User blog: Duncan Ferguson

Approaches to Case-Based Learning (CBL) in Veterinary Curricula

Mon, 12 Oct 2026 22:12:56 GMT

by Duncan Ferguson.

Veterinary class sizes are increasing, and veterinary faculty numbers are declining. However, the American Association of Veterinary Medical College’s (AAVMC) carefully constructed “Day 1” competencies, and entrustable professional activities (EPAs) highlights the need for clinical reasoning skills. What better way to ensure clinical relevance and requisite knowledge than to encourage clinical reasoning with case-based learning (CBL) techniques? However, already stretched faculty (particularly in “pre-clinical” years) will certainly tell you that this is more easily said than done. There is the workload of creating realistic but appropriately scaffolded clinical cases, adjusted for the curricular level. But the rate-limiting factor is often the faculty workload to provide meaningful, individualized and consistent formative feedback to students as they work through cases. With class sizes ever-expanding, the task becomes even more daunting.

So, what are the options? And what do students think about them? Let’s look at the recent literature.

1. Large classroom discussions: One example of this was recently described by Nichelason.¹ Her “Teaching Tip” described assignment of small student groups within a class to prepare arguments for a debate on one of 2 sides of a clinical issue. Different issues were assigned to different parts of the class. Students prepared for a group 2–3-minute presentation, and a shorter rebuttal of the group assigned to the opposite argument. Student engagement was reported as high, and recall of preparative reading materials also high.

My thoughts: Pros: Clinical reasoning in a clinical practice is often practiced in small teams. All students are expected to fulfill a defined active role, and there were low human and technological resource requirements. Cons: The students’ engagement about the broader issues was largely passive, with active involvement during presentation of a subset of the topic. There was no evaluation of subsequent student performance, relying mainly on student opinions about their personal engagement and integration of classroom or pre-exercise concepts. As enhancement of critical reasoning skills is the goal of CBL, it is difficult to see how the large classroom (100-200 student) environment would not discourage those needing the most practice. Except for comments about their research and presentation, the provision of individualized formative feedback may be limited.

2. Digital platform case software: Ritter and Heseltine² describe the use of a specific “online adaptive” case software that in a third-year small animal medicine course. One half of participating students were exposed only to instructor lectures about the cases. A second group had the same experience supplemented by the experience of working through adaptive online case studies on kidney disease. The outcomes were evaluated by performance on a common multiple-choice examination covering the lecture concepts. Students also were surveyed pre- and post-intervention about their confidence in clinical reasoning. The study groups did not differ in examination scores, but these were based upon stated principles in the lectures. Students in the adaptive online case study group reported a significant increase in their confidence with case analysis and noted the importance of immediate feedback.

My thoughts: Pros: Branching logic case studies have long been facilitated by online platforms. In addition to the program described in this study, other common examples include the branching logic options by H5P (open source). Immediate feedback and explanations can be provided. Developed cases can be relatively easily shared and modified. Cons: With most programs, the branching logic is usually based upon finite pre-set multiple choice options so smaller subtleties of understanding and misunderstanding may not be elicited.

3. Online case discussions via message boards (forums) or chatrooms: A recent survey by Brignell et al.³ compared their student attitudes regarding online vs. face-to-face case “clinical relevance” discussions. The online discussion phase occurred first and consisted of discussions amongst 8-10 students on Microsoft Teams, with a facilitator rotating between 2 chatrooms. The face-to-face phase followed and consisted of 8-10 students discussing a case with a facilitator rotating between 2 rooms. Post-experience surveys were requested of the 450 students in the classes. The response rate was 20.4% following the online phase and 15.6% following the face-to-face phase, with only 6% responding to both, allowing paired comparisons. Students responding to both surveys enjoyed the face-to-face environment significantly more and felt that they had better discussions and collaborated more effectively during face-to-face discussions. Students appeared to be equally confident to express their views in both settings and reported digital device distractions in both settings. Students reported being “less afraid to ask questions” and they felt that they developed a more “efficient approach” to case solutions in the face-to-face environment. Students apparently negatively perceived the facilitators in both environments when they guided rather than instructed. Some issues with small group discussions appeared to exist regardless of the environment. The authors recommended that prior structured guidance in using online platforms should enhance group collaboration. Included in this preparation should be careful instruction regarding mobile device use as a potential distraction.

My thoughts: Pros: The realistic in-person and social cues of face-to-face CBL discussions certainly mimic clinical teamwork. However, the use of online resources in large multiple person settings also argues for refined practice with online discussions and communication. Cons: The study had a small paired-response rate (6%) raising concern about 1) student investment in improving instruction and 2) the ability to generalize from the study. Although favored by students, in-person discussions may be harder to coordinate and require adequate small group meeting space. It is important to note that the study was conducted between 2021 and 2022 during the rapid shift to online learning associated with the COVID 19 epidemic. Some of the student opinions may have been shaped by the rapid and generally clumsy conversion of face-to-face learning to online formats. This period generally left a bad impression with students.

Other Options

Conversely, the value of online case discussions can be highlighted by the impracticality or cost of meeting face-to-face. I have long been impressed by the engagement of the truly motivated practitioner (learning “in situ”) in an online message board or even a live chat session. I recall such exchanges when we initiated case discussion on Veterinary Information Network as early as 1990. However, it was always a challenge to attempt to engage and glean the ideas of *all* learners in any environment. Generally, the most “vocal” and confident would give his/her opinion first, followed by be a couple of others piping up to comment, but the majority then would be relegated (usually happily) to passive by-standers. A real question when it comes to training veterinary students is whether learning about the process of clinical reasoning should ever be a passive process. No pain, no gain.

Conducting anonymous surveys during a synchronous chat or asynchronous message board discussion can sometimes identify additional ideas or misconceptions. A message board format that requires a learner to post “something” (unfortunately, even “Hello”) before they can see the responses of others, can be tried. Managing case discussions on a message board requires the instructor to set a certain timeframe or “rhythm” between each question posed, followed by instructor summary and comment. The tendency is, like the live session, that learners have concern about being the first out with an answer, and perhaps the first one needing to be corrected. A challenge for the instructor in a graded course is the weighting of participation in a discussion of any sort.

Summary and the Near Future

Case-based learning (CBL) is the clearest way to ensure practice in clinical reasoning. Scaffolding to concurrent curricular content encourages recognition of its clinical relevance. In a study of first-year veterinary students conducting case analyses online with anonymous peer review for formative feedback, we also brough students together in a laboratory setting to discuss the peer review process as they experienced it.⁴ The group discussion did elicit interesting perspectives not previously recognized by the digital “feedback-on-feedback” comments.

A rational strategy for customizing and individualizing the CBL experience could come from a student interacting with an artificial intelligence (AI) chatbot prompted with detailed case information. In essence, the AI agent would handle the branching aspects of a case, based upon the student’s response. Even history-taking and conduct of a physical examination can be simulated. And as will be discussed in the future, an AI large language model (LLM) can be provided a knowledgebase and be asked to apply a detailed evaluation rubric to provide immediate individualized formative feedback to a student’s written work. Although the social dynamics of a group case discussion might be missing, the individual responsibility to address and write about a case can be reinforced. The most realistic CBL experience probably includes both the requirement for individual thought and accountability as well as the opportunity for team-based problem-solving.

References

1. Amy Nichelason (2026) Fostering critical thinking through debate in veterinary education: a large classroom perspective J. Vet. Med. Ed. 53(4): 454-459. https://utppublishing.com/doi/10.3138/jvme-2025-0035

2. Ritter NL, Heseltine JC (2026) Impact of adaptive case-based learning on clinical reasoning confidence in pre-clinical veterinary students. JVME 53(4):472-477.

https://utppublishing.com/doi/10.3138/jvme-2025-0052

3. Brignell JL, Burton A, Blanchard RN (2025) Veterinary students’ perceptions of online versus face-to-face problem-based learning 1-10 (advanced online on October 2, 2026)

https://utppublishing.com/doi/10.3138/jvme-2025-0125

4. McMichael MA, Ferguson DC, Allender MC, Cope W, Kalantzis M, Haniya S, Searsmith D, Montebello M. (2021): Use of a multimodal, peer-to-peer learning management system for introduction of critical clinical thinking to first-year veterinary students. J Vet Med Educ. 48(2):170-180. https://utppublishing.com/doi/10.3138/jvme.2019-0029

Competency-Based Veterinary Education (CBVE) Drives Increased Use of Digital Simulations and AI

Mon, 31 Aug 2026 18:59:50 GMT

by Duncan Ferguson.

Competency-Based Veterinary Education (CBVE) Drives Increased Use of Digital Simulations and AI

At the end of my formal academic career a decade ago, I chaired a “pre-clinical” department responsible for instruction in veterinary anatomy, physiology, histology, neurobiology, pharmacology and toxicology. Since then, the veterinary education has experienced multiple waves of seed changes. Even in 2016, there were the expense and public sensitivity to the use dead animals for instruction, and the concern over student exposure to embalming solutions. The use of live animals for laboratories and surgical practice had long been limited on animal humane grounds.

The introduction of a new curriculum 15 years ago at the University of Illinois College of Veterinary Medicine brought first and second year students into 8 weeks of clinical blocks alongside final-year students. It quickly became apparent that these students were eager but not properly prepared to appreciate this early clinical exposure’s value in enhancing the relevance of the pre-clinical classroom instruction. The curricular result was expansion of the Clinical Skills Laboratory and of the nature of Objective Subjective Clinical Examinations (OSCEs). At first these focused on the manual processes associated with clinical practice: draping a patient, tying surgical knots, etc. They were not initially designed to evaluate clinical reasoning skills. As a simple example, we still evaluated first and second-year student competency with dosage calculation with a set of online multiple-choice quizzes. The “on-the-fly” assessment of their interpretation of an antibiotic culture and sensitivity, and prescribing ability was only going to come later.

Then, the Competency-Based Veterinary Education (CBVE) initiative by the American Association of Veterinary Medical Colleges moved through its phases to the now refined 32 Competencies in 9 Domains with granular performance Milestones, and 8 Entrustable Professional Activities (EPAs) https://www.aavmc.org/resources/competency-based-veterinary-education/cbve-education-2-0-model/ . Veterinary schools, particularly the newly developed ones, are designing their curricula around this framework, and existing schools are trying to identify where these competencies are taught and/or redesigning their curricula to ensure that they are.

As a recent narrative review describes, the educational simulation technology, clinical skills labs, and externally constructed competency framework are now being supplemented by artificial intelligence (AI).¹

The potential of AI is not only in its “out-of-the-box” capability to create multiple choice questions for a student,² or pass an examination ³, although the capabilities of the AI models are becoming more and more impressive. It is about the potential to interact with specialized or even customized medical professional information in databases (knowledgebases), and about the potential to interact with simulators to customize learning experiences.¹ Large Language models (LLMs) can help faculty identify where in a curriculum the competencies are being taught and evaluate whether student progress is being adequately measured against the Milestone standards.

I can recall the excitement in the early 1990’s when videodisks of interactive educational programs were going to change the nature of veterinary education. However, the subsequent pace of development was slow, and the external review and national or international standards not yet developed. Four decades later, the veterinary profession now could work virtually and collectively on educational programs and standards with the aid of AI. The costs of educationally effective approaches might be higher, but our we can no longer afford the tendency to reinvent the wheel at each of our institutions. The truth is that we never could, but we also probably never gave faculty the credit necessary for inter-institutional cooperation on educational research and development, like we did for other kinds of research. There are examples of such inter-institutional cooperation over AI-driven simulated experiences for medical students.⁴ Why shouldn’t we work together to conduct the necessary educational research in a cooperative manner? Our curricula, faculty, and, certainly, our students deserve it.

References

1. Zhang H, Li A,Ying Li, Nab F, Dong H, Ma Y: Simulation, artificial intelligence, and competency-based frameworks in veterinary medical education: a narrative review. J Vet Sci. 2026 May;27(3):e37 https://vetsci.org/DOIx.php?id=10.4142/jvs.25194

2. 2. Sousa SA, Flay KJ (2025): A survey of veterinary student perceptions on integrating ChatGPT in veterinary education through AI-driven exercises. J. Vet. Med. Ed. 52(6): 734-742.
https://doi.org/10.3138/jvme-2024-0075

3. 3. Coleman MC, Moore JN (2024): Two artificial intelligence models underperform on examinations in a veterinary curriculum. JAVMA 262(5):692-697.
https://doi.org/10.2460/javma.23.12.0666

4. 4. Hicke Y, Geathers J, Vu K et al. (2026): MedSimAI: Simulation and formative feedback generation to enhance deliberate practice in medical education. In LAK26: 16th International Learning Analytics and Knowledge Conference, April 27-May 01, 2026, Bergen, Norway. ACM, New York, NY, USA. 11 pages. https://doi.org/10.1145/3785022.3785092

Moving Evidence-Based Education Blog Back to this Site

Sun, 23 Aug 2026 21:35:52 GMT

by Duncan Ferguson.

Hi everyone,

Our new Moodle theme allows for blogging at this site, and we thought we'd move the Education-Based Blog back here. Look for new posts soon, but we wanted to get the idea so we trotted out some ancient (~10 yo) but hopefully timeless posts that were from the beginning of VetMedAcademy's existence. Don't hesitate to add comments!

Cheers,

Duncan