Exploring the Lived Experience of faculty implementing case-based learning: A Phenomenological Study

Exploring the Lived Experience of faculty implementing case-based learning: A Phenomenological Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Exploring the Lived Experience of faculty implementing case-based learning: A Phenomenological Study Caroline Delany, Jan Illing, Marie McIlroy, Ronan Daly, Catherine Bruen, and 10 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4281033/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 01 Jul, 2025 Read the published version in BMC Medical Education → Version 1 posted 17 You are reading this latest preprint version Abstract Background Case-based learning (CBL) is a useful pedagogical approach, for which learner experience has been well researched. The experience of faculty is less known. CBL was integrated into the first year of a new pre-licensure medical curriculum, so the faculty experience of transition from large group teaching to structured CBL was investigated. Methodology: Interpretative phenomenological analysis (IPA) was undertaken to explore the facilitator lived experience through reflective inquiry. Ten CBL facilitators were purposively selected from a diverse pool of faculty using maximum variation; faculty were involved in patient care, research, and education, and were a mix of ages, ethnicities and genders. Semi-structured interviews were conducted and analysed according to the IPA structure. Results Overall experiences were positive. Facilitators repeatedly expressed the enjoyment felt from closer student interaction. They reported that CBL afforded an authentic and active teaching approach. Other themes included: initial uncertainty regarding their role, anxiety around standardisation of the student experience and concerns regarding the level of content expertise required. However, confidence generally improved with experience facilitating. Conclusion These new insights expose a deeper understanding of perceptions of the role and will better inform faculty development initiatives and support going forward, as well as the iterative design of the CBL process itself. Case Based Learning facilitator transition educator identity curriculum interpretative phenomenological analysis Introduction Case-based learning (CBL) is a pedagogical approach that is increasingly popular in health professions education ( 1 ). Defined by Thistlethwaite, et al. ( 2 ) as “ a learning and teaching approach that aims to prepare students for clinical practice, through the use of authentic clinical cases ”. Case-based learning involves the application of student knowledge to approach and manage a clinical case. The role of CBL facilitators is to foster a collaborative learning environment, facilitating active learning, manage the group dynamics and ensure a psychologically safe space for group interactions. CBL broadly involves a clinical case and a facilitator who guides the discussion using an inquiry-based constructivist approach ( 3 ). Typically, CBL involves a narrative which presents open-ended and authentic dilemmas ( 4 ). Learning outcomes are an integral part of case-based learning, and the learning goals of each case constructively align with the broader curriculum ( 1 ). The implementation of case-based learning has been associated with many positive educational benefits: including linking the basic sciences to professional practice ( 1 ); the creation of opportunities for deeper learning and reflection ( 5 ); and the positives gains from active learning and working collaboratively ( 6 ). Multiple literature reviews and three meta-have concluded CBL is an enjoyable and collaborative learning process which promotes understanding, ( 7 ); ( 6 ); ( 8 ), while facilitators perceived case-based learning to be engaging for students ( 2 ). However, a review of online CBL highlighted deficiencies, underlining the importance of in-person implementation ( 9 ). CBL is, however, demanding in terms of staff time and the period required to develop and refine each case ( 2 ); ( 10 ). In addition, Nordquist et al. ( 4 ) highlighted several areas where CBL implementation may falter, including lack of preparation by stakeholders, misalignment of learning outcomes with the educational context, and conflict between existing teaching regimes and case-based learning. Nordquist et al. ( 4 ) is one of few studies investigating the facilitator perspective of CBL, and indeed reports on the discomfort experienced by staff as they transformed from subject expert to case facilitator. Much of our understanding about CBL is based on the learner’s perspective. Less emphasis in the literature has been placed on exploring the experience of facilitators. Studies have explored the barriers to implementation (particularly time and resources) ( 11 ); ( 12 ); ( 13 ). Garg & Virk ( 11 ) explored the attitudes of facilitators towards CBL, and highlighted the need to build facilitator capacity and confidence through training. Difficulties in adjusting to the role of facilitator and the impact of facilitator perspectives and motivations were found to be relevant to CBL implementation, but were not fully explored. Additional insights have been garnered from studies addressing the CBL facilitator perspective, these focused on strategies aimed at improving learner engagement when facilitating small groups,( 14 ), or the elicitation of feedback and opinions of facilitators for CBL design and implementation ( 15 ). Previous studies have described facilitator perceptions of student learning in CBL and of CBL in comparison to other teaching modalities ( 12 ); ( 13 ); ( 16 ). All of these studies have focussed on learner engagement, faculty time and resources, perceptions of student learning and comparisons to other teaching modalities, but so far, to our knowledge, less emphasis has been placed on exploring the lived experience of being a facilitator and the related perceptions of student/facilitator interactions. Grier and Johnston ( 17 ) argue, educator identity “is based upon the core beliefs one has about teaching and being a teacher that is constantly changing and evolving based upon personal and professional experiences ”, thus we believe that a more comprehensive analysis of the educator’s experience during the shift from traditional didactic teaching to CBL would provide a deeper understanding of this evolution and potential identity impact. Exploring this shift may help to acknowledge challenges, adapt teaching styles, and embrace the mindset needed to effectively support learners in an interactive, collaborative, and empowering learning environment. This study aims to explore the lived experience of facilitators as they implement CBL to inform the continuous development and future support of facilitators. The study aims to address the following research question: • How do CBL Facilitators describe or narrate their lived experience of transitioning from their teaching practices to the small group interactions of structured CBL? The related sub-questions are: What factors do CBL facilitators perceive to have worked well and are perceived to contribute to effective facilitation? How do educators think about themselves and their role as they implement CBL? How does the lived experience of CBL implementation inform facilitators of how they facilitate the sessions? What rewards and challenges do educators experience as their roles and identities shift in a CBL approach? Material and Methods Methodology: Interpretive phenomenological analysis (IPA) was selected to understand the lived experience through a process of reflective inquiry. Smith et al. ( 18 ) advocate IPA as aiming to arrive at the core nature of experience, necessitating a concentration on the subject’s inner life, and making a reflexive turn from outward objects in order to examine how they are perceived inwardly and asking critical questions about the way in which participants have interpreted their experiences Larkin et al. ( 19 ). The Consolidated criteria for Reporting Qualitative research Checklist (COREQ) has been used in the reporting of this study ( 20 ). Context: The transition to CBL occurred as part of a curriculum reform in an Irish University of Medicine and Health Sciences, comprised of more than 4,500 students from Ireland and 95 other countries. Sampling and participants: After ethics approval was obtained, a list of all facilitators involved in delivering Year 1 CBL sessions was accessed, including those staff involved in patient care, research, and education. We worked with facilitator coordinators and reviewed available biographies to explore facilitator career and demographic backgrounds. We then chose participants via purposeful sampling to support the inductive approach of IPA and the need for a degree of representativeness of the facilitator cohort ( 21 ). Facilitators represented a variety of different departments within the university; three clinically trained staff, and seven non-clinically trained academics, drawn from nine different academic disciplines. Data collection: The questionnaire was piloted and minor amendments were made to increase clarity. Facilitators were invited to participate via email and sent the participant information leaflet and consent form. The participants consented to recording were interviewed online on MS Teams. Interviews were semi-structured and ranged from 45 minutes to one hour. Ten participants were chosen as this was suggested as an optimal number for this type of research project (18 (pg. 105)) Small sample sizes are in keeping with the methodological framework as it acknowledges the complexity of human phenomena and allows concentrated focus to explore detailed accounts of individual experiences ( 18 ). Facilitator participants were from four different ethnic backgrounds, five participants identified as male and five identified as female. They had a range of teaching experience from less than one year to over 30 years, spanning professors to new lecturers. During the interview, participants were asked open-ended questions, with follow-up questions based on their responses and the information being sought. The data was gathered between May 2023 and August 2023, this coincided with the end of the academic year following implementation of new curriculum. All interview transcripts were anonymised. Reflexive statement We implemented a diverse team with varying CBL and academic experience and organized regular reflective team meetings to discuss our thoughts and interpretations. Interviews were set up and conducted primarily by CD, RD conducted one. The analysis of data was conducted by CD, JI, MM, MMcI and RD. CD is an Irish, female qualified community doctor. JI is UK and Irish psychologist and experienced health professions education researcher. MM is a female Irish analytic scientist and co-directs the year 1 undergraduate medical programme with MMcI a molecular biologist. RD is a male hospital doctor. CD and JI had no direct involvement in CBL, MM and MMcI were involved in the implementation of CBL but did not facilitate, RD facilitated CBL. All brought a different perspective which facilitated in depth discussions. Data Analysis: Scripts were shared amongst the research team and were read and re-read to immerse researchers in the data. The research team began exploratory noting and constructing experiential statements in accordance with the methodology framework ( 18 ). The team endeavoured to meet for an hour online weekly over the period of analysis and case write up to allow for discussions between members of a team of researchers as we refined themes. Connections across experiential statements were explored and clustered. These clusters were given a title to describe their characteristics and became the personal experiential themes. We worked with these themes to develop group experiential themes across cases, ensuring to highlight the shared and unique features of the experience across the contributing participants. Results and Discussion The results from our analysis led to the identification of several common experiential threads that link individual facilitator’s experiences together. This coding tree included: Positive engagement and interaction with students Powerful educational tool Identity shift: educator to facilitator Time commitment relative to didactic teaching Shared space, planning and logistics Institutional approach to facilitator recruitment Concerns about standardized student experience/ anticipation vs reality Importance of the quality of supporting resources Each thread is explored in more detail below, however in accordance with Smith et al. (18 (pg.117)) the results and discussion have been merged. Positive engagement and interaction with students Participants consistently reported enjoyment and fulfilment from their role as a facilitator. This was associated with the increased proximity and opportunity to interact authentically with students, which facilitators described resulted in positive engagement at both a personal and academic level. This fulfilment influenced their overall experience of the transition from didactic large group lecturing to CBL facilitating, and led to them narrating an overall positive experience, with the vast majority agreeing they would participate in CBL again. Faculty spoke of a renewed appreciation of the learner’s perspective, student’s professionalism, and ability. They reported sessions as fun, enjoyable and interesting. They also commented on how enthusiastic, engaged and insightful the students were. So I think it really brought home to me how enjoyable and how important teaching is. Getting to know the students, getting closer, and I enjoyed that’ (ID 2, male, non-clinical, 20+years teaching). ‘I love working with students and I love to meet them and I love the diversity... [sic], I really have faith in medicine when I see how smart they are... [sic]. And I always love engaging with them.’ (ID 6, female, non-clinical, 9 years teaching) It’s nice to walk around campus and to see students [sic], that you recognize them and they’re not, you know, a tiny face, and from a large lecture theatre you cannot know who they are. (ID 1, male, non-clinical, teaching 17 years) Powerful educational tool Similarly to Burgess et al. (14), facilitators in this study acknowledged that for the system to work it was important to remain cognisant of their role being that of a facilitator, using facilitation methods as opposed to didactic methods. They reflected on the shift from large group lectures with mostly passive students to facilitating active learning and expressed their belief in CBL as an effective educational approach. Some suggesting they believed it was a stronger model from which to learn and others that it was complimentary to lectures. In our study most facilitators felt it was transformative for students and believed that active learning would promote retention of knowledge, this aligns with Thistlethwaite et al. (2), whereby teachers perceived CBL to motivate students. Two of the clinicians noted their sense that students benefit from earlier exposure to clinical terminology and healthcare practices and structures as a result of the authentic clinical narratives embedded early in the programme. Some facilitators described how the CBL experience allowed their own personal development with the opportunity to learn new or revisit content during the case also. They found that they came away with new or refreshed information, skills and insights. ‘The thing is, ... it was an [sic] active thing....I'm hoping that [sic] it should be easier to remember [sic] than something they heard in [sic] a half asleep lecture.’ (ID 1, male, non clinical, teaching 17 years) ‘It's about, you know, using all the methods you have and I mean, I still think, you know, there is a role for lectures....this (CBL) is certainly richer, I think they're more likely to get a deeper understanding of it.... I think they'd probably be more comfortable in the culture of practicing medicine than I think they would have been previously’ (ID 8, male, clinical, 30+ years teaching) Identity Shift: educator to facilitator Participants/interviewees found it difficult to answer if their role as facilitator resulted in an identity shift. The most resounding opinion amongst interviewees was that the role created benefits and opportunities which contributed to their perceptions of themselves as teachers. Some facilitators felt a sense of increased confidence in their professional ability due to how well they transitioned and adapted to the new role. Some experienced staff also noted a greater awareness of teaching skills that they had forgotten they had. Facilitators with varying levels of experience discussed the new skills and techniques they had learned from this experience that they thought would enhance their teaching style for other academic and teaching roles. For some the experience of succeeding while initially feeling outside their comfort zone resulted in increased confidence in trying new pedagogical approaches. They did not acknowledge a shift in personal identity with this experience but did repeatedly express the positive benefits they felt from the social interaction with students. They believed that they would be aiding retention of knowledge for students also acknowledged that their CBL sessions were a reminder of how much they enjoy teaching and the skills and adaptability they have or acquired, which gave a sense of satisfaction and pride. ‘Overall I have learned new skills and learned more about anatomy and physiology… so new things are always good. You know you get bored of giving the same lectures and same tutorials.’ (ID 6, female, non-clinical, nine years teaching) ‘you know learn about each other and [sic] collaboration, respect… all that kind of stuff. But [sic] for my own teaching, I'm thinking this year to do a little bit more of…, maybe once, a flipped classroom.’ (ID 5, female, non-clinical, less than 1 year teaching) ‘I suppose, you know, regaining some confidence, maybe that I had lost myself’ (ID 10, female, non-clinical, 15+ years teaching) Time commitment relative to didactic teaching As with some previous studies mentioned in the introduction (11); (12); (13) facilitators reported concerns about the time commitment to CBL preparation and delivery. Each CBL case required four separate sessions of 90 minutes student contact time (totalling 6 hours per small group of students). Some facilitators felt it was an excessive workload, in terms of preparation time and session time. Some experienced faculty believed that due to their experience and resources which they had honed over their careers, didactic lecturing is much more efficient for large class sizes. Other comments focused on the length and content of a case which varied at times, raising concerns about standardization of cases and unnecessarily giving each case the same allotted time, regardless of need. ‘I was sitting there at home at 8PM [sic] checking emails and doing the tasks that I missed during the afternoon [sic] (due to facilitating CBL sessions).’ (ID 3, female, non clinical, 10 years teaching) ‘Sheer amount of time you have to devote to it.’ ‘You have to put a lot of preparation into teaching. Umm, but as you become more experienced, you kind of know everything off by heart and you don't. So I would say at this stage in my career, I had to put very little, very little preparation into teaching lectures.’ (ID 9, male, non-clinical, 15 years + teaching) Shared space, planning and logistics The teaching space available for CBL was not designed for small group teaching and therefore several groups shared a larger space, resulting in disruptions such as noise and movement from other groups. Some facilitators reported a sense of professional exposurein the shared space; being seen and possibly overheard by other colleagues making them feel vulnerable in their new, unfamiliar role, particularly at the start of CBL implementation. However, a positive aspect noted as a result of this shared communal space was a sense of support, collegiality and increased interaction with other facilitators. Many reported that through the shared experience of the training and the CBL sessions themselves they felt part of the ‘C BL club ’. Through increased student engagement there was a greater awareness of the impact of scheduling in relation to other programme commitments, and the need for more student-centered approaches to scheduling. Timetabling issues occasionally meant that some cases were on topics the students still had to cover later in the curriculum, such as the foundational sciences underpinning the disease or symptoms which some facilitators found made for more challenging sessions. Occasionally CBL sessions were scheduled on exam days where the student’s energy was focused elsewhere. Facilitators also commented on the need to balance out the sessions with some sessions requiring more time than others and some feeling repetitive. Facilitators believed there was benefit to be gained from continuity of the facilitator for all sessions, believing it allowed the student–facilitator relationships to grow and meant both sides had clearer expectations of each other. There were occasionally last minute changes in facilitators availability due to other commitments which meant available facilitators had to combine student groups and work significantly harder with larger groups which they found challenging. ‘So it was quite, …,kind of, collegial and yeah.....there was also a sense that if you were running into trouble in whatever, since there was somebody that you could call on in the room and that was, that was good too’ (ID 10, female, clinical, 15+ years teaching) ' and the noise was very difficult with that quiet group....[sic] because you don't want to keep asking them to repeat.’ (ID 10, female, clinical, 15+ years teaching) In relation to last minute changes and group increase in size, increased responsibility due to same: ‘I suppose it,… it disrupted my happy little life at the time.’ (ID 2, male, non-clinical, 20+ years teaching) Institutional approach to facilitator recruitment Recruitment of facilitators for the new CBL sessions consisted of voluntary sign-up of existing faculty and this approach was a common thread though with conflicting opinions from those engaged in the study. Some facilitators suggested there was a sense of obligation to participate, particularly those at earlier career stages. Some felt it infringed on time for other academic responsibilities. Some believed this commitment was potentially at the detriment of their own career’s progression as it took time away from writing grants or undertaking research. The voluntary approach meant some expressed a sense of unfairness that not all faculty had the same CBL teaching workload. However, these feelings were juxtaposed with a personal interest in exploring the teaching approach and describing enjoyment from the engagement. A belief was also expressed that embracing a new teaching approach may benefit future promotion prospects. Concerns were expressed about the sustainability of the CBL model at the institution because it requires a large voluntary time commitment from the same cohort of dedicated faculty, resulting in some mixed feelings about involvement in the CBL approach. ‘It's a very good opportunity for people early in the(ir) [sic] career to actually get a bit of teaching experience, even though it's not, you know, classic teaching, but at least you can build up your skills and … can actually say…I've done a couple of cases’ (ID 5, female, non-clinical, <1year teaching) ‘(Others) [sic] don't put themselves forward for these things… and that's very unfair. And if you're somebody like me who would like to progress and be promoted and so on, you feel you have to do these things and you have to say yes…, but there's other staff that just are ‘Let's not do it.’ And that's very frustrating as well because you're kind of saying, well, I don't get time to do research or write grants because I'm teaching for no real recognition.’ (ID 6, female, non-clinical, 9 years teaching) Concerns about standardised experience : anticipation vs reality Facilitators’ awareness of their diverse backgrounds and differences in breadth of expertise, led them to express concerns about the potential impact on the student experience. One non-clinician believed that not being a subject matter expert may have been beneficial because they felt more likely to ask open questions which they believed opened up student interactions. Another discussed how students did not look to them to answer questions, and having a broad fundamental science background meant they were not concerned about their clinical status. However, the vast majority of non-clinicians commented that lack of expert knowledge of the case impacted their confidence to guide or draw boundaries on discussions. Occasionally the cases covered clinical skills, such as interpreting an ECG, a concern when facilitators were non-clinical. One facilitator reported overhearing a clinical expert working with a group nearby, which left them feeling the student experience was varied and potentially unfair for students. On the other hand, faculty with clinical backgrounds had concerns about students having higher expectations of them. Overall, both clinicians and non-clinicians described an initial sense of discomfort at the potential of not being a good enough facilitator.However, as their experience with CBL increased this concern reduced. The greater their experience of CBL the more they came to appreciate the core skills and knowledge they did have to offer. They were aware they gravitated towards their own specialty when the session allowed, but also noted their overall confidence improved with increased experience of facilitating sessions. Prior to commencing facilitation, there was a recurring theme of concerns and potential discomfort about managing student engagement and interactions or dealing with group dynamics which echo similar concerns highlighted by Nordquist et al. (4), but for the most part when actually facilitating sessions these concerns did not come to light with the interviewees and any that did were manageable. They expressed awareness of the need to sensitively deal with different students and to use prompts and silences to encourage engagement. Facilitators believed having the same group of students repeatedly worked well and, enabled references to be made to earlier cases and previous discussions, resulting in stronger relationships and deeper student insights. ‘You don't need to be a subject matter expert, but I actually found as you go in not being a subject matter expert actually is probably a benefit here because you can throw out hypothetical questions and get discussions started when there is seemingly a lag in discussion.’ (ID 4, male, non-clinical, 3 years teaching) ‘I suppose I was conscious that you've got these undergraduate students who think that everybody who's teaching them knows everything [sic]. You know, there was a lot around one of my areas of specialty. So I kind of was really getting into my groove there in terms of the content, but also the fact that I was more relaxed as well.’ (ID 10, female, clinical, 15+years teaching) ‘I think my biggest concern was what happens if you’re there for 90 minutes with a group who just don’t do anything and then how do you keep the momentum going for that length of time?...but you know, I couldn’t have been more wrong.’ ID 1, male, non-clinical, 20+ years teaching Importance of the quality of supporting resources The case materials and documents that supported CBL implementation were highly valued and helped to ensure clarity on the direction of discussions as well as standardised outcomes. Facilitators gave tips for successful facilitation that included following the brief, completing the training and using the handbook. The ‘Facilitators Case Handbooks’ in particular were noted as often relied upon for knowledge content and were for the vast majority highly rated and valued. One facilitator mentioned relying on the Facilitators Handbook heavily, at times allowing the students to view it when this facilitator did not feel they had the expertise, knowledge or understanding to verify the students’ answer. This same facilitator mentioned the importance of the key learning outcomes summarised for each session, which they believed was important to increase confidence that the most important content was sufficiently covered. Interviewees also commented on the benefit of the pre-implementation in-person facilitator training sessions, particularly the training workshop where participants role-played a typical CBL session. ‘Reading the handbook was really my go to.’ ‘And I actually found myself showing the students the handbook, so saying, you know, OK, well, you don't seem to get this. This is the answer I have and you know, so maybe this is what you need to know.’ (ID 6, female, non-clinical, 9 years teaching) ‘ …the high-level things are the quality of the documentation that really supported the facilitation. You know, I was blown away by that…. You know, if I ever have to develop something, … I feel that I have a gold standard against which to (compare) [sic], so from a learning perspective, for me that was really, really good. ’ (ID 10, female, clinical, 15+ years teaching) Commenting on the facilitator training workshop where participants role-played a typical CBL session: ‘You know, it became life for me, and I think I got it then, that really changed my perspective on it (ID 2, male, non-clinical, 20+ years teaching) Conclusions In this study, we investigated how first-time CBL facilitators described their lived experience of the transition from their existing teaching practices to the small group interactions of CBL. Overall, the CBL educators narrated a positive, enjoyable and fulfilling experience transitioning from expert to facilitator. They appreciated that they gained new skills and the opportunity to experience new teaching approaches. Their sense of fulfilment in their role was also apparent as the transition brought unanticipated benefits such as increased insight into student perspectives through the student engagement and the renewed or new appreciation for student-centered approaches. There were pre-facilitation anxieties, with many describing feelings of uncertainty, particularly doubting if they had the appropriate expertise to facilitate a clinical case. These anxieties were eased by the experience of actually delivering CBL and resulted in a sense of achievement and pride in their adaptability when successful. Following the CBL experience, they expressed a renewed awareness and appreciation of their skills as educators. CBL facilitators reflected on what they perceived contributed to effective facilitation outside the formal CBL training. Facilitators suggested having knowledge of the programme curriculum, clarity on learning outcomes and an awareness of the stage appropriateness of the content helped with setting boundaries for the case discussions. Facilitators believed that a broad knowledge base equipped them to deal with the CBL approach, and having flexibility with how the sessions run was important. When facilitating sessions, facilitators suggested that setting clear expectations for the students and being firm about the structure and format helped the session. When dealing with students, they believed it was important to be supportive and encouraging, to use emotional intelligence to sensitively deal with different group characteristics and to acknowledge that it is a facilitating, not teaching, role, thus the need for patience, prompts, and pauses to enable all students to speak and feel supported. They also reported an informal sense of a community of practice amongst facilitators (‘a CBL club’) as they shared approaches and mutual support. One of the areas of greatest concern described by facilitators prior to implementing CBL was how they would cope with managing poor student engagement and handling difficult group dynamics. However, when the CBL structure was being followed by facilitators and students, this did not prove to be a problematic area. They also had apprehensions about no longer being the expert with all the answers and how they would manage student expectations as a result. Facilitators reported this concern for the most part did not manifest in practice, when it did they were able to manage it, and their confidence in facilitation grew as they gained experience by doing sessions. Logistical issues of where and when the sessions were run, and the sustainability of the model at the institution were concerns because it requires a large voluntary time commitment from staff which encroached on their other academic responsibilities, possibly hindering personal opportunities for academic promotion. They expressed their sense of importance of maintaining the same facilitator for a full case and of a well written and structured handbook with clear learning outcomes to act as a guide. The supporting structures of well-written case handbooks with clear learning outcomes and formal facilitator training in advance of the sessions assist in preparing them. However, anxiety about facilitating was only fully eased for some with real and repeated experience of facilitation. This study shed light on the previously under-explored experience of facilitators as they transition from traditional didactic teaching methods to the more student-centered approach in CBL. Exploring the lived experience of educators during this shift provided insights into how facilitators perceive their role and will better inform faculty development initiatives and support going forward.. This shift influenced both instructional techniques and the educator's sense of purpose, adaptability, and awareness of students' needs. Study strengths and limitations This in depth study captured the lived experiences of new CBL facilitators, allowing for fresh insights into the positive and negative thoughts and experiences they have. However, this may also be viewed as a limitation as it is possible that perceptions of staff will change further over time. Some additional limitations are that it reported on single site and that the majority of students in the institution studied are international, with a large cohort from North America and Asia but the facilitators were for the majority Irish, and all European. Abbreviations CBL Case Based Learning IPA Interpretative phenomenological analysis CORE-Q The Consolidated criteria for Reporting Qualitative research Checklist Declarations Ethics approval and consent to participate was sought and gained from RCSI Dublin Ethics committee, and informed consent to participate was voluntarily given from every interviewee Consent for publication- given by Dr.Caroline Delany and co authors Availability of data and materials- interview schedule is available from the corresponding author, and an audit trail of the analysis process can be provided Competing interests- the authors are all employed by the institution where the facilitation of these Case Based Learning sessions was conducted Funding- funding was by The Royal College of Surgeons in Ireland Dublin Campus Authors' contributions- please see reflexive statement Acknowledgements- thanks to Professor. 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Additional Declarations Competing interest reported. The authors are all employed by the institution where the facilitation of these Case Based Learning sessions was conducted (The Royal College of Surgeons in Ireland) Supplementary Files SupplementarymaterialforResearchPaperSubmissionbyDr.CarolineDelany.docx Cite Share Download PDF Status: Published Journal Publication published 01 Jul, 2025 Read the published version in BMC Medical Education → Version 1 posted Editorial decision: Revision requested 26 Jan, 2025 Reviews received at journal 20 Jan, 2025 Reviews received at journal 19 Jan, 2025 Reviewers agreed at journal 18 Jan, 2025 Reviewers agreed at journal 16 Jan, 2025 Reviews received at journal 15 Jan, 2025 Reviewers agreed at journal 09 Jan, 2025 Reviewers agreed at journal 09 Jan, 2025 Reviewers agreed at journal 09 Jan, 2025 Reviews received at journal 20 Jun, 2024 Reviewers agreed at journal 15 Jun, 2024 Reviewers agreed at journal 14 Jun, 2024 Reviewers invited by journal 12 Jun, 2024 Editor assigned by journal 07 Jun, 2024 Editor invited by journal 19 Apr, 2024 Submission checks completed at journal 19 Apr, 2024 First submitted to journal 17 Apr, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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The authors are all employed by the institution where the facilitation of these Case Based Learning sessions was conducted (The Royal College of Surgeons in Ireland)","formattedTitle":"Exploring the Lived Experience of faculty implementing case-based learning: A Phenomenological Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eCase-based learning (CBL) is a pedagogical approach that is increasingly popular in health professions education (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Defined by Thistlethwaite, et al. (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) as \u0026ldquo;\u003cem\u003ea learning and teaching approach that aims to prepare students for clinical practice, through the use of authentic clinical cases\u003c/em\u003e\u0026rdquo;. Case-based learning involves the application of student knowledge to approach and manage a clinical case. The role of CBL facilitators is to foster a collaborative learning environment, facilitating active learning, manage the group dynamics and ensure a psychologically safe space for group interactions.\u003c/p\u003e \u003cp\u003eCBL broadly involves a clinical case and a facilitator who guides the discussion using an inquiry-based constructivist approach (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Typically, CBL involves a narrative which presents open-ended and authentic dilemmas (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Learning outcomes are an integral part of case-based learning, and the learning goals of each case constructively align with the broader curriculum (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe implementation of case-based learning has been associated with many positive educational benefits: including linking the basic sciences to professional practice (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e); the creation of opportunities for deeper learning and reflection (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e); and the positives gains from active learning and working collaboratively (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Multiple literature reviews and three meta-have concluded CBL is an enjoyable and collaborative learning process which promotes understanding, (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e); (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e); (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e), while facilitators perceived case-based learning to be engaging for students (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). However, a review of online CBL highlighted deficiencies, underlining the importance of in-person implementation (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eCBL is, however, demanding in terms of staff time and the period required to develop and refine each case (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e); (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). In addition, Nordquist et al. (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) highlighted several areas where CBL implementation may falter, including lack of preparation by stakeholders, misalignment of learning outcomes with the educational context, and conflict between existing teaching regimes and case-based learning. Nordquist et al. (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) is one of few studies investigating the facilitator perspective of CBL, and indeed reports on the discomfort experienced by staff as they transformed from subject expert to case facilitator.\u003c/p\u003e \u003cp\u003eMuch of our understanding about CBL is based on the learner\u0026rsquo;s perspective. Less emphasis in the literature has been placed on exploring the experience of facilitators. Studies have explored the barriers to implementation (particularly time and resources) (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e); (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e); (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Garg \u0026amp; Virk (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e) explored the attitudes of facilitators towards CBL, and highlighted the need to build facilitator capacity and confidence through training. Difficulties in adjusting to the role of facilitator and the impact of facilitator perspectives and motivations were found to be relevant to CBL implementation, but were not fully explored. Additional insights have been garnered from studies addressing the CBL facilitator perspective, these focused on strategies aimed at improving learner engagement when facilitating small groups,(\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e), or the elicitation of feedback and opinions of facilitators for CBL design and implementation (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Previous studies have described facilitator perceptions of student learning in CBL and of CBL in comparison to other teaching modalities (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e); (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e); (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). All of these studies have focussed on learner engagement, faculty time and resources, perceptions of student learning and comparisons to other teaching modalities, but so far, to our knowledge, less emphasis has been placed on exploring the lived experience of being a facilitator and the related perceptions of student/facilitator interactions.\u003c/p\u003e \u003cp\u003eGrier and Johnston (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e) argue, educator identity \u003cem\u003e\u0026ldquo;is based upon the core beliefs one has about teaching and being a teacher that is constantly changing and evolving based upon personal and professional experiences\u003c/em\u003e\u0026rdquo;, thus we believe that a more comprehensive analysis of the educator\u0026rsquo;s experience during the shift from traditional didactic teaching to CBL would provide a deeper understanding of this evolution and potential identity impact. Exploring this shift may help to acknowledge challenges, adapt teaching styles, and embrace the mindset needed to effectively support learners in an interactive, collaborative, and empowering learning environment.\u003c/p\u003e \u003cp\u003eThis study aims to explore the lived experience of facilitators as they implement CBL to inform the continuous development and future support of facilitators.\u003c/p\u003e \u003cp\u003eThe study aims to address the following research question:\u003c/p\u003e \u003cp\u003e\u0026bull; How do CBL Facilitators describe or narrate their lived experience of transitioning from their teaching practices to the small group interactions of structured CBL?\u003c/p\u003e \u003cp\u003eThe related sub-questions are:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eWhat factors do CBL facilitators perceive to have worked well and are perceived to contribute to effective facilitation?\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eHow do educators think about themselves and their role as they implement CBL?\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eHow does the lived experience of CBL implementation inform facilitators of how they facilitate the sessions?\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eWhat rewards and challenges do educators experience as their roles and identities shift in a CBL approach?\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e"},{"header":"Material and Methods","content":"\u003cp\u003eMethodology:\u003c/p\u003e \u003cp\u003eInterpretive phenomenological analysis (IPA) was selected to understand the lived experience through a process of reflective inquiry. Smith et al. (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e) advocate IPA as aiming to arrive at the core nature of experience, necessitating a concentration on the subject\u0026rsquo;s inner life, and making a reflexive turn from outward objects in order to examine how they are perceived inwardly and asking critical questions about the way in which participants have interpreted their experiences Larkin et al. (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe Consolidated criteria for Reporting Qualitative research Checklist (COREQ) has been used in the reporting of this study (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eContext:\u003c/p\u003e \u003cp\u003eThe transition to CBL occurred as part of a curriculum reform in an Irish University of Medicine and Health Sciences, comprised of more than 4,500 students from Ireland and 95 other countries.\u003c/p\u003e \u003cp\u003eSampling and participants:\u003c/p\u003e \u003cp\u003e After ethics approval was obtained, a list of all facilitators involved in delivering Year 1 CBL sessions was accessed, including those staff involved in patient care, research, and education. We worked with facilitator coordinators and reviewed available biographies to explore facilitator career and demographic backgrounds. We then chose participants via purposeful sampling to support the inductive approach of IPA and the need for a degree of representativeness of the facilitator cohort (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). Facilitators represented a variety of different departments within the university; three clinically trained staff, and seven non-clinically trained academics, drawn from nine different academic disciplines.\u003c/p\u003e \u003cp\u003eData collection:\u003c/p\u003e \u003cp\u003eThe questionnaire was piloted and minor amendments were made to increase clarity. Facilitators were invited to participate via email and sent the participant information leaflet and consent form. The participants consented to recording were interviewed online on MS Teams.\u003c/p\u003e \u003cp\u003eInterviews were semi-structured and ranged from 45 minutes to one hour. Ten participants were chosen as this was suggested as an optimal number for this type of research project (18 (pg. 105)) Small sample sizes are in keeping with the methodological framework as it acknowledges the complexity of human phenomena and allows concentrated focus to explore detailed accounts of individual experiences (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Facilitator participants were from four different ethnic backgrounds, five participants identified as male and five identified as female. They had a range of teaching experience from less than one year to over 30 years, spanning professors to new lecturers.\u003c/p\u003e \u003cp\u003e During the interview, participants were asked open-ended questions, with follow-up questions based on their responses and the information being sought.\u003c/p\u003e \u003cp\u003eThe data was gathered between May 2023 and August 2023, this coincided with the end of the academic year following implementation of new curriculum. All interview transcripts were anonymised.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eReflexive statement\u003c/h2\u003e \u003cp\u003eWe implemented a diverse team with varying CBL and academic experience and organized regular reflective team meetings to discuss our thoughts and interpretations. Interviews were set up and conducted primarily by CD, RD conducted one. The analysis of data was conducted by CD, JI, MM, MMcI and RD. CD is an Irish, female qualified community doctor. JI is UK and Irish psychologist and experienced health professions education researcher. MM is a female Irish analytic scientist and co-directs the year 1 undergraduate medical programme with MMcI a molecular biologist. RD is a male hospital doctor. CD and JI had no direct involvement in CBL, MM and MMcI were involved in the implementation of CBL but did not facilitate, RD facilitated CBL. All brought a different perspective which facilitated in depth discussions.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eData Analysis:\u003c/h2\u003e \u003cp\u003eScripts were shared amongst the research team and were read and re-read to immerse researchers in the data. The research team began exploratory noting and constructing experiential statements in accordance with the methodology framework (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). The team endeavoured to meet for an hour online weekly over the period of analysis and case write up to allow for discussions between members of a team of researchers as we refined themes. Connections across experiential statements were explored and clustered. These clusters were given a title to describe their characteristics and became the personal experiential themes. We worked with these themes to develop group experiential themes across cases, ensuring to highlight the shared and unique features of the experience across the contributing participants.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results and Discussion","content":"\u003cp\u003eThe results from our analysis led to the\u0026nbsp;identification of several common experiential threads that link individual facilitator\u0026rsquo;s experiences together.\u0026nbsp;This coding tree included:\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003ePositive engagement and interaction with students\u003c/li\u003e\n \u003cli\u003ePowerful educational tool\u003c/li\u003e\n \u003cli\u003eIdentity shift: educator to facilitator\u003c/li\u003e\n \u003cli\u003eTime commitment relative to didactic teaching\u003c/li\u003e\n \u003cli\u003eShared space, planning and logistics\u003c/li\u003e\n \u003cli\u003eInstitutional approach to facilitator recruitment\u003c/li\u003e\n \u003cli\u003eConcerns about standardized student experience/ anticipation vs reality\u003c/li\u003e\n \u003cli\u003eImportance of the quality of supporting resources\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eEach thread is explored in more detail below, however in accordance with Smith et al.\u0026nbsp;(18 (pg.117))\u0026nbsp;the results and discussion have been merged.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePositive engagement and interaction with students\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants consistently reported enjoyment and fulfilment from their role as a facilitator. This was associated with the increased proximity and opportunity to interact authentically with students, which facilitators described resulted in positive engagement at both a personal and academic level. This fulfilment influenced their overall experience of the transition from didactic large group lecturing to CBL facilitating, and led to them narrating an overall positive experience, with the vast majority agreeing they would participate in CBL again.\u003c/p\u003e\n\u003cp\u003eFaculty spoke of a renewed appreciation of the learner\u0026rsquo;s perspective, student\u0026rsquo;s professionalism, and ability. They reported sessions as fun, enjoyable and interesting. They also commented on how enthusiastic, engaged and insightful the students were.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eSo I think it really brought home to me how enjoyable and how important teaching is.\u003c/em\u003e \u003cem\u003eGetting to know the students, getting closer, and I enjoyed that\u0026rsquo;\u0026nbsp;\u003c/em\u003e(ID 2, male, non-clinical, 20+years teaching).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026lsquo;I love working with students and I love to meet them and I love the diversity... [sic], I really have faith in medicine when I see how smart they are... [sic]. And I always love engaging with them.\u0026rsquo;\u003c/em\u003e (ID 6, female, non-clinical, 9 years teaching)\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eIt\u0026rsquo;s nice to walk around campus and to see students [sic], that you recognize them and they\u0026rsquo;re not, you know, a tiny face, and from a large lecture theatre you cannot know who they are.\u003c/em\u003e (ID 1, male, non-clinical, teaching 17 years)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePowerful educational tool\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSimilarly to Burgess et al. (14), facilitators in this study acknowledged that for the system to work it was important to remain cognisant of their role being that of a facilitator, using facilitation methods as opposed to didactic methods. They reflected on the shift from large group lectures with mostly passive students to facilitating active learning and expressed their belief in CBL as an effective educational approach. Some suggesting they believed it was a stronger model from which to learn and others that it was complimentary to lectures. In our study most facilitators felt it was transformative for students and believed that active learning would promote retention of knowledge, this aligns with\u0026nbsp;Thistlethwaite et al. (2), whereby teachers perceived CBL to motivate students. Two of the clinicians noted their sense that students benefit from earlier exposure to clinical terminology and healthcare practices and structures as a result of the authentic clinical narratives embedded early in the programme. Some facilitators described how the CBL experience allowed their own personal development with the opportunity to learn new or revisit content during the case also. They found that they came away with new or refreshed information, skills and insights.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026lsquo;The thing is, ... it was an [sic] active thing....I\u0026apos;m hoping that [sic] it should be easier to remember [sic] than something they heard in [sic] a half asleep lecture.\u0026rsquo;\u0026nbsp;\u003c/em\u003e(ID 1, male, non clinical, teaching 17 years)\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026lsquo;It\u0026apos;s about, you know, using all the methods you have and I mean, I still think, you know, there is a role for lectures....this (CBL) is certainly richer, I think they\u0026apos;re more likely to get a deeper understanding of it.... I think they\u0026apos;d probably be more comfortable in the culture of practicing medicine than I think they would have been previously\u0026rsquo;\u0026nbsp;\u003c/em\u003e(ID 8, male, clinical, 30+ years teaching)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIdentity Shift: educator to facilitator\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants/interviewees found it difficult to answer if their role as facilitator resulted in an identity shift. The most resounding opinion amongst interviewees was that the role created benefits and opportunities which contributed to their perceptions of themselves as teachers.\u003c/p\u003e\n\u003cp\u003eSome facilitators felt a sense of increased confidence in their professional ability due to how well they transitioned and adapted to the new role. Some experienced staff also noted a greater awareness of teaching skills that they had forgotten they had. Facilitators with varying levels of experience discussed the new skills and techniques they had learned from this experience that they thought would enhance their teaching style for other academic and teaching roles. For some the experience of succeeding while initially feeling outside their comfort zone resulted in increased confidence in trying new pedagogical approaches. They did not acknowledge a shift in personal identity with this experience but did repeatedly express the positive benefits they felt from the social interaction with students. They believed that they would be aiding retention of knowledge for students also acknowledged that their CBL sessions were a reminder of how much they enjoy teaching and the skills and adaptability they have or acquired, which gave a sense of satisfaction and pride.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026lsquo;Overall I have learned new skills and learned more about anatomy and physiology\u0026hellip; so new things are always good. You know you get bored of giving the same lectures and same tutorials.\u0026rsquo;\u0026nbsp;\u003c/em\u003e(ID 6, female, non-clinical, nine years teaching)\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026lsquo;you know learn about each other and [sic] collaboration, respect\u0026hellip; all that kind of stuff.\u003c/em\u003e\u003cbr\u003e\u0026nbsp;\u003cem\u003e\u0026nbsp;But [sic] for my own teaching, I\u0026apos;m thinking this year to do a little bit more of\u0026hellip;, maybe once, a flipped classroom.\u0026rsquo;\u0026nbsp;\u003c/em\u003e(ID 5, female, non-clinical, less than 1 year teaching)\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026lsquo;I suppose, you know, regaining some confidence, maybe that I had lost myself\u0026rsquo;\u0026nbsp;\u003c/em\u003e(ID 10, female, non-clinical, 15+ years teaching)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTime commitment relative to didactic teaching\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAs with some previous studies mentioned in the introduction\u0026nbsp;(11);\u0026nbsp;(12);\u0026nbsp;(13)\u0026nbsp;facilitators reported concerns about the time commitment to CBL preparation and delivery. Each CBL case required four separate sessions of 90 minutes student contact time (totalling 6 hours per small group of students). Some facilitators felt it was an excessive workload, in terms of preparation time and session time. Some experienced faculty believed that due to their experience and resources which they had honed over their careers, didactic lecturing is much more efficient for large class sizes. Other comments focused on the length and content of a case which varied at times, raising concerns about standardization of cases and unnecessarily giving each case the same allotted time, regardless of need.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026lsquo;I was sitting there at home at 8PM [sic] checking emails and doing the tasks that I missed during the afternoon [sic] (due to facilitating CBL sessions).\u0026rsquo;\u0026nbsp;\u003c/em\u003e(ID 3, female, non clinical, 10 years teaching)\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;\u0026lsquo;Sheer amount of time you have to devote to it.\u0026rsquo; \u0026lsquo;You have to put a lot of preparation into teaching. Umm, but as you become more experienced, you kind of know everything off by heart and you don\u0026apos;t. So I would say at this stage in my career, I had to put very little, very little preparation into teaching lectures.\u0026rsquo;\u003c/em\u003e\u003cbr\u003e\u0026nbsp;\u0026nbsp;(ID 9, male, non-clinical, 15 years + teaching)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eShared space, planning and logistics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe teaching space available for CBL was not designed for small group teaching and therefore several groups shared a larger space, resulting in disruptions such as noise and movement from other groups. Some facilitators reported a sense of professional exposurein the shared space; being seen and possibly overheard by other colleagues making them feel vulnerable in their new, unfamiliar role, particularly at the start of CBL implementation. However, a positive aspect noted as a result of this shared communal space was a sense of support, collegiality and increased interaction with other facilitators. Many reported that through the shared experience of the training and the CBL sessions themselves they felt part of the \u0026lsquo;C\u003cem\u003eBL club\u003c/em\u003e\u0026rsquo;.\u003c/p\u003e\n\u003cp\u003eThrough increased student engagement there was a greater awareness of the impact of scheduling in relation to other programme commitments, and the need for more student-centered approaches to scheduling. Timetabling issues occasionally meant that some cases were on topics the students still had to cover later in the curriculum, such as the foundational sciences underpinning the disease or symptoms which some facilitators found made for more challenging sessions. Occasionally CBL sessions were scheduled on exam days where the student\u0026rsquo;s energy was focused elsewhere. Facilitators also commented on the need to balance out the sessions with some sessions requiring more time than others and some feeling repetitive.\u003c/p\u003e\n\u003cp\u003eFacilitators believed there was benefit to be gained from continuity of the facilitator for all sessions, believing it allowed the student\u0026ndash;facilitator relationships to grow and meant both sides had clearer expectations of each other. There were occasionally last minute changes in facilitators availability due to other commitments which meant available facilitators had to combine student groups and work significantly harder with larger groups which they found challenging.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026lsquo;So it was quite, \u0026hellip;,kind of, collegial and yeah.....there was also a sense that if you were running into trouble in whatever, since there was somebody that you could call on in the room and that was, that was good too\u0026rsquo;\u0026nbsp;\u003c/em\u003e(ID 10, female, clinical, 15+ years teaching)\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026apos; and the noise was very difficult with that quiet group....[sic] because you don\u0026apos;t want to keep asking them to repeat.\u0026rsquo;\u0026nbsp;\u003c/em\u003e(ID 10, female, clinical, 15+ years teaching)\u003c/p\u003e\n\u003cp\u003eIn relation to last minute changes and group increase in size, increased responsibility due to same:\u003cem\u003e\u0026nbsp;\u0026lsquo;I suppose it,\u0026hellip; it disrupted my happy little life at the time.\u0026rsquo;\u0026nbsp;\u003c/em\u003e(ID 2, male, non-clinical, 20+ years teaching)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInstitutional approach to facilitator recruitment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRecruitment of facilitators for the new CBL sessions consisted of voluntary sign-up of existing faculty and this approach was a common thread though with conflicting opinions from those engaged in the study. Some facilitators suggested there was a sense of obligation to participate, particularly those at earlier career stages. Some felt it infringed on time for other academic responsibilities. Some believed this commitment was potentially at the detriment of their own career\u0026rsquo;s progression as it took time away from writing grants or undertaking research. The voluntary approach meant some expressed a sense of unfairness that not all faculty had the same CBL teaching workload. However, these feelings were juxtaposed with a personal interest in exploring the teaching approach and describing enjoyment from the engagement. A belief was also expressed that embracing a new teaching approach may benefit future promotion prospects.\u003c/p\u003e\n\u003cp\u003eConcerns were expressed about the sustainability of the CBL model at the institution because it requires a large voluntary time commitment from the same cohort of dedicated faculty, resulting in some mixed feelings about involvement in the CBL approach.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026lsquo;It\u0026apos;s a very good opportunity for people early in the(ir) [sic] career to actually get a bit of teaching experience, even though it\u0026apos;s not, you know, classic teaching, but at least you can build up your skills and \u0026hellip; can actually say\u0026hellip;I\u0026apos;ve done a couple of cases\u0026rsquo;\u0026nbsp;\u003c/em\u003e(ID 5, female, non-clinical, \u0026lt;1year teaching)\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026lsquo;(Others)\u003c/em\u003e\u003cem\u003e\u0026nbsp;[sic]\u0026nbsp;\u003c/em\u003e\u003cem\u003edon\u0026apos;t put themselves forward for these things\u0026hellip; and that\u0026apos;s very unfair.\u003c/em\u003e \u003cem\u003eAnd if you\u0026apos;re somebody like me who would like to progress and be promoted and so on, you feel you have to do these things and you have to say yes\u0026hellip;, but there\u0026apos;s other staff that just are \u0026lsquo;Let\u0026apos;s not do it.\u0026rsquo; And that\u0026apos;s very frustrating as well because you\u0026apos;re kind of saying, well, I don\u0026apos;t get time to do research or write grants because I\u0026apos;m teaching for no real recognition.\u0026rsquo;\u0026nbsp;\u003c/em\u003e(ID 6, female, non-clinical, 9 years teaching)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConcerns about standardised experience\u003c/strong\u003e: \u003cstrong\u003eanticipation vs reality\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFacilitators\u0026rsquo; awareness of their diverse backgrounds and differences in breadth of expertise, led them to express concerns about the potential impact on the student experience. One non-clinician believed that not being a subject matter expert may have been beneficial because they felt more likely to ask open questions which they believed opened up student interactions. Another discussed how students did not look to them to answer questions, and having a broad fundamental science background meant they were not concerned about their clinical status. However, the vast majority of non-clinicians commented that lack of expert knowledge of the case impacted their confidence to guide or draw boundaries on discussions. Occasionally the cases covered clinical skills, such as interpreting an ECG, a concern when facilitators were non-clinical. One facilitator reported overhearing a clinical expert working with a group nearby, which left them feeling the student experience was varied and potentially unfair for students.\u003c/p\u003e\n\u003cp\u003eOn the other hand, faculty with clinical backgrounds had concerns about students having higher expectations of them. Overall, both clinicians and non-clinicians described an initial sense of discomfort at the potential of not being a good enough facilitator.However, as their experience with CBL increased this concern reduced. The greater their experience of CBL the more they came to appreciate the core skills and knowledge they did have to offer. They were aware they gravitated towards their own specialty when the session allowed, but also noted their overall confidence improved with increased experience of facilitating sessions.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePrior to commencing facilitation, there was a recurring theme of concerns and potential discomfort about managing student engagement and interactions or dealing with group dynamics which echo similar concerns highlighted by Nordquist et al. (4), but for the most part when actually facilitating sessions these concerns did not come to light with the interviewees and any that did were manageable. They expressed awareness of the need to sensitively deal with different students and to use prompts and silences to encourage engagement. Facilitators believed having the same group of students repeatedly worked well and, enabled references to be made to earlier cases and previous discussions, resulting in stronger relationships and deeper student insights.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;\u0026lsquo;You don\u0026apos;t need to be a subject matter expert, but I actually found as you go in not being a subject matter expert actually is probably a benefit here because you can throw out hypothetical questions and get discussions started when there is seemingly a lag in discussion.\u0026rsquo;\u0026nbsp;\u003c/em\u003e(ID 4, male, non-clinical, 3 years teaching)\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026lsquo;I suppose I was conscious that you\u0026apos;ve got these undergraduate students who think that everybody who\u0026apos;s teaching them knows everything [sic]. You know, there was a lot around one of my areas of specialty. So I kind of was really getting into my groove there in terms of the content, but also the fact that I was more relaxed as well.\u0026rsquo;\u003c/em\u003e (ID 10, female, clinical, 15+years teaching)\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026lsquo;I think my biggest concern was what happens if you\u0026rsquo;re there for 90 minutes with a group who just don\u0026rsquo;t do anything and then how do you keep the momentum going for that length of time?...but you know, I couldn\u0026rsquo;t have been more wrong.\u0026rsquo; ID 1, male, non-clinical, 20+ years teaching\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eImportance of the quality of supporting resources\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe case materials and documents that supported CBL implementation were highly valued and helped to ensure clarity on the direction of discussions as well as standardised outcomes. Facilitators gave tips for successful facilitation that included following the brief, completing the training and using the handbook. The \u0026lsquo;Facilitators Case Handbooks\u0026rsquo; in particular were noted as often relied upon for knowledge content and were for the vast majority highly rated and valued. One facilitator mentioned relying on the Facilitators Handbook heavily, at times allowing the students to view it when this facilitator did not feel they had the expertise, knowledge or understanding to verify the students\u0026rsquo; answer. This same facilitator mentioned the importance of the key learning outcomes summarised for each session, which they believed was important to increase confidence that the most important content was sufficiently covered. Interviewees also commented on the benefit of the pre-implementation in-person facilitator training sessions, particularly the training workshop where participants role-played a typical CBL session.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026lsquo;Reading the handbook was really my go to.\u0026rsquo; \u0026lsquo;And I actually found myself showing the students the handbook, so saying, you know, OK, well, you don\u0026apos;t seem to get this.\u003c/em\u003e\u003cbr\u003e\u0026nbsp;\u003cem\u003e\u0026nbsp;This is the answer I have and you know, so maybe this is what you need to know.\u0026rsquo;\u0026nbsp;\u003c/em\u003e(ID 6, female, non-clinical, 9 years teaching)\u003c/p\u003e\n\u003cp\u003e\u0026lsquo;\u003cem\u003e\u0026hellip;the high-level things are the quality of the documentation that really supported the facilitation.\u0026nbsp;\u003c/em\u003e \u003cem\u003eYou know, I was blown away by that\u0026hellip;.\u003c/em\u003e\u003cem\u003e\u0026nbsp;You know, if I ever have to develop something, \u0026hellip; I feel that I have a gold standard against which to (compare) [sic], so from a learning perspective, for me that was really, really good.\u003c/em\u003e\u0026rsquo;\u003cem\u003e\u0026nbsp;(ID 10, female, clinical, 15+ years teaching)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eCommenting on the facilitator training workshop where participants role-played a typical CBL session:\u0026nbsp;\u003cem\u003e\u0026lsquo;You know, \u0026nbsp;it became life for me, \u0026nbsp;and I think I got it then, that really changed my perspective on it\u0026nbsp;\u003c/em\u003e(ID 2, male, non-clinical, 20+ years teaching)\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eIn this study, we investigated how first-time CBL facilitators described their lived experience of the transition from their existing teaching practices to the small group interactions of CBL. Overall, the CBL educators narrated a positive, enjoyable and fulfilling experience transitioning from expert to facilitator. They appreciated that they gained new skills and the opportunity to experience new teaching approaches. Their sense of fulfilment in their role was also apparent as the transition brought unanticipated benefits such as increased insight into student perspectives through the student engagement and the renewed or new appreciation for student-centered approaches. There were pre-facilitation anxieties, with many describing feelings of uncertainty, particularly doubting if they had the appropriate expertise to facilitate a clinical case. These anxieties were eased by the experience of actually delivering CBL and resulted in a sense of achievement and pride in their adaptability when successful. Following the CBL experience, they expressed a renewed awareness and appreciation of their skills as educators.\u003c/p\u003e \u003cp\u003eCBL facilitators reflected on what they perceived contributed to effective facilitation outside the formal CBL training. Facilitators suggested having knowledge of the programme curriculum, clarity on learning outcomes and an awareness of the stage appropriateness of the content helped with setting boundaries for the case discussions. Facilitators believed that a broad knowledge base equipped them to deal with the CBL approach, and having flexibility with how the sessions run was important. When facilitating sessions, facilitators suggested that setting clear expectations for the students and being firm about the structure and format helped the session. When dealing with students, they believed it was important to be supportive and encouraging, to use emotional intelligence to sensitively deal with different group characteristics and to acknowledge that it is a facilitating, not teaching, role, thus the need for patience, prompts, and pauses to enable all students to speak and feel supported. They also reported an informal sense of a community of practice amongst facilitators (\u0026lsquo;a CBL club\u0026rsquo;) as they shared approaches and mutual support.\u003c/p\u003e \u003cp\u003eOne of the areas of greatest concern described by facilitators prior to implementing CBL was how they would cope with managing poor student engagement and handling difficult group dynamics. However, when the CBL structure was being followed by facilitators and students, this did not prove to be a problematic area. They also had apprehensions about no longer being the expert with all the answers and how they would manage student expectations as a result. Facilitators reported this concern for the most part did not manifest in practice, when it did they were able to manage it, and their confidence in facilitation grew as they gained experience by doing sessions.\u003c/p\u003e \u003cp\u003eLogistical issues of where and when the sessions were run, and the sustainability of the model at the institution were concerns because it requires a large voluntary time commitment from staff which encroached on their other academic responsibilities, possibly hindering personal opportunities for academic promotion.\u003c/p\u003e \u003cp\u003eThey expressed their sense of importance of maintaining the same facilitator for a full case and of a well written and structured handbook with clear learning outcomes to act as a guide.\u003c/p\u003e \u003cp\u003eThe supporting structures of well-written case handbooks with clear learning outcomes and formal facilitator training in advance of the sessions assist in preparing them. However, anxiety about facilitating was only fully eased for some with real and repeated experience of facilitation.\u003c/p\u003e \u003cp\u003eThis study shed light on the previously under-explored experience of facilitators as they transition from traditional didactic teaching methods to the more student-centered approach in CBL. Exploring the lived experience of educators during this shift provided insights into how facilitators perceive their role and will better inform faculty development initiatives and support going forward.. This shift influenced both instructional techniques and the educator's sense of purpose, adaptability, and awareness of students' needs.\u003c/p\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eStudy strengths and limitations\u003c/h2\u003e \u003cp\u003eThis in depth study captured the lived experiences of new CBL facilitators, allowing for fresh insights into the positive and negative thoughts and experiences they have. However, this may also be viewed as a limitation as it is possible that perceptions of staff will change further over time. Some additional limitations are that it reported on single site and that the majority of students in the institution studied are international, with a large cohort from North America and Asia but the facilitators were for the majority Irish, and all European.\u003c/p\u003e \u003c/div\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCBL\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCase Based Learning\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eIPA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eInterpretative phenomenological analysis\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCORE-Q\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eThe Consolidated criteria for Reporting Qualitative research Checklist\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003col\u003e\n \u003cli\u003eEthics approval and consent to participate was sought and gained from RCSI Dublin Ethics committee, and informed consent to participate was voluntarily given from every interviewee\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eConsent for publication- given by Dr.Caroline Delany and co authors\u003c/li\u003e\n \u003cli\u003eAvailability of data and materials- interview schedule is available from the corresponding author, and an audit trail of the analysis process can be provided\u003c/li\u003e\n \u003cli\u003eCompeting interests- the authors are all employed by the institution where the facilitation of these Case Based Learning sessions was conducted\u003c/li\u003e\n \u003cli\u003eFunding- funding was by The Royal College of Surgeons in Ireland Dublin Campus\u003c/li\u003e\n \u003cli\u003eAuthors\u0026apos; contributions- please see reflexive statement\u003c/li\u003e\n \u003cli\u003eAcknowledgements- thanks to Professor. Fiona Kent and Ms. Mary Smyth\u003c/li\u003e\n \u003cli\u003eAuthors\u0026apos; information (optional)- please see reflexive statement\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eLoftus. (2022). Case-Based Learning. In S. Loftus, \u003cem\u003eAn Introduction to Medical Teaching.\u003c/em\u003e \u003c/li\u003e\n\u003cli\u003eThistlethwaite, J., Davies, D., Ekeocha, S., Kidd, M. C., Matthews, P., . . . Clay, D. (2012, May). The effectiveness of case-based learning in health professional education. A BEME systematic review: BEME Guide No. 23. \u003cem\u003eMedical Teacher\u003c/em\u003e, pp. 421-444.\u003c/li\u003e\n\u003cli\u003eDas, S., Das, A., Raj, P., \u0026amp; Kumar, N. (2021, October). Case-based learning: Modern teaching tool meant for present curriculum: A behavioral analysis from faculties\u0026rsquo; perspective. \u003cem\u003eJournal of Education and Health Promotion\u003c/em\u003e.\u003c/li\u003e\n\u003cli\u003eNordquist, J., Sundberg, K., Johansson, L., Sandelin, K., \u0026amp; Nordenstrom, J. (2012, January). Case-Based Learning in Surgery: Lessons Learned. \u003cem\u003eWorld Journal of Surgery\u003c/em\u003e, pp. 945-955.\u003c/li\u003e\n\u003cli\u003eMcLean, S. (2016, April). Case-Based Learning and its Application in Medical and Health-Care Fields: A Review of Worldwide Literature. \u003cem\u003eJournal of Medical Education and Curriculum Development\u003c/em\u003e.\u003c/li\u003e\n\u003cli\u003eMaia, D., Andrade, R., Alfonso, J., Costa, P., Valente, C., \u0026amp; Espregueira-Mendes, J. (2023). Academic Performance and Perceptions of Undergraduate Medical Students in Case-Based Learning Compared to Other Teaching Strategies: A Systematic Review with Meta-Analysis. \u003cem\u003eEducation Sciences\u003c/em\u003e.\u003c/li\u003e\n\u003cli\u003eCen, X., Hua, Y., Niu, S., \u0026amp; Yu, T. (2021). Application of case-based learning in medical. \u003cem\u003eEuropean Review for Medical and Pharmacological Sciences\u003c/em\u003e, pp. 3173-3181.\u003c/li\u003e\n\u003cli\u003eTsekhmister, Y. (2023). Effectiveness of case-based learning in medical and pharmacy education: A meta-analysis. \u003cem\u003eElectronic Journal of General Medicine\u003c/em\u003e.\u003c/li\u003e\n\u003cli\u003eDonkin, R., Yule, H., \u0026amp; Fyfe, T. (2023, August). Online case-based learning in medical education: a scoping review. \u003cem\u003eBMC Medical Education\u003c/em\u003e.\u003c/li\u003e\n\u003cli\u003eWilliams, B. (2005, August). Case based learning\u0026mdash;a review of the literature: is there scope for this educational paradigm in prehospital education? \u003cem\u003eEmergency Medicine Journal\u003c/em\u003e, pp. 577-581.\u003c/li\u003e\n\u003cli\u003eGarg, P., \u0026amp; Virk, A. (2023). Faculty perception regarding Case based learning - a Qualitative study. \u003cem\u003eInternational Journal of Life Sciences Biotechnology and Pharma Research\u003c/em\u003e, pp. 119-124.\u003c/li\u003e\n\u003cli\u003eSule, R. (2016). Medical Students and Faculty Perceptions Towards a Case Based Learning Intervention at an Indian Medical College (Doctoral dissertation).\u003c/li\u003e\n\u003cli\u003eSalih, K., Elnour, S., Albaqami, A. A., Alaklobi, R. O., Elhassan, K. E., Abbas, M., . . . \u0026amp; Alfaifi, J. A. (2003). Comparison Between Faculty Members and Students Toward Learning through Problem-Based Learning and Case-Based Learning in an Innovative Curriculum in a Regional University in the KSA. \u003cem\u003eBahrain Medical Bulletin\u003c/em\u003e, 1291-1294.\u003c/li\u003e\n\u003cli\u003eBurgess, A., van Diggele, C., Roberts, C., \u0026amp; Mellis, C. (2020). Facilitating small group learning in the health professions. \u003cem\u003eBMC Medical Education\u003c/em\u003e.\u003c/li\u003e\n\u003cli\u003eJacob, S. A., Dhing, O. H., \u0026amp; Malone, D. (2019). Perceptions of Australian and Malaysian Educators in an Undergraduate Pharmacy Program on Case-based Learning. \u003cem\u003eAmerican Journal of Pharmaceutical Education\u003c/em\u003e.\u003c/li\u003e\n\u003cli\u003eNelson, K. (2010). Case-based learning (CBL) in selected physical therapy curricula and its perceived effectiveness by students, faculty, and administrators (Doctoral dissertation,).\u003c/li\u003e\n\u003cli\u003eGrier, J. M., \u0026amp; Johnston, C. (2009). An Inquiry Into the Development of Teacher Identities in STEM Career Changers. \u003cem\u003eJournal of Science Teacher Education\u003c/em\u003e, 57-75.\u003c/li\u003e\n\u003cli\u003eSmith, J. A., Flowers, P., \u0026amp; Larkin, M. (2022). \u003cem\u003eInterpretative Phenomenological Analysis: Theory, Method and Research.\u003c/em\u003e SAGE.\u003c/li\u003e\n\u003cli\u003eLarkin, M., Watts, S., \u0026amp; Clifton, E. (2006). Giving voice and making sense in interpretative phenomenological analysis. \u003cem\u003eQualitative Research in Psychology\u003c/em\u003e, 102-120.\u003c/li\u003e\n\u003cli\u003eTong, A., Sainsbury, P., \u0026amp; Craig, J. (2007). Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. \u003cem\u003eInternational Journal for Quality in Healthcare\u003c/em\u003e, 349-357\u003c/li\u003e\n\u003cli\u003ePatton, M. Q. (2002). \u003cem\u003eQualitative Research \u0026amp; Evaluation Methods.\u003c/em\u003e SAGE Publications.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Case Based Learning, facilitator, transition, educator identity, curriculum, interpretative phenomenological analysis","lastPublishedDoi":"10.21203/rs.3.rs-4281033/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4281033/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eCase-based learning (CBL) is a useful pedagogical approach, for which learner experience has been well researched. The experience of faculty is less known. CBL was integrated into the first year of a new pre-licensure medical curriculum, so the faculty experience of transition from large group teaching to structured CBL was investigated.\u003c/p\u003e\u003ch2\u003eMethodology:\u003c/h2\u003e \u003cp\u003eInterpretative phenomenological analysis (IPA) was undertaken to explore the facilitator lived experience through reflective inquiry. Ten CBL facilitators were purposively selected from a diverse pool of faculty using maximum variation; faculty were involved in patient care, research, and education, and were a mix of ages, ethnicities and genders. Semi-structured interviews were conducted and analysed according to the IPA structure.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eOverall experiences were positive. Facilitators repeatedly expressed the enjoyment felt from closer student interaction. They reported that CBL afforded an authentic and active teaching approach. Other themes included: initial uncertainty regarding their role, anxiety around standardisation of the student experience and concerns regarding the level of content expertise required. However, confidence generally improved with experience facilitating.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThese new insights expose a deeper understanding of perceptions of the role and will better inform faculty development initiatives and support going forward, as well as the iterative design of the CBL process itself.\u003c/p\u003e","manuscriptTitle":"Exploring the Lived Experience of faculty implementing case-based learning: A Phenomenological Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-04-23 15:48:16","doi":"10.21203/rs.3.rs-4281033/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-01-26T11:05:43+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-01-20T21:21:32+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-01-20T04:15:58+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"152366735126339569222822737635100588187","date":"2025-01-18T13:31:10+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"234581420351190658154057721471645616840","date":"2025-01-16T08:17:04+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-01-15T12:09:19+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"315832597024037007770559060118628983900","date":"2025-01-10T04:17:44+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"87143667408862895400154572285706533006","date":"2025-01-09T18:25:28+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"200965573414345645857304923026130553926","date":"2025-01-09T12:52:55+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-06-20T09:32:20+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"105608149734954346923784197028556260008","date":"2024-06-15T06:24:25+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"188503983547353658871481335224864300192","date":"2024-06-14T09:20:29+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-06-13T03:09:19+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-06-08T02:58:13+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-04-19T10:18:51+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-04-19T10:17:01+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2024-04-17T09:50:54+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"fe50ef10-867b-48ff-950e-49c1ea4fe9df","owner":[],"postedDate":"April 23rd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-07-07T16:02:06+00:00","versionOfRecord":{"articleIdentity":"rs-4281033","link":"https://doi.org/10.1186/s12909-025-07364-8","journal":{"identity":"bmc-medical-education","isVorOnly":false,"title":"BMC Medical Education"},"publishedOn":"2025-07-01 15:57:33","publishedOnDateReadable":"July 1st, 2025"},"versionCreatedAt":"2024-04-23 15:48:16","video":"","vorDoi":"10.1186/s12909-025-07364-8","vorDoiUrl":"https://doi.org/10.1186/s12909-025-07364-8","workflowStages":[]},"version":"v1","identity":"rs-4281033","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4281033","identity":"rs-4281033","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}