Abstract
Background
Teaching pharmacology is challenging due to its complex content and extensive terminology. Traditional lecture-based learning (LBL) limits engagement and retention, while case-based learning (CBL) uses real-world scenarios to improve critical thinking. Although prior research has explored CBL's impact in pharmacology education, few studies directly compare CBL and LBL in terms of memory retention and student satisfaction over a prolonged period. This study addresses this gap by comparing both methods over 4 weeks.
Methods
Two educational sessions, unrelated to the curriculum or block assessments, were conducted with third- and fourth-year preclinical medical students, where basic pharmacology is delivered. Students were randomly assigned to either LBL or CBL for each session. Short-term retention was assessed immediately after the sessions, while long-term retention was evaluated 4 weeks later using multiple-choice questions designed to measure recall and cognitive understanding. Additionally, a general electronic survey was conducted to evaluate student satisfaction.
Results
Comparative analysis revealed notable patterns in retention and knowledge acquisition. Short-term retention was slightly higher in the LBL group (mean 7.94, SD 1.51) than in the CBL group (mean 7.30, SD 1.60), though the difference was not statistically significant (P = .076). Conversely, long-term retention was slightly higher in the CBL group (mean 6.95, SD 1.87) than in the LBL group (mean 6.22, SD 1.88), but this difference was also not significant (P = .095). Within-group analysis, the results showed a significant decline in long-term retention for knowledge-based questions in LBL, while CBL maintained retention over time (P < .001). No significant differences in cognition or satisfaction were observed.
Conclusions
CBL enhances long-term retention and knowledge acquisition, supporting its integration into pharmacology education. Further research should explore its broader application in medical curricula.
Introduction
Pharmacology is the scientific study of drugs and their effects on living organisms and is essential to medical science. 1 It covers the mechanisms of drug action, pharmacokinetics, pharmacodynamics, therapeutic uses, adverse effects, and drug-drug interactions. 2 A comprehensive grasp of pharmacology allows healthcare practitioners to make informed judgments about drug prescriptions, manage potential interactions, and ultimately enhance patient care and public health outcomes. 3
However, teaching pharmacology is inherently challenging due to the complexity of the subject, which includes numerous concepts, mechanisms, and medication names. To effectively convey this information, educators have utilized various teaching methods, including lectures, case-based learning (CBL), team-based learning (TBL), flipped classrooms, student-led objective tutorials, and online platforms.2,4–7 Despite these diverse approaches, there remains no consensus on the effectiveness of any single method, which underscores the need for further investigation.
Lecture-based learning (LBL) has long been the predominant method in medical education due to its efficiency in delivering substantial amounts of information in a structured format. 8 This technique allows educators to present complex concepts systematically, which can be beneficial for students who are new to the subject. However, LBL is often criticized for fostering minimal student engagement, leading to passive learning and poor knowledge retention. 9 The distinction between short-term and long-term memory highlights the limitations of LBL; while short-term memory retains information temporarily, long-term memory facilitates the retention of knowledge over extended periods—critical for healthcare professionals who must quickly recall drug mechanisms and interactions in clinical settings. 10
In contrast, CBL has emerged as a more interactive and student-centered pedagogical approach in medical education. CBL is a student-centered, dynamic learning method that guides students through analyzing, diagnosing, and treating patients using their theoretical knowledge. 11 CBL differs from the LBL in 3 key aspects: (1) degree of student involvement, (2) level of interactivity, and (3) practical skills.12–15 CBL encourages active learning by requiring students to apply theoretical knowledge to clinical challenges. This method develops critical thinking, problem-solving, and decision-making skills, which are essential in medical practice. 13 Furthermore, students work in small groups to analyze and debate clinical cases, which fosters teamwork. This technique promotes peer learning by allowing students to share their ideas and experiences. 14 CBL requires students to apply theoretical information to real-life clinical circumstances, fostering practical abilities including clinical reasoning and decision-making. 15 CBL not only bridges the gap between theoretical knowledge and practical application but also enhances student motivation and retention of information, as students engage actively in the learning process.12,13 CBL involves real-world clinical scenarios that challenge students to apply their pharmacological knowledge to solve problems, make decisions, and understand the implications of drug therapy in patient care. This method promotes critical thinking, peer collaboration, and a deeper understanding of pharmacological principles.12,16
Existing literature indicates varying degrees of success among different instructional methods. For instance, a study by Arora and Hashilkar found that student-led objective tutorials (SLOT) effectively improved learning and passing scores compared to conventional methods. 4 A comprehensive evaluation involving 21,269 students suggested that problem-based learning (PBL), team-based learning (TBL) combined with CBL, and flipped classrooms might represent optimal teaching methods for pharmacology. 7 The recognition of CBL's benefits in pharmacology teaching has prompted further investigation into its effectiveness.17,18 CBL has been shown to enhance analytical skills and learning outcomes, ultimately improving clinical decision-making. 19
This study aims to assess the effect of 2 different teaching methods, CBL and LBL, on pharmacology learning outcomes, by specifically comparing and evaluating the benefits of CBL versus LBL and examining memory retention as well as student satisfaction associated with both methods. It also aims to contribute to the ongoing discourse on effective pharmacology education, with the potential to apprise curriculum development and instructional methods in medical education.
Methods
The study was conducted during the academic year 2023–24 at the College of Medicine (COM) of King Saud bin Abdulaziz University for Health Sciences (KSAU-HS) in Jeddah, Saudi Arabia. This randomized experimental study aimed to evaluate the effectiveness of case-based learning (CBL) compared to lecture-based learning (LBL) among medical students. Ethical approval for the study was obtained from the Institutional Review Board of King Abdullah International Medical Research Center (KAIMRC) (IRB/2303/23, study number SP23R/187/08, dated 11 September 2023).
The sample size was calculated using parameters from a previous study conducted by Chiranjeevi, U., et al (2022). 17 The criteria used for the calculation included a mean of 7.3 for group 1 (LBL) and 7 for group 2 (CBL), with alpha set at .05 and beta at .8. Based on these parameters, the required sample size was determined to be 67 students per group, resulting in a total of 134 participants. However, due to practical limitations, 76 students participated in the study.
The inclusion criteria consisted of male and female medical students in their third and fourth years, where basic pharmacology is delivered, at KSAU-HS, Jeddah, who provided informed consent for participation. Non-medical students were excluded from the study. A total of 76 students (41 males and 35 females) met the inclusion criteria.
Students who consented were randomly assigned to 1 of 2 equivalent groups, namely Group 1 (CBL) and Group 2 (LBL), following the completion of electronic registration and coding. The randomization process employed a computer-generated randomization sequence to ensure unbiased allocation. Details of the randomization method, including stratification by gender to balance male and female students across the groups, were implemented to maintain equivalence between groups. However, attendance on the specific day of the assignment could not be guaranteed. Therefore, the final group composition reflected the participants who were present on their assigned day. The reporting of this study conforms to the CONSORT 2010 Statement for randomized controlled trials in healthcare research. 20 The CONSORT 2010 Checklist has been completed and is provided as a supplementary file (Appendix 2).
Two educational sessions were conducted, focusing on topics not previously covered to minimize pre-knowledge bias: Inhaled Antibiotics and Substances of Abuse having titles of “Inhaled Antibiotics in Chronic Respiratory Disease” and “Treatment of Drug Abuse,” respectively. These topics were outside the regular curriculum, and not part of the final assessment of any ongoing block. And representing their first exposure to the CBL approach in pharmacology Each teaching session was scheduled for a duration of 50 min, which was followed by a 10-min short-term assessment. The assessments for cognition and knowledge comprised 10 multiple choice questions (MCQs) developed and validated by experts in the field (Appendix 1), along with feedback forms for students (Figures 1 and 2).
General Design of the Study and the Distribution of the Participants Among 2 Lectures.
Flow Chart of the Design of the Study.
Case-based learning (CBL) sessions were conducted using published guidelines in the literature. 21 The process included 7 steps; establishing a case, group analysis, brainstorming, formulating learning objectives, disseminating findings, sharing results, and identifying areas for improvement to integrate into clinical practice. All the relevant material to the cases was provided before the sessions to facilitate preparation and ensure active engagement throughout the sessions.
Case scenarios included clinical problems, patient histories, laboratory investigations, medical histories, and treatment plans. MCQs were mixed between knowledge and cognitive questions and were each weighed as 1 mark for correct response and analyzed with student satisfaction for both groups. Following the sessions, both groups completed the short-term memory assessments to determine the immediate effectiveness of the learning techniques. The same assessment questions were used to assess retention at the end of each academic block (long-term), which was scheduled after 4 weeks of the teaching sessions. This long-term intervale was selected based on the existing literature. 22 (Figure 2). The satisfaction survey consisted of a single item designed to assess participants’ perceptions of the method of delivery. A general scale from 1 to 5 was used, where 1 represented the lowest level of satisfaction and 5 the highest. The survey was distributed after the assessment, allowing participants to provide feedback based on their experience.
Statistical Analysis
The data collection was done using Microsoft Excel (Version 2021 © MS Corporation) and analysis using IBM SPSS Statistics software (Version 20 © IBM Corporation, 2012). The mean and standard deviation were calculated for the assessment scores, while One-way ANOVA was used to assess differences in the mean scores. Additionally, Paired t-test was utilized to compare quantitative variables such as those between students’ scores between male and female raters. Statistical analysis included the presentation of categorical data as counts and percentages, while continuous data were expressed as mean ± standard deviation. A paired Student's t-test was utilized to compare mean scores from assessments conducted immediately after the sessions and 4 weeks later for both groups. An independent t-test assessed the mean differences between the 2 learning methods. A significance level of P ≤ .05 was established for all analyses.
Results
In this study, we included a total of 76 medical students in their third and fourth years of study. The cohort consisted of 41 male and 35 female students. However, as mentioned in the methods, attendance on the specific day of the assignment could not be guaranteed, and the final group composition reflected only those participants who were present on their assigned day. Participants were randomly assigned to lecture-based learning (LBL) or case-based learning (CBL) groups using a computer-generated randomization sequence to ensure unbiased allocation. Stratification by gender was implemented to balance male and female students across the groups and maintain equivalence. The lecture topics and assessments were conducted outside the regular curriculum to minimize pre-existing knowledge bias. Table 1 provides a detailed demographic breakdown of the groups, showing a higher proportion of male participants in the CBL group (78%) and female participants in the LBL group (77.1%). Similarly, a slight majority of fourth-year students (60.4%) attended the CBL sessions, while third-year students were more evenly distributed.
Gender and Year-wise Distribution in LBL and CBL Groups.
This table presents the gender distribution (male and female) and the year of study (third and fourth year) among participants in lecture-based learning (LBL) and case-based learning (CBL) groups. Metrics include sample size (n), percentages (%), odds ratios (ORs), 95% confidence intervals (CIs), and P-values derived from a chi-squared test.
The comparative analysis of learning outcomes between LBL and CBL groups, presented in
Comparison of Learning Outcomes Between LBL and CBL Groups.
This table presents the results of the independent samples test, comparing learning outcomes between LBL (lecture-based learning) and CBL (case-based learning) groups. Metrics such as short-term retention (ST), long-term retention (LT), cognition, knowledge acquisition, and student satisfaction are analyzed. It includes means, standard deviations (SD), 95% confidence intervals (CI), and P-values.
Table 3 provides insights within-group performance trends based on paired samples analysis. A significant reduction in long-term retention was observed in the LBL group, with a mean score of 6.22 (SD 1.88), indicating a decline compared to short-term retention (mean 7.94, SD 1.51; P < .001). In contrast, the CBL group demonstrated stable and improved retention, with a higher mean long-term retention score of 6.95 (SD 1.87; P < .001). Cognition scores showed no significant changes within either group.
Performance trends in learning outcomes for LBL and CBL groups.
This table presents the results of the paired samples test, analyzing performance trends within LBL (lecture-based learning) and CBL (case-based learning) groups. It evaluates short-term retention (ST), long-term retention (LT), cognition, knowledge acquisition, and student satisfaction. Metrics reported include the sample size (n), means, standard deviations (SD), 95% confidence intervals (CI), and P-values.
Student satisfaction trends revealed differences between the 2 groups. The LBL group exhibited a slight but statistically significant decline in satisfaction levels over time, with a mean score of 4.43 (SD 0.77) for long-term satisfaction compared to 4.63 (SD 0.61) for short-term satisfaction (P = .012). In contrast, the CBL group maintained consistent satisfaction levels, with mean scores of 4.76 (SD 0.50) for short-term satisfaction and 4.71 (SD 0.52) for long-term satisfaction, showing no significant difference (P = .422). These findings suggest that CBL maintains more stable levels of satisfaction.
Discussion
This study assessed the effectiveness of the case-based learning (CBL) teaching method for pharmacology instruction among third and fourth-year medical students at King Saud bin Abdulaziz University for Health Sciences in Jeddah (KSAU-HS). The findings revealed that while lecture-based learning (LBL) was effective for short-term retention, CBL demonstrated superior outcomes in promoting long-term retention of knowledge. Specifically, long-term retention in the CBL group was maintained at higher levels, with a mean score of 6.95 compared to 6.22 in the LBL group, which showed a significant reduction over time. This aligns with previous research emphasizing the active, applied nature of CBL as a superior method for fostering durable learning outcomes in pharmacology education.17,18
The study's major findings indicated that the CBL method is more effective than LBL in promoting long-term information retention in pharmacology instruction. The differences in student performance between short-term and long-term assessments indicate a key difference between these 2 teaching methods. While both strategies produced similar outcomes immediately following the learning sessions, LBL did not maintain the same degree of knowledge retention over time. In contrast, CBL allowed students to maintain their performance, suggesting that the active and applied nature of CBL promotes deeper learning, making it a superior method for supporting long-term memory. This is particularly important in a subject like pharmacology, where students are expected to recall complex information about drug mechanisms, interactions, and therapeutic applications, not just for exams but throughout their medical careers. 2
One of the reasons for the superior long-term retention in CBL can be attributed to its learner-centered approach, which promotes active participation and critical thinking. In contrast to the passive nature of LBL, where students primarily receive information, CBL engages students by requiring them to apply the knowledge to real-world cases.23,24 This active learning process encourages the development of problem-solving skills and deeper understanding, which are essential for retaining information in long-term memory. The effectiveness of CBL over LBL in pharmacology education is well documented. For instance, Srinivasan and colleagues have shown that case-based learning enhances students’ knowledge while also improving their ability to integrate and apply it effectively which is crucial for complex disciplines like pharmacology. 25 Additionally, the interactive nature of CBL allows students to make connections between theoretical knowledge and practical application, leading to better encoding of information in long-term memory. 15
Short-term memory plays a crucial role in both CBL and LBL during the initial learning phase. Short-term memory, which temporarily holds and processes information, is often sufficient for immediate recall, such as in exams taken directly after lectures. However, the ability to transfer information from short-term memory to long-term memory is what differentiates effective learning methods. The limited capacity and duration of short-term memory make it less reliable for complex subjects like pharmacology, where students must retain and apply information long after the initial learning session. LBL, while effective for short-term retention, often fails to engage students in a manner that promotes the consolidation of knowledge into long-term memory. As evidenced by our study and supported by research from Freeman et al (2014), LBL's lack of interactive engagement and real-world application limits its effectiveness for long-term retention. 9
Moreover, the nature of pharmacology as a discipline requires students to retain not just isolated facts but also to understand how different concepts and mechanisms interrelate. The active learning strategies used in CBL facilitate this process. As Vora et al (2015) highlighted, the inquiry-driven model of CBL allows students to engage with the material through reasoning, discussion, and application, thereby reinforcing knowledge through multiple cognitive pathways. 19 This differs significantly from LBL, where information is often presented in a linear fashion, and students may not engage in the same level of critical thinking or problem-solving. This difference may explain why students in the CBL group were able to retain their knowledge over the long term, while those in the LBL group experienced a decline in performance.
Furthermore, student engagement and satisfaction are important factors in the effectiveness of teaching methods. Although our study found no significant differences in student satisfaction between the CBL and LBL groups, previous research has shown that CBL is generally more favored by students. For instance, Kaur et al (2020) found that students in a pharmacology course using CBL were more engaged and attended sessions more frequently compared to those in LBL settings. 18 This increased engagement likely contributed to better retention of information. The results of our study are consistent with these findings, indicating that while both methods may be equally effective in the short term, CBL's emphasis on interaction and problem-solving likely contributes to its long-term benefits.
The lack of significant changes in cognitive-based questions in our study compared to Chiranjeevi et al (2022) raises important considerations about the type of assessments used to evaluate student learning. While our study focused on knowledge-based questions, Chiranjeevi's study demonstrated that CBL was also effective in application-based assessments, where students were required to apply theoretical knowledge to clinical scenarios. 17 This aligns with research from Prince (2004), which suggests that problem-based and case-based learning approaches are particularly effective in fostering critical thinking and application skills, both of which are essential for medical education. The differences in findings between the 2 studies may reflect the inherent strengths of CBL in not only improving knowledge retention but also in enhancing students’ ability to apply their knowledge in clinical contexts. 26
Despite these findings, the study has several limitations that must be acknowledged. One significant limitation is the small number of assessment questions used to evaluate knowledge and cognitive outcomes. This limited pool of questions restricts the ability to draw robust conclusions about the differences in learning outcomes between the LBL and CBL groups. Furthermore, students were recruited voluntarily, as the lectures were conducted outside the standard curriculum to minimize the influence of pre-existing knowledge. While this approach reduced potential biases, it may have introduced variability in participant motivation and engagement, potentially affecting the results.
Although the recruitment process ensured an equal distribution of gender and balanced numbers in each group, attendance on the assigned lecture days could not be controlled. Consequently, the final group compositions depended on the students who attended, rather than those who were initially assigned, which partially undermined the randomization process. Additionally, the single-institution setting and relatively small sample size further restrict the generalizability of the findings. Future research with larger, more diverse samples, multi-institutional participation, and a broader range of assessment tools would provide a more comprehensive understanding of CBL's impact on student learning outcomes.
In summary, CBL's effectiveness in pharmacology education can be attributed to several factors. First, its active, inquiry-driven approach helps students engage with the material on a deeper level, promoting better long-term retention. Second, CBL encourages the application of theoretical knowledge, which is crucial for students preparing for clinical practice. Lastly, the interactive and student-centered nature of CBL helps foster engagement and satisfaction, which is important for sustaining motivation and interest in the subject. As pharmacology is a foundational subject in medical education, adopting teaching methods that support both the retention and application of knowledge is essential for preparing students for their future roles in healthcare. 18
Conclusion
In conclusion, this study demonstrates that case-based learning (CBL) is more effective than lecture-based learning (LBL) in teaching pharmacology, particularly for long-term knowledge retention. While LBL was found to be effective for short-term retention, the significant decline in long-term retention scores highlights its limitations in sustaining learning over time. In contrast, CBL's emphasis on active participation, critical thinking, and real-world application allows students to retain information more effectively, making it a superior method for fostering durable learning outcomes.
Medical schools and health sciences institutions should consider adopting CBL more broadly in their pharmacology curricula. Additionally, future research is recommended to explore the broader impact of CBL on critical thinking, clinical reasoning, and students’ confidence in applying pharmacology in real-world scenarios. Expanding the scope of research to include larger, more diverse questions and varied assessment methods would provide a more comprehensive understanding of CBL's role in medical education.
Supplemental Material
sj-docx-1-mde-10.1177_23821205251332814 - Supplemental material for Comparing Case-Based and Lecture-Based Learning Methods in Pharmacology Teaching: Assessing Learning Outcomes, Memory Retention, and Student Satisfaction at the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
Supplemental material, sj-docx-1-mde-10.1177_23821205251332814 for Comparing Case-Based and Lecture-Based Learning Methods in Pharmacology Teaching: Assessing Learning Outcomes, Memory Retention, and Student Satisfaction at the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia by Razaz Abdulaziz Felemban, Muhammad Anwar Khan and Nouf Sulaiman Alharbi in Journal of Medical Education and Curricular Development
Supplemental Material
sj-doc-2-mde-10.1177_23821205251332814 - Supplemental material for Comparing Case-Based and Lecture-Based Learning Methods in Pharmacology Teaching: Assessing Learning Outcomes, Memory Retention, and Student Satisfaction at the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
Supplemental material, sj-doc-2-mde-10.1177_23821205251332814 for Comparing Case-Based and Lecture-Based Learning Methods in Pharmacology Teaching: Assessing Learning Outcomes, Memory Retention, and Student Satisfaction at the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia by Razaz Abdulaziz Felemban, Muhammad Anwar Khan and Nouf Sulaiman Alharbi in Journal of Medical Education and Curricular Development
Footnotes
Abbreviations
Acknowledgments
We would like to thank all of the students who participated in the study. Special gratitude to all faculty members for their valuable effort spent in validating the assessment questions. In addition, we would like to express our gratitude to the Department of Medical Education (DME) for their unwavering support in conducting this study, as well as colleagues from the College of Medicine at KSAU-HS for their insights and input throughout the process.
Ethical Considerations and Informed Consents
This study was carried out in accordance with the Helsinki Protocol and was approved by the Institutional Review Board (IRB) of King Abdullah International Medical Research Center (KAIMRC), a research wing of KSAU-HS, Jeddah (IRB/2303/23, study number SP23R/187/08, dated September 11, 2023). Written informed consent was obtained from all participants prior to study initiation. Participants were informed of the study objectives, procedures, and their right to withdraw at any time without penalty. The signed consent forms were securely stored as a part of the study documentation.
Author Contributions
RAF conceptualized and designed the study, searched the existing literature, and wrote the entire manuscript. MAK statistically analyzed the collected data and reviewed the manuscript. NSA supervised the study and reviewed the manuscript.
Funding
The authors received no financial support for the research, authorship, and/or publication of this article.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Data Availability Statement
The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.
Supplemental Material
Supplemental material for this article is available online.
References
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