European Journal of Cardiovascular Medicine

Anatomy forms the keystone of medical education; however, it is often perceived by first-year MBBS students as voluminous, abstract, and difficult to retain when delivered predominantly through conventional lecture methods. Traditional lectures, although efficient for content delivery to large groups, are largely passive and may inadequately stimulate higher-order cognitive processes such as application and analysis.¹ This limitation becomes critical in Competency Based Medical Education (CBME), where early clinical exposure and integration of knowledge are emphasized. Consequently, innovative teaching–learning methods that foster active participation and clinical correlation are increasingly advocated in undergraduate medical curricula.²

Case Based Learning (CBL) has emerged as a promising pedagogical model to address these challenges by contextualizing anatomical concepts within clinical scenarios, thereby enhancing relevance and motivation.³ Case-Based Learning (CBL) is a learner-centered instructional strategy that integrates clinical scenarios into teaching to promote active learning, clinical reasoning, and application of foundational knowledge to real-world contexts.⁴ Rooted in constructivist learning theory and adult learning principles, CBL encourages learners to construct knowledge through problem analysis, discussion, and contextualization rather than passive reception of information. In medical education, CBL has been shown to enhance deep learning, long-term retention, and student engagement by bridging the gap between basic sciences and clinical practice, particularly during the pre-clinical years.⁵ Several studies have demonstrated that CBL improves analytical thinking, diagnostic reasoning, and relevance of learning when compared with traditional didactic lectures, especially in complex and concept-heavy subjects such as Anatomy.^6,7,8

In this context, the present student-based experimental study was designed to compare the efficacy of Case-Based Learning and Conventional Lecture methods in teaching selected Anatomy topics among first-year MBBS students. A crossover design was adopted to strengthen internal validity, reduce selection bias, and allow each group to serve as its own control. Knowledge acquisition and retention were objectively assessed using pre-test, post-test, and delayed retention tests, while students’ perceptions were explored through structured feedback. By addressing gaps related to learning retention, learner perception, and methodological rigor, this study aimed to generate evidence to inform effective Anatomy teaching strategies aligned with CBME principles.

Objectives

1 To compare the efficacy of Case Based Learning with Conventional Lecture methods in teaching Anatomy topics.

2 To determine the perception of students regarding the Case Based Learning and Conventional Lecture methods in learning Anatomy topics.

Study setting: Department of Anatomy, Government Medical College (GMC), Dindigul. Study Population: I MBBS students of GMC, Dindigul Study Period: January 2024 to June 2024. Study duration: 6 months duration Study Design: Students based Experimental study Sampling Design & Sample Size: 120 The study followed Simple Random sampling method to assign students of I MBBS of GMC, Dindigul into 2 Batches (Batch A & Batch B) attending Anatomy classes. Study Procedure The study was implemented in two sequential instructional levels using a crossover experimental design. In the first level, Batch A was taught the Anatomy topic Lymphatic Drainage of the Breast using the Case-Based Learning (CBL) approach, while Batch B was taught on the same topic through the Conventional Lecture method. The CBL intervention was structured around four to five clinically relevant case scenarios designed to contextualize anatomical concepts. These cases were supplemented with guided analytical tasks that encouraged students to apply anatomical knowledge, engage in discussion, and develop clinical reasoning skills. To ensure uniformity and avoid instructor-related bias, both teaching methods were delivered by the same faculty member. Prior to the instructional session, all students underwent a pre-test consisting of 20 multiple-choice questions (MCQs) to assess baseline knowledge of the topic. Immediately after completion of the teaching session, a post-test using a similar MCQ format was administered to evaluate immediate knowledge gain. To assess long-term retention of the taught concepts, a concept retention test was conducted four weeks after the intervention. Following completion of the first instructional level, the groups were crossed over to strengthen internal validity and reduce inter-batch variability. In the second level, Batch A received instruction through the Conventional Lecture method, while Batch B was taught using Case-Based Learning for the topic Varicose Vein. (Table 1). The same standardized assessment protocol pre-test, post-test, and four-week retention test was followed to ensure consistency across both teaching learning methods and topics. At the end of both instructional levels, students’ perceptions regarding the effectiveness, engagement, and learning experience associated with Case-Based Learning and Conventional Lecture methods were collected using a structured feedback questionnaire. This comprehensive approach enabled comparison of both objective learning outcomes and subjective learner perceptions, thereby providing a holistic evaluation of the two teaching methodologies. Table 1: Study Procedure Topic I (Lymphatic drainage of Breast) Pre-test Batch A (Case Based Learning) Batch B (Conventional Lecture) Post test Concept Retention test (4 weeks after the intervention) CROSS OVER Topic II (Varicose Vein) Pre-test Batch A (Conventional Lecture) Batch B (Case Based Learning) Post test Concept Retention test (4 weeks after the intervention) Statistical Analysis All data collected during the study were initially entered into Microsoft Excel 2010 and was subsequently exported for statistical analysis using Epi Info software version 7.2 for Windows. Descriptive statistics were employed to summarize the data, including calculation of frequencies and percentages for categorical variables, and mean with standard deviation as well as median with interquartile range for continuous variables, as appropriate. Prior to inferential analysis, tests for normality were performed using the Shapiro–Wilk test and the Kolmogorov–Smirnov test to determine the distribution characteristics of the continuous variables. To assess within-group differences in knowledge scores before and after the educational interventions, paired t-tests were used to compare pre-test and post-test scores, as well as post-test and retention test scores within each batch. Comparisons between the two teaching learning methods were carried out using independent sample t-tests to evaluate differences in post-intervention and retention scores between Case-Based Learning and Conventional Lecture groups. All statistical tests were two-tailed, and a p-value of less than 0.05 was considered statistically significant. Ethical considerations: The aims and methodology of the study were explained in detail to all participating students, and written informed consent was obtained before their inclusion and utilization of study data. The study protocol received approval from the Institutional Ethics Committee, Government Medical College, Dindigul. (IEC Certificate no: 16/09/IEC-2024)

Most students were aged 19 years (40.0%), followed by 20 years (38.3%) and 18 years (21.7%). Female students constituted a slightly higher proportion of the study population (58.3%) compared to male students (41.7%). The mean age of the participants was 19.17 years with a standard deviation (SD) of 0.76 years, indicating a relatively homogeneous age distribution among the students. (Table 2)

The mean pre-test, post-test, and retention test scores was analysed for both teaching–learning methods across the two anatomy topics using a crossover design. Pre-test scores across both batches remained comparable, indicating similar baseline knowledge prior to intervention. For the topic Lymphatic Drainage of the Breast, students taught using Case-Based Learning (Batch A) demonstrated higher mean post-test scores (17.02) and retention test scores (15.00) compared to those taught using the Conventional Lecture method (Batch B), who achieved mean post-test and retention scores of 15.12 and 13.08 respectively. This difference between batches was statistically significant in post-test score (p< 0.0001; t-value is 5.557) and retention test scores (p<0.0001; t-value is 5.907) respectively. The difference between pre-test vs post-test in topic I was also statistically significant: For A batch (p = 0.0002) & B batch (p = 0.029). (Table 3)

Similarly, for the topic Varicose Vein, higher mean post-test (15.37) and retention test scores (13.38) were observed among students exposed to Case-Based Learning (Batch B) when compared to those taught using the Conventional Lecture method (Batch A), who recorded mean post-test and retention scores of 13.15 and 11.03 respectively. This difference between batches was statistically significant in post-test score (p<0.0001; t-value is -5.104) and retention test scores (p<0.0001; t-value is -5.458) respectively. The difference between pre-test vs post-test in topic II was also statistically significant: For A batch (p = 0.001) & B batch (p = 0.0009). (Table 3)

The overall preference of students regarding the teaching–learning method. A substantial majority of students (78.3%) expressed preference for Case-Based Learning, whereas only 21.7% preferred the Conventional Lecture method. (Table 4)

Among male students, 68.0% preferred Case-Based Learning and 32.0% favoured Conventional Lectures. Among female students, a higher proportion (85.7%) preferred Case-Based Learning, while only 14.3% reported preference for Conventional Lecture method. Overall, Case-Based Learning was preferred by both genders, with a notably higher preference observed among female students. (Table 5)

Table 2: Age and Gender Distribution (n=120)

Table 3: Pre, Post Test & Retention Test Scores Distribution (n=120)

Table 4: Preferred TLM distribution (n=120)

Table 5: Gender perspective with respect to TLM (n=120)

The present student-based experimental study demonstrated that Case-Based Learning (CBL) was superior to the Conventional Lecture method in terms of immediate knowledge gain, concept retention, and student perception in teaching Anatomy to first-year MBBS students. Across both topics: Lymphatic drainage of the breast and Varicose vein, the students exposed to CBL showed higher post-test scores and better four-week retention, along with overwhelmingly positive feedback regarding engagement, clinical relevance, and conceptual clarity.

The findings of the present study are largely consistent with earlier Indian and international studies evaluating the role of CBL in anatomy education. Singh et al.⁹ demonstrated that 62–74% of students perceived improved understanding, problem-solving ability, and interaction following CBL sessions, with 73% rating facilitators as helpful, and 71% supporting the feasibility of combining CBL with lectures. Similar positive perceptions were observed in the present study, where a substantial proportion of students reported enhanced understanding and long-term recall following CBL exposure. Das et al.¹⁰, in a nursing cohort, reported a 21% improvement in post-test scores following CBL, with over 85% of students agreeing that CBL enhanced critical thinking, teamwork, and self-directed learning. The magnitude of improvement observed in the present MBBS cohort aligns with these findings, suggesting that CBL is effective across different health-professional learner groups, particularly in concept-heavy foundational subjects like Anatomy. The role of retention, a critical concern in anatomy education, has been emphasized by Prasanthi et al.¹¹, who demonstrated that post-test scores at 30-day follow-up remained significantly higher in the CBL group compared to routine teaching. This observation parallels the present study, where four-week concept retention scores remained consistently higher following CBL, supporting the argument that CBL promotes deeper learning rather than short-term memorization.

Internationally, Merritt et al.¹² reported statistically significant improvement in post-session quiz scores following integrated CBL sessions involving breast and upper-limb anatomy, with students highlighting improved integration and real-life application. Yao et al.¹³, in a large quasi-experimental study, demonstrated that while theoretical examination scores did not differ significantly, students exposed to CBL-integrated flipped classrooms scored significantly higher in practical examinations (65.94% vs 57.27%, p = 0.004) and performed better on application- and analysis-level questions (+8% and +11%, respectively).

Demetri et al.¹⁴ reported no statistically significant difference in knowledge acquisition between CBL and lectures (84% vs 78%, p = 0.056) among orthopaedic residents, although satisfaction and engagement were comparable. This contrast may be explained by differences in learner maturity, baseline motivation, and curricular context, as postgraduate residents differ substantially from first-year MBBS students who are still developing foundational clinical reasoning skills. Similarly, Vedi et al.¹⁵ noted that while post-test scores improved significantly (p < 0.01) in online CBT participants, some literature has shown equivalent performance between lectures and CBL, emphasizing that implementation quality, group dynamics, facilitator role, and assessment design critically influence outcomes.

The present study demonstrated that Case-Based Learning (CBL) was more effective than the Conventional Lecture method in enhancing immediate knowledge gain, long-term concept retention, and learner engagement among first-year MBBS students in Anatomy. Students exposed to CBL consistently achieved higher post-test and four-week retention scores and expressed a strong preference for this method due to its clinical relevance and interactive nature. The findings support the integration of CBL as a complementary teaching–learning strategy within the Competency-Based Medical Education framework to promote deeper learning and application of anatomical knowledge. Acknowledgements: We would like to acknowledge the I MBBS Students, Faculty of Department of Anatomy and Community Medicine, GMC, Dindigul for their valuable participations, suggestions and motivations. Funding: No funding sources Conflict of interest: None declared

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