BackgroundCase-based learning (CBL) is a highly interactive instructional format widely used in medical education. One goal of CBL is to integrate basic biomedical knowledge and its application to concrete patient cases and their clinical management. In this context, we focus the role of teacher questions as triggers for reproductive vs. elaborative student responses. Specifically, our research questions concern the kinds of questions posed by clinical teachers, the kinds of responses given by students, the prediction of student responses based upon teacher questions, and the differences between the two medical disciplines in focus of our study, internal medicine and surgery.MethodsWe analyse 19 videotaped seminars (nine internal medicine, ten surgery) taught by clinicians and attended by advanced medical students. Multiple raters performed a low-inference rating process using a theory-based categorical scheme with satisfactory interrater-reliability.ResultsWe found that medical teachers mostly posed initial (instead of follow-up) questions and that their questions were more often closed (instead of open). Also, more reasoning (than reproductive) questions were posed. A high rate of student non-response was observed while elaborative and reproductive student responses had a similar prevalence. In the prediction context, follow-up reasoning questions were associated with low non-response and many elaborative answers. In contrast, the highest student non-response rate followed open reproduction questions and initial reasoning questions. Most reproductive statements by students were made following closed reproduction questions.ConclusionsThese results deepen our understanding of interactive, questions-driven medical teaching and provide an empirical basis for clinical teachers to use questions in didactically fruitful ways.

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Background Case-based group discussions (CBGD) are a specific, interaction-focused format dedicated to fostering medical students’ skills in applying basic biomedical knowledge to patient cases. Existing conceptions of CBGD suggest that a gradient towards increased opportunities for students to make elaborative verbal contributions is an important element of such seminars. To verify this assumption, we investigate empirically if clinical teachers progress from more basic, knowledge-oriented questions towards more advanced, elaboration-oriented questions in such seminars. Methods We videotaped 21 different clinical teachers and 398 medical students in 32 CBGD-seminars on surgery and internal medicine. We coded closed-reproductive and open-elaborative teacher questions as well as reproductive and elaborative student responses to these questions. Inter-rater reliability was satisfactory. To determine trends regarding the teacher questions / student responses, we compared eight time-segments of equal duration per seminar. Results Overall, clinical teachers asked more closed-reproductive than open-elaborative questions. Students gave more reproductive than elaborative responses. Regarding the frequencies of these forms of teacher questions / student responses, we found no significant differences over time. Conclusions Clinical teachers did not deliberately modify the types of questions over time to push students towards more elaborative responses. We conclude that the critical question to which degree promising teaching approaches are actually put into clinical teaching practice should be raised more purposefully in medical education research.

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Introduction: Case-based group discussions (CBGD) are a specific, interaction-focused form of case based medical education dedicated to foster medical students’ skills of applying basic biomedical knowledge to patient cases. In such seminars, teacher question-student response patters are a crucial aspect. We empirically investigate to which degree clinical teachers progress from more basic, knowledge-oriented towards more advanced, elaboration-oriented questions in CBGD-seminars.Methods: We video recorded 32 case-based seminars in the areas of surgery and internal medicine. 21 different clinical teachers had taught and 398 medical students had attended these seminars. We coded closed-reproductive and open-elaborative teacher questions as well as reproductive and elaborative student responses to these questions. Interrater reliability was satisfactory. For determining trends regarding the teacher questions / student responses, we compared eight equally long time-segments per seminar.Results: Overall, clinical teachers posed more closed-reproductive than open-elaborative questions to students and the latter gave more reproductive than elaborative responses. Regarding the frequencies of these forms of teacher questions / student responses, we found no significant differences over time.Discussion: We found that clinical teachers did not deliberately modify the types of questions they posed over time to push their students towards more elaborative responses. Generally, this raises the critical question to which degree promising didactic concepts are actually put into clinical teaching practice. In our sample, we observed substantial heterogeneity regarding the variables in focus of our study. We conclude that medical education researchers should more thoroughly take different starting conditions and teaching approaches of different teachers into account.