UNSTRUCTURED CASES IN CASE-BASED LEARNING BENEFIT STUDENTS WITH PRIMARY-CARE CAREER PREFERENCES

BACKGROUND: The impact of instructional method on students with opposi ng surgical career orientations was investigated in a prospective stud y. METHODS: Students were randomly assigned to structured or unstructu red case-based discussions. Clinical reasoning (OSCE and a diagnosis e xercise), subject knowledge (multiple choice test [MCT]), method prefe rence, and pre-third year career preference were compared. RESULTS: Tw enty-two students listed a surgical career high (Surgical) and 20 low (Primary). Surgical MCT scores were higher than Primary regardless of instructional method. Surgical diagnosis exercise scores were higher t han Primary with the structured method (22.0 +/- 2.3 versus 15.1 +/- 3 .0, P <0.08), Unstructured scores on this exercise were similar (19.7 +/- 1.8 Surgical versus 20.3 +/- 3.5 Primary). Analysis of variance su ggested an interaction on the diagnosis exercise between method and ca reer (P = 0.16). Students preferred the unstructured method. CONCLUSIO NS: The improved diagnosis exercise performance implies that unstructu red cases positively influence surgical domain specific reasoning for nonsurgical career students. These method effects increase our underst anding of case-based methods in surgical education. (C) 1998 by Excerp ta Medica, Inc.