of factual information related to drug names, mechanisms of action, indications, and adverse effects. Traditional lecture-based teaching frequently emphasizes memorization, which may limit students’ ability to apply pharmacological knowledge in real clinical situations. As a result, learners often struggle to integrate theoretical concepts with practical decision-making in patient care. With the shift toward competency-based medical education (CBME), there is an increasing emphasis on student-centered and clinically oriented teaching–learning strategies. Active learning approaches such as case-based learning (CBL) encourage critical thinking, clinical reasoning, and self-directed learning by engaging students in real or simulated patient scenarios. Such methods allow learners to correlate pharmacological concepts with clinical practice, thereby improving long-term retention and understanding. The National Medical Commission (NMC) has also advocated the use of innovative and integrated teaching strategies to enhance learner engagement and clinical competence. In this context, CBL serves as an effective educational tool that promotes analytical thinking, discussion, and application of knowledge rather than passive information absorption. Although several studies have demonstrated the benefits of CBL in small group settings, evidence regarding its effectiveness in large classroom settings remains limited. Therefore, the present study was undertaken to evaluate the effectiveness of case-based learning compared to traditional didactic lectures in undergraduate pharmacology teaching at GMCH Sundargarh. The study aimed to assess students’ academic performance, learning experience, and perception of CBL as a teaching–learning method.

A descriptive, interventional study was conducted in the Department of Pharmacology at GMCH Sundargarh, Odisha, after obtaining approval from the Institutional Ethics Committee. The study was carried out over a period of five months. A total of 120 second-year MBBS (fourth semester) students participated in the study. All students who were present and consented to participate were included. Prior to implementation, departmental meetings were conducted to sensitize faculty members regarding the concept and methodology of case-based learning. Faculty members collaboratively developed clinical case scenarios, problem-based questions, and prescription-based exercises for two selected topics: 1. Drugs used in Acid Peptic Disease 2. Drugs used in Tuberculosis Students were informed in advance about the teaching–learning approach and objectives of the sessions. Study Procedure The 120 students were randomly divided into two equal groups (Group A and Group B), each comprising 60 students. • Phase 1: Group A was taught the topic of drugs used in acid peptic disease using the CBL approach, while Group B received teaching on the same topic through conventional didactic lectures. • Phase 2 (Crossover): The teaching methods were interchanged for the second topic (drugs used in tuberculosis). Group A received didactic lectures, and Group B underwent case-based learning. Each teaching session lasted for two hours. In the CBL sessions, a brief introduction to the topic was followed by discussion of clinical case scenarios. Students were encouraged to analyze the case, identify problems, suggest appropriate drug therapy, and justify their choices with scientific reasoning. Faculty members facilitated discussions and clarified concepts when required. Assessment and Data Collection Following completion of both teaching modules, students undertook a written assessment conducted two weeks later. The assessment consisted of a combination of multiple-choice questions, short-answer questions, and problem-based questions designed to assess both knowledge and application skills. Student attendance was recorded throughout the sessions. Feedback from students was collected using a prevalidated structured questionnaire consisting of Likert-scale items assessing understanding, engagement, satisfaction, and perceived usefulness of the teaching method. Faculty feedback was also obtained using a separate structured questionnaire to evaluate feasibility and acceptance of the CBL approach. Statistical Analysis Data were entered and analyzed using R statistical software. Descriptive statistics were used to summarize student performance and feedback responses. Comparison of mean scores between the two teaching methods was performed using the Student’s t-test. A p-value of less than 0.05 was considered statistically significant.

A total of 120 second-year MBBS students (fourth semester) participated in the study. Among them, 54 were male and 66 were female, with a mean age of 20.4 ± 0.9 years. All enrolled students completed both phases of the crossover study design. The two groups were comparable in terms of demographic characteristics and baseline academic exposure, with the only difference being the teaching–learning method used during each session. Attendance during the teaching sessions was recorded and compared between the two instructional methods. A statistically significant difference was observed between the groups, with higher attendance noted during the case-based learning (CBL) sessions compared to the didactic lecture (DL) sessions (p < 0.05). This finding indicates greater student engagement and interest during CBL-based teaching (Table 1). Table 1. Demographic Characteristics of Study Participants (n = 120) Variable Value Total number of students 120 Male, n (%) 54 (45.0%) Female, n (%) 66 (55.0%) Mean age (years ± SD) 20.4 ± 0.9 Semester Fourth (Second Professional MBBS) Study design Crossover design Student performance was evaluated using a written test conducted two weeks after completion of the teaching sessions. The overall mean scores obtained by students in the CBL and DL groups did not differ significantly (p > 0.05), indicating comparable overall academic performance between the two teaching approaches. Table 2. Comparison of Attendance Between Teaching Methods Teaching Method Mean Attendance (%) Standard Deviation p-value Case-Based Learning (CBL) Higher — < 0.05 Didactic Lecture (DL) Lower — Student’s t-test applied; statistically significant difference observed. However, when the test results were analyzed based on the type of questions, a distinct pattern emerged. Students taught using the CBL method scored significantly higher in application-based and critical-thinking questions compared to those taught through traditional lectures. In contrast, students exposed to didactic lectures performed better in knowledge-based and recall-oriented questions. These differences were found to be statistically significant (Table 2). Table 3. Comparison of Mean Test Scores Between CBL and DL Methods Teaching Method Mean Score (± SD) p-value Case-Based Learning (CBL) Comparable > 0.05 Didactic Lecture (DL) Comparable No statistically significant difference in overall scores. All 120 students voluntarily completed the feedback questionnaire, yielding a 100% response rate. Overall, students expressed a positive perception of the CBL approach. Most participants agreed that CBL improved their understanding of pharmacological concepts, enhanced clinical reasoning, and increased classroom interaction. Students reported that CBL sessions encouraged active participation and helped them correlate theoretical knowledge with clinical practice. Table 4. Performance Based on Type of Questions Type of Question Better Performance Observed With Statistical Significance Knowledge-based (recall) Didactic Lecture (DL) Significant Application-based / Critical thinking Case-Based Learning (CBL) Significant However, some students felt that CBL sessions were time-consuming and required greater effort and preparation compared to conventional lectures. A section of students suggested increasing the number of CBL sessions and incorporating a wider variety of clinical cases to enhance learning effectiveness (Table 3). Table 5. Student Perception of Case-Based Learning (Likert Scale Responses) Domain Assessed Overall Response Improved understanding of topic Positive Better clinical correlation Positive Increased classroom interaction Positive Encouraged active participation Positive Required more effort/time Reported by some students Desire for more CBL sessions Frequently suggested All faculty members involved in the study provided feedback on the CBL methodology. Faculty responses indicated that CBL was effective in promoting student engagement, critical thinking, and interactive learning. However, they also highlighted the need for structured faculty training programs to ensure uniform delivery of CBL sessions. Additional suggestions included the development of a standardized repository of case scenarios, prescriptions, and problem-based questions to facilitate smoother implementation in future academic sessions (Table 4). Table 6. Faculty Perception of Case-Based Learning Aspect Faculty Response Student engagement Improved Promotion of critical thinking Improved Feasibility of implementation Acceptable Need for faculty training Strongly recommended Need for case repository Strongly recommended Comparison of student attendance between case-based learning (CBL) and didactic lecture (DL) sessions, showing significantly higher attendance during CBL sessions (p < 0.05). Overall mean scores obtained by students following CBL and DL teaching methods, demonstrating no statistically significant difference in total marks. Distribution of student responses to the feedback questionnaire based on a 5-point Likert scale, reflecting positive perception toward CBL sessions. Faculty responses to the feedback questionnaire indicating acceptance of CBL as an effective teaching–learning method and highlighting the need for structured training and resources. Appendix 1. Student Feedback Questionnaire (5-point Likert scale: 1 = Strongly disagree, 2 = Disagree, 3 = Neutral, 4 = Agree, 5 = Strongly agree) S. No Statements 1 Case-based learning (CBL) helped me understand the topic better. 2 Didactic lectures were helpful in understanding the topic. 3 The cases/problems discussed during CBL were relevant to the topic taught. 4 CBL helped me relate drugs to their basic mechanisms of action. 5 CBL improved my ability to apply basic science concepts to clinical situations. 6 CBL helped me identify potential drug-related problems in patients. 7 My learning skills improved more with CBL compared to didactic lectures. 8 CBL motivated me to explore the topic beyond classroom teaching. 9 A balanced combination of didactic lectures and CBL sessions would enhance learning. 10 CBL sessions should be preceded by didactic lectures for better comprehension. 11 Exposure to CBL will help me prepare better for the final university examinations. 12 CBL should be introduced as a regular teaching–learning method for future batches. Any other suggestions/comments: _______________________________ Abbreviation: CBL – Case-Based Learning Appendix 2. Faculty Feedback Questionnaire (5-point Likert scale: 1 = Strongly disagree, 2 = Disagree, 3 = Neutral, 4 = Agree, 5 = Strongly agree) S. No Statements 1 Students were more actively involved and engaged during CBL sessions. 2 Preparation for CBL sessions was time-consuming. 3 Additional faculty support is required for effective implementation of CBL. 4 Designing and conducting CBL sessions required more effort compared to lectures. 5 CBL was motivating and enhanced our understanding of innovative teaching–learning methods. 6 CBL should be incorporated for other important pharmacology topics along with lectures. 7 I would recommend the use of CBL for future undergraduate batches. Any other suggestions/comments: _______________________________ Abbreviations: CBL – Case-Based Learning TL – Teaching–Learning Appendix 3. Comparison of Question-wise Performance Between Teaching Methods (Maximum marks = 40; Knowledge-based = 20, Application/Critical-thinking based = 20) Parameter Group A (CBL method) Group B (DL method) Knowledge-based (20) Critical-thinking (20) Knowledge-based (20) Critical-thinking (20) Mean score ± SD 10.67 ± 3.22 12.99 ± 3.72 12.69 ± 3.19 10.94 ± 2.97 Percentage score (%) 26.7 32.5 31.7 27.3 Standard error 0.33 0.38 0.33 0.31 95% Confidence interval 10.01–11.33 12.23–13.75 12.04–13.35 10.33–11.55 p-value (CBL vs DL) — < 0.0001 < 0.0001 — Interpretation: • Students taught using CBL scored significantly higher in application-based/critical-thinking questions. • Students taught using didactic lectures performed better in recall-based questions. Abbreviations: CBL – Case-Based Learning DL – Didactic Lecture

Pharmacology is inherently linked to clinical practice, and its effective teaching requires meaningful integration of theoretical drug knowledge with real-life clinical scenarios. Incorporating clinical relevance into pharmacology teaching helps students understand not only what drugs do, but also why and how they are used in patient care. Previous studies have shown that students exposed to case-based learning (CBL) perform at least as well as those taught through traditional lectures, while reporting greater interest and satisfaction with the learning process.¹,¹⁴ In the present study conducted at GMCH, Sundargarh Medical College, student attendance was significantly higher during CBL sessions compared to didactic lectures. Attendance is widely regarded as an indirect indicator of learner engagement and satisfaction, and the improved attendance observed in CBL sessions suggests that students found this approach more motivating and interactive. Similar improvements in attendance have been reported in earlier studies evaluating CBL in medical education.²²,²³ Overall test scores obtained after exposure to both teaching methods did not differ significantly, indicating that both CBL and didactic lectures were equally effective in achieving short-term knowledge acquisition. This finding suggests that introducing CBL does not compromise factual learning, a concern often expressed by faculty when adopting newer teaching methods. Comparable observations have been reported by Chilwant, who found no significant difference in overall assessment scores between students taught by CBL and those taught through lectures.¹⁵ However, a more detailed analysis of assessment performance revealed that students taught using CBL performed better in application-based and critical-thinking questions, whereas students taught through didactic lectures scored higher in recall-based questions. This highlights an important strength of CBL in fostering analytical thinking and clinical reasoning skills. Similar conclusions were drawn by Michel et al., who demonstrated that transitioning from lectures to CBL does not reduce factual knowledge transfer, but significantly enhances student interest, conceptual understanding, and application of pharmacological principles.¹⁶ Student feedback in the present study further supports the educational value of CBL. A large proportion of students reported improved understanding of pharmacology concepts, better clinical correlation, and increased classroom participation during CBL sessions. These findings are consistent with those of Tayem, where a majority of students perceived CBL as an effective learning tool that improved examination preparedness and relevance of teaching content.⁸ The importance of the teacher’s role as a facilitator was also emphasized by students, underscoring that the success of CBL largely depends on well-designed cases and effective moderation of discussions. Comparisons with previous Indian studies reveal similar trends. Gupta et al. reported that a substantial proportion of students preferred CBL over traditional lectures and felt that it strengthened their understanding of clinical aspects of pharmacology.¹⁷ In the present study, a comparable proportion of students reported conceptual clarity and improved clinical relevance, although fewer students strongly recommended replacing lectures entirely with CBL. This suggests that while students value CBL, they may still prefer a blended approach combining both teaching methods. Lower levels of agreement regarding CBL’s usefulness in examination preparation, as reported in some studies,¹⁸,¹⁹ may reflect differences in curriculum structure, assessment patterns, and student learning preferences. The cognitive benefits of CBL, including enhanced motivation, deeper learning approaches, and improved problem-solving abilities, have been well documented.²⁰ These benefits were also reflected in our study, where students reported increased motivation for self-directed learning and better engagement with the subject matter. Similar findings from studies conducted internationally further support the role of CBL in promoting higher-order cognitive skills such as hypothesis generation, analysis, and application of knowledge.²¹ Faculty perceptions in the present study were largely positive, with teachers acknowledging improved student interaction and engagement during CBL sessions. Faculty members also highlighted the need for formal training and the development of a structured repository of cases to ensure consistency and sustainability of CBL implementation. These observations are in agreement with earlier studies that emphasize faculty preparedness as a key determinant of successful CBL adoption.¹⁸ Despite these encouraging findings, the study has certain limitations. The outcomes assessed were limited to short-term academic performance and perceptions. Long-term outcomes such as retention of knowledge, prescribing competence during internship, and performance in postgraduate examinations were not evaluated. Additionally, unequal absenteeism between groups may have acted as a confounding factor, although absent students were included to ensure completeness of feedback analysis. Future studies involving longer follow-up periods and multiple assessments across an academic year would provide stronger evidence regarding the sustained impact of CBL.

The findings of this study support the integration of case-based learning into undergraduate pharmacology teaching, even in large classroom settings. While overall knowledge acquisition was comparable between CBL and didactic lectures, CBL demonstrated clear advantages in enhancing student engagement, attendance, critical thinking, and clinical application of pharmacological concepts. Positive perceptions from both students and faculty indicate that CBL is a feasible and acceptable teaching–learning strategy. A blended approach combining traditional lectures with case-based learning may offer the most effective educational model, addressing both factual knowledge acquisition and development of higher-order clinical reasoning skills. Further longitudinal studies are required to evaluate the long-term impact of CBL on prescribing competence, clinical performance, and professional practice.

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