- Directed case study method for teaching human anatomy and physiology


William H. Cliff and Ann W. Wright

Department of Biology, Niagara University, Niagara, New York 14109

A mastery of human anatomy and physiology requires a familiarity with a vast number of details about the human body. A directed method of case analysis is described that helps students deepen and solidify their understanding of anatomical and physiological facts, concepts, and principles. The successful case had four distinctive features as follows: clear learning objectives, a concise and informative scenario, straightforward and didactic questions, and an emphasis on information readily available to the student. A directed case study is presented, and its salient features are described. A procedure for integrating case analyses into an undergraduate anatomy and physiology course is outlined. Student response to this type of case study suggests that this method improves the ease of learning, the depth of learning, and an appreciation of the relevance of and a curiosity about anatomy and physiology. The addition of case analyses to a two-semester integrated course in anatomy and physiology was also associated with an improvement in exam performance. The regular use of directed case analysis is a valuable addition to the traditional methods of lecture, textbook reading, and laboratory for the teaching of human anatomy and physiology.

Key words; case studies; teaching undergraduate students; evaluation

AM. J. PHYSIOL. 270 (ADVT PHYSIOL. EDUC. 15): S19-S28, 1996



A "case” for the case method in human anatomy and physiology. Human anatomy and physiology is and physiology. Human anatomy and physiology is undeniably a content-rich systematic course of study. Our students must know when the atrioventricular valves close during the heart beat, what all of the cranial nerves (and their functions) are, where the spleen is, bow muscles contract, and many other details about the human body. A mastery of the subject has been recognized as the ability to correctly recall a substantial fraction of this massive corpus of facts. The teaching of anatomy and physiology has focused on improving the student’s capability to recall the pertinent ones. Lectures, textbooks, and to some extent the laboratories are designed to make this process easier. Nevertheless, there are a number of reasons why a case analysis approach to teaching anatomy and physiology can be a useful adjunct to the traditional lecture-textbook-laboratory method of instruction in an undergraduate course in human anatomy and physiology.

I) Human anatomy and physiology is a foundational course for advanced topics in the basic or clinical sciences that put increasing emphasis on problem solving. Why not help students develop the necessary synthetic, analytic, and diagnostic thinking skills early in their program of study by introducing case analvsis?

2) The teaching of human anatomy and physiology often introduces subjects (description of disease processes, clinical procedures and issues of health and fitness) explored or emphasized in greater detail in more advanced clinical courses. A case that deals with disease or pathology often deepens the student’s understanding of the normal human anatomy and physiology, proves immediate real-life relevance, and helps develop an appreciation that the mastery of human anatomy and physiology is essential for achieving the clinical expertise of a competent health professional.

3) Mere accumulation of a massive body of facts can never be the sole goal for this or any similar type of course. Students have become truly knowledgeable if they can correctly apply the facts that they have learned about the human body to the solution of relevant real-world problems.

The potential that case analysis holds in the teaching of human anatomy and physiology has been recognized in some introductory anatomy and physiology textbooks. Recent publications of Marieb (4) Martini (6) and Van Wynsberghe et al. (10) include case studies in the teaching materials. Some texts provide brief case scenarios at the end of each chapter (see Refs. 4 and 6). Others provide more extensive cases at the end of the major sections of the text (10). The Student’s Application book for Martini’s third edition textbook (7) is a good illustration of how cases are being integrated into the textbook supplements. Independent case study texts also exist. Van Wynsberghe and Cooley’s “Case Histories in Human Physiology” (9) or Berne and Levy’s “Case Studies in Physiology” (1) are particularly well-written examples. The latter was prepared for medical students.

These case approaches provide a strong clinical correlate to the basic science taught in the course. Nevertheless, much of this material does not appear to have been specifically written to reinforce or deepen the student’s understanding of the anatomy or physiology. Instead, the cases serve primarily to illustrate disease states, give real-world relevance, and provide motivation for learning. The strength of these approaches is the development of clinical problem-solving skills by the student. The case method described in this paper retains the true-to-life clinical relevance found in contemporary texts. However, it has the primary goal of enhancing the student’s understanding of the key concepts and processes of human anatomy and physiology. The distinctions of a directed case study approach. Because the intent of the case method described here is the mastery of ideas and processes, the cases are content driven. They are built around specific learning objectives. Furthermore, the cases are highly directed. The student is asked a series of specific questions concerning the case. By answering these questions, a student is forced to review, relearn, and apply information that he or she has already gained from the text or from the lecture. Commonly, our cases resemble the decision or dilemma case (2) in which a scenario is presented, and a student must assemble the relevant information, identify key concepts, and make informed assessmentsto solve a problem. The goal is to obtain a deeper “working” knowledge of the material rather than simply captivate attention with interesting clinical situations.

Being directed, the cases are not open-ended. There is a single specific answer expected for nearly all of the questions. Open-ended cases foster intellectual development as students consider opposing or alternate possibilities in their approach to the solution of a problem. Nevertheless, such a format can also cause confusion and cognitive frustration if students do not have the prerequisite intellectual maturity to handle the open-endedness of this method. We have found the use of directed case analysis to be necessary for lower-division students. They still need guidance in applying their knowledge to real-world problems. Because our primary goal is to strengthen our student’s grasp of the factual and conceptual aspects of anatomy and physiology and secondarily to develop greater critical thinking skills, we have found the directed case to be the most suitable approach.

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