title: Role of case structure and prior experience in a case-based surgical clerkship.
abstract: BACKGROUND
  As case-based methods replaced lectures in a surgical clerkship, the influences of case structure and prior experience on learning were investigated.
  
  
  METHODS
  Early and late third-year students randomly received different cases. "Structured" cases had data presented and summarized. "Unstructured" cases required questions to faculty for information. Multiple choice tests and differential diagnosis activities were administered. An attitudinal questionnaire gauged student perceptions.
  
  
  RESULTS
  In both multiple choice and differential diagnosis activities, the late rotation, "unstructured" group scored higher than the "structured" group. Conversely, the early rotation, "unstructured" group scored lower than the "structured" group. Combined, rotation, and structure significantly affected both multiple choice and differential diagnosis activities (ANOVA, P < or = 0.02). Early rotation, "unstructured" students described a more enjoyable experience, despite lower evaluation scores.
  
  
  CONCLUSIONS
  Surgical clerkship case-based learning is profoundly affected by case structure and prior clinical experience. Case-based curriculum should be tailored to accommodate these interactions.
authors.affiliation: Department of Surgery, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, Piscataway, USA.
authors.forename: J P
authors.initials: JP
authors.lastname: Sutyak
authors.forename: R B
authors.initials: RB
authors.lastname: Lebeau
authors.forename: A J
authors.initials: AJ
authors.lastname: Spotnitz
authors.forename: A M
authors.initials: AM
authors.lastname: O'Donnell
authors.forename: P R
authors.initials: PR
authors.lastname: Mehne
mesh_terms: D002982:Clinical Clerkship; D003937:Diagnosis, Differential; D004521:Educational Measurement; D013502:General Surgery / Q000193:education*; D006801:Humans; D011897:Random Allocation; D013663:Teaching / Q000379:methods*