Unstructured Cases in Case-based Learning Benefit Students with Primary Care Career Preferences

Background: The impact of instructional method on students with opposing surgical career orientations was investigated in a prospective study. Methods: Students were randomly assigned to structured or unstructured case-based discussions. Clinical reasoning (OSCE and a diagnosis exercise), subject knowledge (multiple choice test [MCT]), method preference, and pre-third year career preference were compared. Results: Twenty-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 than 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 suggested an interaction on the diagnosis exercise between method and career (P = 0.16). Students preferred the unstructured method. Conclusions: The improved diagnosis exercise performance implies that unstructured cases positively influence surgical domain specific reasoning for nonsurgical career students. These method effects increase our understanding of case-based methods in surgical education.