ROLE OF CASE STRUCTURE AND PRIOR EXPERIENCE IN A CASE-BASED SURGICAL CLERKSHIP

BACKGROUND: As case-based methods replaced lectures in a surgical cler kship, the influences of case structure and prior experience on learni ng were investigated. METHODS: Early and late third-year students rand omly received different cases. ''Structured'' cases had data presented and summarized. ''Unstructured'' cases required questions to faculty for information. Multiple choice tests and differential diagnosis acti vities were administered. An attitudinal questionnaire gauged student perceptions. RESULTS: In both multiple choice and differential diagnos is activities, the late rotation, ''unstructured'' group scored higher than the ''structured'' group. Conversely, the early rotation, ''unst ructured'' group scored lower than the ''structured'' group. Combined, rotation, and structure significantly affected both multiple choice a nd differential diagnosis activities (ANOVA, P less than or equal to 0 .02). Early rotation, ''unstructured'' students described a more enjoy able experience, despite lower evaluation scores. CONCLUSIONS: Surgica l clerkship case-based learning is profoundly affected by case structu re and prior clinical experience. Case-based curriculum should be tail ored to accommodate these interactions.