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Case studies.

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Case studies are stories that are used as a teaching tool to show the application of a theory or concept to real situations. Dependent on the goal they are meant to fulfill, cases can be fact-driven and deductive where there is a correct answer, or they can be context driven where multiple solutions are possible. Various disciplines have employed case studies, including humanities, social sciences, sciences, engineering, law, business, and medicine. Good cases generally have the following features: they tell a good story, are recent, include dialogue, create empathy with the main characters, are relevant to the reader, serve a teaching function, require a dilemma to be solved, and have generality.

Instructors can create their own cases or can find cases that already exist. The following are some things to keep in mind when creating a case:

  • What do you want students to learn from the discussion of the case?
  • What do they already know that applies to the case?
  • What are the issues that may be raised in discussion?
  • How will the case and discussion be introduced?
  • What preparation is expected of students? (Do they need to read the case ahead of time? Do research? Write anything?)
  • What directions do you need to provide students regarding what they are supposed to do and accomplish?
  • Do you need to divide students into groups or will they discuss as the whole class?
  • Are you going to use role-playing or facilitators or record keepers? If so, how?
  • What are the opening questions?
  • How much time is needed for students to discuss the case?
  • What concepts are to be applied/extracted during the discussion?
  • How will you evaluate students?

To find other cases that already exist, try the following websites:

  • The National Center for Case Study Teaching in Science , University of Buffalo. SUNY-Buffalo maintains this set of links to other case studies on the web in disciplines ranging from engineering and ethics to sociology and business
  • A Journal of Teaching Cases in Public Administration and Public Policy , University of Washington

For more information:

  • World Association for Case Method Research and Application

Book Review :  Teaching and the Case Method , 3rd ed., vols. 1 and 2, by Louis Barnes, C. Roland (Chris) Christensen, and Abby Hansen. Harvard Business School Press, 1994; 333 pp. (vol 1), 412 pp. (vol 2).

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Making Learning Relevant With Case Studies

The open-ended problems presented in case studies give students work that feels connected to their lives.

Students working on projects in a classroom

To prepare students for jobs that haven’t been created yet, we need to teach them how to be great problem solvers so that they’ll be ready for anything. One way to do this is by teaching content and skills using real-world case studies, a learning model that’s focused on reflection during the problem-solving process. It’s similar to project-based learning, but PBL is more focused on students creating a product.

Case studies have been used for years by businesses, law and medical schools, physicians on rounds, and artists critiquing work. Like other forms of problem-based learning, case studies can be accessible for every age group, both in one subject and in interdisciplinary work.

You can get started with case studies by tackling relatable questions like these with your students:

  • How can we limit food waste in the cafeteria?
  • How can we get our school to recycle and compost waste? (Or, if you want to be more complex, how can our school reduce its carbon footprint?)
  • How can we improve school attendance?
  • How can we reduce the number of people who get sick at school during cold and flu season?

Addressing questions like these leads students to identify topics they need to learn more about. In researching the first question, for example, students may see that they need to research food chains and nutrition. Students often ask, reasonably, why they need to learn something, or when they’ll use their knowledge in the future. Learning is most successful for students when the content and skills they’re studying are relevant, and case studies offer one way to create that sense of relevance.

Teaching With Case Studies

Ultimately, a case study is simply an interesting problem with many correct answers. What does case study work look like in classrooms? Teachers generally start by having students read the case or watch a video that summarizes the case. Students then work in small groups or individually to solve the case study. Teachers set milestones defining what students should accomplish to help them manage their time.

During the case study learning process, student assessment of learning should be focused on reflection. Arthur L. Costa and Bena Kallick’s Learning and Leading With Habits of Mind gives several examples of what this reflection can look like in a classroom: 

Journaling: At the end of each work period, have students write an entry summarizing what they worked on, what worked well, what didn’t, and why. Sentence starters and clear rubrics or guidelines will help students be successful. At the end of a case study project, as Costa and Kallick write, it’s helpful to have students “select significant learnings, envision how they could apply these learnings to future situations, and commit to an action plan to consciously modify their behaviors.”

Interviews: While working on a case study, students can interview each other about their progress and learning. Teachers can interview students individually or in small groups to assess their learning process and their progress.

Student discussion: Discussions can be unstructured—students can talk about what they worked on that day in a think-pair-share or as a full class—or structured, using Socratic seminars or fishbowl discussions. If your class is tackling a case study in small groups, create a second set of small groups with a representative from each of the case study groups so that the groups can share their learning.

4 Tips for Setting Up a Case Study

1. Identify a problem to investigate: This should be something accessible and relevant to students’ lives. The problem should also be challenging and complex enough to yield multiple solutions with many layers.

2. Give context: Think of this step as a movie preview or book summary. Hook the learners to help them understand just enough about the problem to want to learn more.

3. Have a clear rubric: Giving structure to your definition of quality group work and products will lead to stronger end products. You may be able to have your learners help build these definitions.

4. Provide structures for presenting solutions: The amount of scaffolding you build in depends on your students’ skill level and development. A case study product can be something like several pieces of evidence of students collaborating to solve the case study, and ultimately presenting their solution with a detailed slide deck or an essay—you can scaffold this by providing specified headings for the sections of the essay.

Problem-Based Teaching Resources

There are many high-quality, peer-reviewed resources that are open source and easily accessible online.

  • The National Center for Case Study Teaching in Science at the University at Buffalo built an online collection of more than 800 cases that cover topics ranging from biochemistry to economics. There are resources for middle and high school students.
  • Models of Excellence , a project maintained by EL Education and the Harvard Graduate School of Education, has examples of great problem- and project-based tasks—and corresponding exemplary student work—for grades pre-K to 12.
  • The Interdisciplinary Journal of Problem-Based Learning at Purdue University is an open-source journal that publishes examples of problem-based learning in K–12 and post-secondary classrooms.
  • The Tech Edvocate has a list of websites and tools related to problem-based learning.

In their book Problems as Possibilities , Linda Torp and Sara Sage write that at the elementary school level, students particularly appreciate how they feel that they are taken seriously when solving case studies. At the middle school level, “researchers stress the importance of relating middle school curriculum to issues of student concern and interest.” And high schoolers, they write, find the case study method “beneficial in preparing them for their future.”

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Case-based learning.

Case-based learning (CBL) is an established approach used across disciplines where students apply their knowledge to real-world scenarios, promoting higher levels of cognition (see Bloom’s Taxonomy ). In CBL classrooms, students typically work in groups on case studies, stories involving one or more characters and/or scenarios.  The cases present a disciplinary problem or problems for which students devise solutions under the guidance of the instructor. CBL has a strong history of successful implementation in medical, law, and business schools, and is increasingly used within undergraduate education, particularly within pre-professional majors and the sciences (Herreid, 1994). This method involves guided inquiry and is grounded in constructivism whereby students form new meanings by interacting with their knowledge and the environment (Lee, 2012).

There are a number of benefits to using CBL in the classroom. In a review of the literature, Williams (2005) describes how CBL: utilizes collaborative learning, facilitates the integration of learning, develops students’ intrinsic and extrinsic motivation to learn, encourages learner self-reflection and critical reflection, allows for scientific inquiry, integrates knowledge and practice, and supports the development of a variety of learning skills.

CBL has several defining characteristics, including versatility, storytelling power, and efficient self-guided learning.  In a systematic analysis of 104 articles in health professions education, CBL was found to be utilized in courses with less than 50 to over 1000 students (Thistlethwaite et al., 2012). In these classrooms, group sizes ranged from 1 to 30, with most consisting of 2 to 15 students.  Instructors varied in the proportion of time they implemented CBL in the classroom, ranging from one case spanning two hours of classroom time, to year-long case-based courses. These findings demonstrate that instructors use CBL in a variety of ways in their classrooms.

The stories that comprise the framework of case studies are also a key component to CBL’s effectiveness. Jonassen and Hernandez-Serrano (2002, p.66) describe how storytelling:

Is a method of negotiating and renegotiating meanings that allows us to enter into other’s realms of meaning through messages they utter in their stories,

Helps us find our place in a culture,

Allows us to explicate and to interpret, and

Facilitates the attainment of vicarious experience by helping us to distinguish the positive models to emulate from the negative model.

Neurochemically, listening to stories can activate oxytocin, a hormone that increases one’s sensitivity to social cues, resulting in more empathy, generosity, compassion and trustworthiness (Zak, 2013; Kosfeld et al., 2005). The stories within case studies serve as a means by which learners form new understandings through characters and/or scenarios.

CBL is often described in conjunction or in comparison with problem-based learning (PBL). While the lines are often confusingly blurred within the literature, in the most conservative of definitions, the features distinguishing the two approaches include that PBL involves open rather than guided inquiry, is less structured, and the instructor plays a more passive role. In PBL multiple solutions to the problem may exit, but the problem is often initially not well-defined. PBL also has a stronger emphasis on developing self-directed learning. The choice between implementing CBL versus PBL is highly dependent on the goals and context of the instruction.  For example, in a comparison of PBL and CBL approaches during a curricular shift at two medical schools, students and faculty preferred CBL to PBL (Srinivasan et al., 2007). Students perceived CBL to be a more efficient process and more clinically applicable. However, in another context, PBL might be the favored approach.

In a review of the effectiveness of CBL in health profession education, Thistlethwaite et al. (2012), found several benefits:

Students enjoyed the method and thought it enhanced their learning,

Instructors liked how CBL engaged students in learning,

CBL seemed to facilitate small group learning, but the authors could not distinguish between whether it was the case itself or the small group learning that occurred as facilitated by the case.

Other studies have also reported on the effectiveness of CBL in achieving learning outcomes (Bonney, 2015; Breslin, 2008; Herreid, 2013; Krain, 2016). These findings suggest that CBL is a vehicle of engagement for instruction, and facilitates an environment whereby students can construct knowledge.

Science – Students are given a scenario to which they apply their basic science knowledge and problem-solving skills to help them solve the case. One example within the biological sciences is two brothers who have a family history of a genetic illness. They each have mutations within a particular sequence in their DNA. Students work through the case and draw conclusions about the biological impacts of these mutations using basic science. Sample cases: You are Not the Mother of Your Children ; Organic Chemisty and Your Cellphone: Organic Light-Emitting Diodes ;   A Light on Physics: F-Number and Exposure Time

Medicine – Medical or pre-health students read about a patient presenting with specific symptoms. Students decide which questions are important to ask the patient in their medical history, how long they have experienced such symptoms, etc. The case unfolds and students use clinical reasoning, propose relevant tests, develop a differential diagnoses and a plan of treatment. Sample cases: The Case of the Crying Baby: Surgical vs. Medical Management ; The Plan: Ethics and Physician Assisted Suicide ; The Haemophilus Vaccine: A Victory for Immunologic Engineering

Public Health – A case study describes a pandemic of a deadly infectious disease. Students work through the case to identify Patient Zero, the person who was the first to spread the disease, and how that individual became infected.  Sample cases: The Protective Parent ; The Elusive Tuberculosis Case: The CDC and Andrew Speaker ; Credible Voice: WHO-Beijing and the SARS Crisis

Law – A case study presents a legal dilemma for which students use problem solving to decide the best way to advise and defend a client. Students are presented information that changes during the case.  Sample cases: Mortgage Crisis Call (abstract) ; The Case of the Unpaid Interns (abstract) ; Police-Community Dialogue (abstract)

Business – Students work on a case study that presents the history of a business success or failure. They apply business principles learned in the classroom and assess why the venture was successful or not. Sample cases: SELCO-Determining a path forward ; Project Masiluleke: Texting and Testing to Fight HIV/AIDS in South Africa ; Mayo Clinic: Design Thinking in Healthcare

Humanities - Students consider a case that presents a theater facing financial and management difficulties. They apply business and theater principles learned in the classroom to the case, working together to create solutions for the theater. Sample cases: David Geffen School of Drama


Finding and Writing Cases

Consider utilizing or adapting open access cases - The availability of open resources and databases containing cases that instructors can download makes this approach even more accessible in the classroom. Two examples of open databases are the Case Center on Public Leadership and Harvard Kennedy School (HKS) Case Program , which focus on government, leadership and public policy case studies.

  • Consider writing original cases - In the event that an instructor is unable to find open access cases relevant to their course learning objectives, they may choose to write their own. See the following resources on case writing: Cooking with Betty Crocker: A Recipe for Case Writing ; The Way of Flesch: The Art of Writing Readable Cases ;   Twixt Fact and Fiction: A Case Writer’s Dilemma ; And All That Jazz: An Essay Extolling the Virtues of Writing Case Teaching Notes .

Implementing Cases

Take baby steps if new to CBL - While entire courses and curricula may involve case-based learning, instructors who desire to implement on a smaller-scale can integrate a single case into their class, and increase the number of cases utilized over time as desired.

Use cases in classes that are small, medium or large - Cases can be scaled to any course size. In large classes with stadium seating, students can work with peers nearby, while in small classes with more flexible seating arrangements, teams can move their chairs closer together. CBL can introduce more noise (and energy) in the classroom to which an instructor often quickly becomes accustomed. Further, students can be asked to work on cases outside of class, and wrap up discussion during the next class meeting.

Encourage collaborative work - Cases present an opportunity for students to work together to solve cases which the historical literature supports as beneficial to student learning (Bruffee, 1993). Allow students to work in groups to answer case questions.

Form diverse teams as feasible - When students work within diverse teams they can be exposed to a variety of perspectives that can help them solve the case. Depending on the context of the course, priorities, and the background information gathered about the students enrolled in the class, instructors may choose to organize student groups to allow for diversity in factors such as current course grades, gender, race/ethnicity, personality, among other items.  

Use stable teams as appropriate - If CBL is a large component of the course, a research-supported practice is to keep teams together long enough to go through the stages of group development: forming, storming, norming, performing and adjourning (Tuckman, 1965).

Walk around to guide groups - In CBL instructors serve as facilitators of student learning. Walking around allows the instructor to monitor student progress as well as identify and support any groups that may be struggling. Teaching assistants can also play a valuable role in supporting groups.

Interrupt strategically - Only every so often, for conversation in large group discussion of the case, especially when students appear confused on key concepts. An effective practice to help students meet case learning goals is to guide them as a whole group when the class is ready. This may include selecting a few student groups to present answers to discussion questions to the entire class, asking the class a question relevant to the case using polling software, and/or performing a mini-lesson on an area that appears to be confusing among students.  

Assess student learning in multiple ways - Students can be assessed informally by asking groups to report back answers to various case questions. This practice also helps students stay on task, and keeps them accountable. Cases can also be included on exams using related scenarios where students are asked to apply their knowledge.

Barrows HS. (1996). Problem-based learning in medicine and beyond: a brief overview. New Directions for Teaching and Learning, 68, 3-12.  

Bonney KM. (2015). Case Study Teaching Method Improves Student Performance and Perceptions of Learning Gains. Journal of Microbiology and Biology Education, 16(1): 21-28.

Breslin M, Buchanan, R. (2008) On the Case Study Method of Research and Teaching in Design.  Design Issues, 24(1), 36-40.

Bruffee KS. (1993). Collaborative learning: Higher education, interdependence, and authority of knowledge. Johns Hopkins University Press, Baltimore, MD.

Herreid CF. (2013). Start with a Story: The Case Study Method of Teaching College Science, edited by Clyde Freeman Herreid. Originally published in 2006 by the National Science Teachers Association (NSTA); reprinted by the National Center for Case Study Teaching in Science (NCCSTS) in 2013.

Herreid CH. (1994). Case studies in science: A novel method of science education. Journal of Research in Science Teaching, 23(4), 221–229.

Jonassen DH and Hernandez-Serrano J. (2002). Case-based reasoning and instructional design: Using stories to support problem solving. Educational Technology, Research and Development, 50(2), 65-77.  

Kosfeld M, Heinrichs M, Zak PJ, Fischbacher U, Fehr E. (2005). Oxytocin increases trust in humans. Nature, 435, 673-676.

Krain M. (2016) Putting the learning in case learning? The effects of case-based approaches on student knowledge, attitudes, and engagement. Journal on Excellence in College Teaching, 27(2), 131-153.

Lee V. (2012). What is Inquiry-Guided Learning?  New Directions for Learning, 129:5-14.

Nkhoma M, Sriratanaviriyakul N. (2017). Using case method to enrich students’ learning outcomes. Active Learning in Higher Education, 18(1):37-50.

Srinivasan et al. (2007). Comparing problem-based learning with case-based learning: Effects of a major curricular shift at two institutions. Academic Medicine, 82(1): 74-82.

Thistlethwaite JE et al. (2012). The effectiveness of case-based learning in health professional education. A BEME systematic review: BEME Guide No. 23.  Medical Teacher, 34, e421-e444.

Tuckman B. (1965). Development sequence in small groups. Psychological Bulletin, 63(6), 384-99.

Williams B. (2005). Case-based learning - a review of the literature: is there scope for this educational paradigm in prehospital education? Emerg Med, 22, 577-581.

Zak, PJ (2013). How Stories Change the Brain. Retrieved from:


case studies in teacher education

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  • Teaching with Cases

At professional schools (like Harvard’s Law, Business, Education, or Medical Schools), courses often adopt the so-called "case method" of teaching , in which students are confronted with real-world problems or scenarios involving multiple stakeholders and competing priorities. Most of the cases which faculty use with their students are written by professionals who have expertise in researching and writing in that genre, and for good reason—writing a truly masterful case, one which can engage students in hours of debate and deliberation, takes a lot of time and effort. It can be effective, nevertheless, for you to try implementing some aspects of the case-teaching approach in your class. Among the benefits which accrue to using case studies are the following:

  • the fact that it gives your students the opportunity to "practice" a real-world application;
  • the fact that it compels them (and you!) to reconstruct all of the divergent and convergent perspectives which different parties might bring to the scenario;
  • the fact that it motivates your students to anticipate a wide range of possible responses which a reader might have; and
  • the fact that it invites your students to indulge in metacognition as they revisit the process by which they became more knowledgeable about the scenario.

Features of an Effective Teaching Case

Case Cards

While no two case studies will be exactly alike, here are some of those principles:

  • The case should illustrate what happens when a concept from the course could be, or has been, applied in the real world. Depending on the course, a “concept” might mean any one among a range of things, including an abstract principle, a theory, a tension, an issue, a method, an approach, or simply a way of thinking characteristic of an academic field. Whichever you choose, you should make sure to “ground” the case in a realistic setting early in the narrative, so that participants understand their role in the scenario.
  • The case materials should include enough factual content and context to allow students to explore multiple perspectives. In order for participants to feel that they are encountering a real-world application of the course material, and that they have some freedom and agency in terms of how they interpret it, they need to be able to see the issue or problem from more than one perspective. Moreover, those perspectives need to seem genuine, and to be sketched in enough detail to seem complex. (In fact, it’s not a bad idea to include some “extraneous” information about the stakeholders involved in the case, so that students have to filter out things that seem relevant or irrelevant to them.) Otherwise, participants may fall back on picking obvious “winners” and “losers” rather than seeking creative, negotiated solutions that satisfy multiple stakeholders.
  • The case materials should confront participants with a range of realistic constraints, hard choices, and authentic outcomes. If the case presumes that participants will all become omniscient, enjoy limitless resources, and succeed, they won’t learn as much about themselves as team-members and decision-makers as if they are forced to confront limitations, to make tough decisions about priorities, and to be prepared for unexpected results. These constraints and outcomes can be things which have been documented in real life, but they can also be things which the participants themselves surface in their deliberations.

Kay Merseth

  • The activity should include space to reflect upon the decision-making process and the lessons of the case. Writing a case offers an opportunity to engage in multiple layers of reflection. For you, as the case writer, it is an occasion to anticipate how you (if you were the instructor) might create scenarios that are aligned with, and likely to meet the learning objectives of, a given unit of your course. For the participants whom you imagine using your case down the road, the case ideally should help them (1) to understand their own hidden assumptions, priorities, values, and biases better; and (2) to close the gap between their classroom learning and its potential real-world applications.

For more information...

Kim, Sara et al. 2006. "A Conceptual Framework for Developing Teaching Cases: A Review and Synthesis of the Literature across Disciplines." Medical Education 40: 867–876.

Herreid, Clyde Freeman. 2011. "Case Study Teaching." New Directions for Teaching and Learning 128: 31–40.

Nohria, Nitin. 2021. "What the Case Study Method Really Teaches." Harvard Business Review .

Swiercz, Paul Michael. "SWIF Learning: A Guide to Student Written-Instructor Facilitated Case Writing."

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In This Article Expand or collapse the "in this article" section Case Study in Education Research

Introduction, general overview and foundational texts of the late 20th century.

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Case Study in Education Research by Lorna Hamilton LAST REVIEWED: 21 April 2021 LAST MODIFIED: 27 June 2018 DOI: 10.1093/obo/9780199756810-0201

It is important to distinguish between case study as a teaching methodology and case study as an approach, genre, or method in educational research. The use of case study as teaching method highlights the ways in which the essential qualities of the case—richness of real-world data and lived experiences—can help learners gain insights into a different world and can bring learning to life. The use of case study in this way has been around for about a hundred years or more. Case study use in educational research, meanwhile, emerged particularly strongly in the 1970s and 1980s in the United Kingdom and the United States as a means of harnessing the richness and depth of understanding of individuals, groups, and institutions; their beliefs and perceptions; their interactions; and their challenges and issues. Writers, such as Lawrence Stenhouse, advocated the use of case study as a form that teacher-researchers could use as they focused on the richness and intensity of their own practices. In addition, academic writers and postgraduate students embraced case study as a means of providing structure and depth to educational projects. However, as educational research has developed, so has debate on the quality and usefulness of case study as well as the problems surrounding the lack of generalizability when dealing with single or even multiple cases. The question of how to define and support case study work has formed the basis for innumerable books and discursive articles, starting with Robert Yin’s original book on case study ( Yin 1984 , cited under General Overview and Foundational Texts of the Late 20th Century ) to the myriad authors who attempt to bring something new to the realm of case study in educational research in the 21st century.

This section briefly considers the ways in which case study research has developed over the last forty to fifty years in educational research usage and reflects on whether the field has finally come of age, respected by creators and consumers of research. Case study has its roots in anthropological studies in which a strong ethnographic approach to the study of peoples and culture encouraged researchers to identify and investigate key individuals and groups by trying to understand the lived world of such people from their points of view. Although ethnography has emphasized the role of researcher as immersive and engaged with the lived world of participants via participant observation, evolving approaches to case study in education has been about the richness and depth of understanding that can be gained through involvement in the case by drawing on diverse perspectives and diverse forms of data collection. Embracing case study as a means of entering these lived worlds in educational research projects, was encouraged in the 1970s and 1980s by researchers, such as Lawrence Stenhouse, who provided a helpful impetus for case study work in education ( Stenhouse 1980 ). Stenhouse wrestled with the use of case study as ethnography because ethnographers traditionally had been unfamiliar with the peoples they were investigating, whereas educational researchers often worked in situations that were inherently familiar. Stenhouse also emphasized the need for evidence of rigorous processes and decisions in order to encourage robust practice and accountability to the wider field by allowing others to judge the quality of work through transparency of processes. Yin 1984 , the first book focused wholly on case study in research, gave a brief and basic outline of case study and associated practices. Various authors followed this approach, striving to engage more deeply in the significance of case study in the social sciences. Key among these are Merriam 1988 and Stake 1995 , along with Yin 1984 , who established powerful groundings for case study work. Additionally, evidence of the increasing popularity of case study can be found in a broad range of generic research methods texts, but these often do not have much scope for the extensive discussion of case study found in case study–specific books. Yin’s books and numerous editions provide a developing or evolving notion of case study with more detailed accounts of the possible purposes of case study, followed by Merriam 1988 and Stake 1995 who wrestled with alternative ways of looking at purposes and the positioning of case study within potential disciplinary modes. The authors referenced in this section are often characterized as the foundational authors on this subject and may have published various editions of their work, cited elsewhere in this article, based on their shifting ideas or emphases.

Merriam, S. B. 1988. Case study research in education: A qualitative approach . San Francisco: Jossey-Bass.

This is Merriam’s initial text on case study and is eminently accessible. The author establishes and reinforces various key features of case study; demonstrates support for positioning the case within a subject domain, e.g., psychology, sociology, etc.; and further shapes the case according to its purpose or intent.

Stake, R. E. 1995. The art of case study research . Thousand Oaks, CA: SAGE.

Stake is a very readable author, accessible and yet engaging with complex topics. The author establishes his key forms of case study: intrinsic, instrumental, and collective. Stake brings the reader through the process of conceptualizing the case, carrying it out, and analyzing the data. The author uses authentic examples to help readers understand and appreciate the nuances of an interpretive approach to case study.

Stenhouse, L. 1980. The study of samples and the study of cases. British Educational Research Journal 6:1–6.

DOI: 10.1080/0141192800060101

A key article in which Stenhouse sets out his stand on case study work. Those interested in the evolution of case study use in educational research should consider this article and the insights given.

Yin, R. K. 1984. Case Study Research: Design and Methods . Beverley Hills, CA: SAGE.

This preliminary text from Yin was very basic. However, it may be of interest in comparison with later books because Yin shows the ways in which case study as an approach or method in research has evolved in relation to detailed discussions of purpose, as well as the practicalities of working through the research process.

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Case Method Teaching and Learning

What is the case method? How can the case method be used to engage learners? What are some strategies for getting started? This guide helps instructors answer these questions by providing an overview of the case method while highlighting learner-centered and digitally-enhanced approaches to teaching with the case method. The guide also offers tips to instructors as they get started with the case method and additional references and resources.

On this page:

What is case method teaching.

  • Case Method at Columbia

Why use the Case Method?

Case method teaching approaches, how do i get started.

  • Additional Resources

The CTL is here to help!

For support with implementing a case method approach in your course, email [email protected] to schedule your 1-1 consultation .

Cite this resource: Columbia Center for Teaching and Learning (2019). Case Method Teaching and Learning. Columbia University. Retrieved from [today’s date] from  

Case method 1 teaching is an active form of instruction that focuses on a case and involves students learning by doing 2 3 . Cases are real or invented stories 4  that include “an educational message” or recount events, problems, dilemmas, theoretical or conceptual issue that requires analysis and/or decision-making.

Case-based teaching simulates real world situations and asks students to actively grapple with complex problems 5 6 This method of instruction is used across disciplines to promote learning, and is common in law, business, medicine, among other fields. See Table 1 below for a few types of cases and the learning they promote.

Table 1: Types of cases and the learning they promote.

For a more complete list, see Case Types & Teaching Methods: A Classification Scheme from the National Center for Case Study Teaching in Science.

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Case Method Teaching and Learning at Columbia

The case method is actively used in classrooms across Columbia, at the Morningside campus in the School of International and Public Affairs (SIPA), the School of Business, Arts and Sciences, among others, and at Columbia University Irving Medical campus.

Faculty Spotlight:

Professor Mary Ann Price on Using Case Study Method to Place Pre-Med Students in Real-Life Scenarios

Read more  

Professor De Pinho on Using the Case Method in the Mailman Core

Case method teaching has been found to improve student learning, to increase students’ perception of learning gains, and to meet learning objectives 8 9 . Faculty have noted the instructional benefits of cases including greater student engagement in their learning 10 , deeper student understanding of concepts, stronger critical thinking skills, and an ability to make connections across content areas and view an issue from multiple perspectives 11 . 

Through case-based learning, students are the ones asking questions about the case, doing the problem-solving, interacting with and learning from their peers, “unpacking” the case, analyzing the case, and summarizing the case. They learn how to work with limited information and ambiguity, think in professional or disciplinary ways, and ask themselves “what would I do if I were in this specific situation?”

The case method bridges theory to practice, and promotes the development of skills including: communication, active listening, critical thinking, decision-making, and metacognitive skills 12 , as students apply course content knowledge, reflect on what they know and their approach to analyzing, and make sense of a case. 

Though the case method has historical roots as an instructor-centered approach that uses the Socratic dialogue and cold-calling, it is possible to take a more learner-centered approach in which students take on roles and tasks traditionally left to the instructor. 

Cases are often used as “vehicles for classroom discussion” 13 . Students should be encouraged to take ownership of their learning from a case. Discussion-based approaches engage students in thinking and communicating about a case. Instructors can set up a case activity in which students are the ones doing the work of “asking questions, summarizing content, generating hypotheses, proposing theories, or offering critical analyses” 14 . 

The role of the instructor is to share a case or ask students to share or create a case to use in class, set expectations, provide instructions, and assign students roles in the discussion. Student roles in a case discussion can include: 

  • discussion “starters” get the conversation started with a question or posing the questions that their peers came up with; 
  • facilitators listen actively, validate the contributions of peers, ask follow-up questions, draw connections, refocus the conversation as needed; 
  • recorders take-notes of the main points of the discussion, record on the board, upload to CourseWorks, or type and project on the screen; and 
  • discussion “wrappers” lead a summary of the main points of the discussion. 

Prior to the case discussion, instructors can model case analysis and the types of questions students should ask, co-create discussion guidelines with students, and ask for students to submit discussion questions. During the discussion, the instructor can keep time, intervene as necessary (however the students should be doing the talking), and pause the discussion for a debrief and to ask students to reflect on what and how they learned from the case activity. 

Note: case discussions can be enhanced using technology. Live discussions can occur via video-conferencing (e.g., using Zoom ) or asynchronous discussions can occur using the Discussions tool in CourseWorks (Canvas) .

Table 2 includes a few interactive case method approaches. Regardless of the approach selected, it is important to create a learning environment in which students feel comfortable participating in a case activity and learning from one another. See below for tips on supporting student in how to learn from a case in the “getting started” section and how to create a supportive learning environment in the Guide for Inclusive Teaching at Columbia . 

Table 2. Strategies for Engaging Students in Case-Based Learning

Approaches to case teaching should be informed by course learning objectives, and can be adapted for small, large, hybrid, and online classes. Instructional technology can be used in various ways to deliver, facilitate, and assess the case method. For instance, an online module can be created in CourseWorks (Canvas) to structure the delivery of the case, allow students to work at their own pace, engage all learners, even those reluctant to speak up in class, and assess understanding of a case and student learning. Modules can include text, embedded media (e.g., using Panopto or Mediathread ) curated by the instructor, online discussion, and assessments. Students can be asked to read a case and/or watch a short video, respond to quiz questions and receive immediate feedback, post questions to a discussion, and share resources. 

For more information about options for incorporating educational technology to your course, please contact your Learning Designer .

To ensure that students are learning from the case approach, ask them to pause and reflect on what and how they learned from the case. Time to reflect  builds your students’ metacognition, and when these reflections are collected they provides you with insights about the effectiveness of your approach in promoting student learning.

Well designed case-based learning experiences: 1) motivate student involvement, 2) have students doing the work, 3) help students develop knowledge and skills, and 4) have students learning from each other.  

Designing a case-based learning experience should center around the learning objectives for a course. The following points focus on intentional design. 

Identify learning objectives, determine scope, and anticipate challenges. 

  • Why use the case method in your course? How will it promote student learning differently than other approaches? 
  • What are the learning objectives that need to be met by the case method? What knowledge should students apply and skills should they practice? 
  • What is the scope of the case? (a brief activity in a single class session to a semester-long case-based course; if new to case method, start small with a single case). 
  • What challenges do you anticipate (e.g., student preparation and prior experiences with case learning, discomfort with discussion, peer-to-peer learning, managing discussion) and how will you plan for these in your design? 
  • If you are asking students to use transferable skills for the case method (e.g., teamwork, digital literacy) make them explicit. 

Determine how you will know if the learning objectives were met and develop a plan for evaluating the effectiveness of the case method to inform future case teaching. 

  • What assessments and criteria will you use to evaluate student work or participation in case discussion? 
  • How will you evaluate the effectiveness of the case method? What feedback will you collect from students? 
  • How might you leverage technology for assessment purposes? For example, could you quiz students about the case online before class, accept assignment submissions online, use audience response systems (e.g., PollEverywhere) for formative assessment during class? 

Select an existing case, create your own, or encourage students to bring course-relevant cases, and prepare for its delivery

  • Where will the case method fit into the course learning sequence? 
  • Is the case at the appropriate level of complexity? Is it inclusive, culturally relevant, and relatable to students? 
  • What materials and preparation will be needed to present the case to students? (e.g., readings, audiovisual materials, set up a module in CourseWorks). 

Plan for the case discussion and an active role for students

  • What will your role be in facilitating case-based learning? How will you model case analysis for your students? (e.g., present a short case and demo your approach and the process of case learning) (Davis, 2009). 
  • What discussion guidelines will you use that include your students’ input? 
  • How will you encourage students to ask and answer questions, summarize their work, take notes, and debrief the case? 
  • If students will be working in groups, how will groups form? What size will the groups be? What instructions will they be given? How will you ensure that everyone participates? What will they need to submit? Can technology be leveraged for any of these areas? 
  • Have you considered students of varied cognitive and physical abilities and how they might participate in the activities/discussions, including those that involve technology? 

Student preparation and expectations

  • How will you communicate about the case method approach to your students? When will you articulate the purpose of case-based learning and expectations of student engagement? What information about case-based learning and expectations will be included in the syllabus?
  • What preparation and/or assignment(s) will students complete in order to learn from the case? (e.g., read the case prior to class, watch a case video prior to class, post to a CourseWorks discussion, submit a brief memo, complete a short writing assignment to check students’ understanding of a case, take on a specific role, prepare to present a critique during in-class discussion).

Andersen, E. and Schiano, B. (2014). Teaching with Cases: A Practical Guide . Harvard Business Press. 

Bonney, K. M. (2015). Case Study Teaching Method Improves Student Performance and Perceptions of Learning Gains†. Journal of Microbiology & Biology Education , 16 (1), 21–28.

Davis, B.G. (2009). Chapter 24: Case Studies. In Tools for Teaching. Second Edition. Jossey-Bass. 

Garvin, D.A. (2003). Making the Case: Professional Education for the world of practice. Harvard Magazine. September-October 2003, Volume 106, Number 1, 56-107.

Golich, V.L. (2000). The ABCs of Case Teaching. International Studies Perspectives. 1, 11-29. 

Golich, V.L.; Boyer, M; Franko, P.; and Lamy, S. (2000). The ABCs of Case Teaching. Pew Case Studies in International Affairs. Institute for the Study of Diplomacy. 

Heath, J. (2015). Teaching & Writing Cases: A Practical Guide. The Case Center, UK. 

Herreid, C.F. (2011). Case Study Teaching. New Directions for Teaching and Learning. No. 128, Winder 2011, 31 – 40. 

Herreid, C.F. (2007). Start with a Story: The Case Study Method of Teaching College Science . National Science Teachers Association. Available as an ebook through Columbia Libraries. 

Herreid, C.F. (2006). “Clicker” Cases: Introducing Case Study Teaching Into Large Classrooms. Journal of College Science Teaching. Oct 2006, 36(2).  

Krain, M. (2016). Putting the Learning in Case Learning? The Effects of Case-Based Approaches on Student Knowledge, Attitudes, and Engagement. Journal on Excellence in College Teaching. 27(2), 131-153. 

Lundberg, K.O. (Ed.). (2011). Our Digital Future: Boardrooms and Newsrooms. Knight Case Studies Initiative. 

Popil, I. (2011). Promotion of critical thinking by using case studies as teaching method. Nurse Education Today, 31(2), 204–207.

Schiano, B. and Andersen, E. (2017). Teaching with Cases Online . Harvard Business Publishing. 

Thistlethwaite, JE; Davies, D.; Ekeocha, S.; Kidd, J.M.; MacDougall, C.; Matthews, P.; Purkis, J.; Clay D. (2012). The effectiveness of case-based learning in health professional education: A BEME systematic review . Medical Teacher. 2012; 34(6): e421-44. 

Yadav, A.; Lundeberg, M.; DeSchryver, M.; Dirkin, K.; Schiller, N.A.; Maier, K. and Herreid, C.F. (2007). Teaching Science with Case Studies: A National Survey of Faculty Perceptions of the Benefits and Challenges of Using Cases. Journal of College Science Teaching; Sept/Oct 2007; 37(1). 

Weimer, M. (2013). Learner-Centered Teaching: Five Key Changes to Practice. Second Edition. Jossey-Bass.

Additional resources 

Teaching with Cases , Harvard Kennedy School of Government. 

Features “what is a teaching case?” video that defines a teaching case, and provides documents to help students prepare for case learning, Common case teaching challenges and solutions, tips for teaching with cases. 

Promoting excellence and innovation in case method teaching: Teaching by the Case Method , Christensen Center for Teaching & Learning. Harvard Business School. 

National Center for Case Study Teaching in Science . University of Buffalo. 

A collection of peer-reviewed STEM cases to teach scientific concepts and content, promote process skills and critical thinking. The Center welcomes case submissions. Case classification scheme of case types and teaching methods:

  • Different types of cases: analysis case, dilemma/decision case, directed case, interrupted case, clicker case, a flipped case, a laboratory case. 
  • Different types of teaching methods: problem-based learning, discussion, debate, intimate debate, public hearing, trial, jigsaw, role-play. 

Columbia Resources

Resources available to support your use of case method: The University hosts a number of case collections including: the Case Consortium (a collection of free cases in the fields of journalism, public policy, public health, and other disciplines that include teaching and learning resources; SIPA’s Picker Case Collection (audiovisual case studies on public sector innovation, filmed around the world and involving SIPA student teams in producing the cases); and Columbia Business School CaseWorks , which develops teaching cases and materials for use in Columbia Business School classrooms.

Center for Teaching and Learning

The Center for Teaching and Learning (CTL) offers a variety of programs and services for instructors at Columbia. The CTL can provide customized support as you plan to use the case method approach through implementation. Schedule a one-on-one consultation. 

Office of the Provost

The Hybrid Learning Course Redesign grant program from the Office of the Provost provides support for faculty who are developing innovative and technology-enhanced pedagogy and learning strategies in the classroom. In addition to funding, faculty awardees receive support from CTL staff as they redesign, deliver, and evaluate their hybrid courses.

The Start Small! Mini-Grant provides support to faculty who are interested in experimenting with one new pedagogical strategy or tool. Faculty awardees receive funds and CTL support for a one-semester period.

Explore our teaching resources.

  • Blended Learning
  • Contemplative Pedagogy
  • Inclusive Teaching Guide
  • FAQ for Teaching Assistants
  • Metacognition

CTL resources and technology for you.

  • Overview of all CTL Resources and Technology
  • The origins of this method can be traced to Harvard University where in 1870 the Law School began using cases to teach students how to think like lawyers using real court decisions. This was followed by the Business School in 1920 (Garvin, 2003). These professional schools recognized that lecture mode of instruction was insufficient to teach critical professional skills, and that active learning would better prepare learners for their professional lives. ↩
  • Golich, V.L. (2000). The ABCs of Case Teaching. <i>International Studies Perspectives. </i>1, 11-29. ↩
  • </span><span style="font-weight: 400;">Herreid, C.F. (2007). </span><i><span style="font-weight: 400;">Start with a Story: The Case Study Method of Teaching College Science</span></i><span style="font-weight: 400;">. National Science Teachers Association. Available as an </span><a href=""><span style="font-weight: 400;">ebook</span></a><span style="font-weight: 400;"> through Columbia Libraries. ↩
  • Davis, B.G. (2009). Chapter 24: Case Studies. In <i>Tools for Teaching. </i>Second Edition. Jossey-Bass. ↩
  • Andersen, E. and Schiano, B. (2014). <i>Teaching with Cases: A Practical Guide</i>. Harvard Business Press. ↩
  • Lundberg, K.O. (Ed.). (2011). <i>Our Digital Future: Boardrooms and Newsrooms. </i>Knight Case Studies Initiative. ↩
  • Heath, J. (2015). <i>Teaching & Writing Cases: A Practical Guide. </i>The Case Center, UK. ↩
  • Bonney, K. M. (2015). Case Study Teaching Method Improves Student Performance and Perceptions of Learning Gains†. <i>Journal of Microbiology & Biology Education</i>, <i>16</i>(1), 21–28.<a href=""></a> ↩
  • Krain, M. (2016). Putting the Learning in Case Learning? The Effects of Case-Based Approaches on Student Knowledge, Attitudes, and Engagement. <i>Journal on Excellence in College Teaching. </i>27(2), 131-153. ↩
  • Thistlethwaite, JE; Davies, D.; Ekeocha, S.; Kidd, J.M.; MacDougall, C.; Matthews, P.; Purkis, J.; Clay D. (2012). <a href="">The effectiveness of case-based learning in health professional education: A BEME systematic review</a>. <i>Medical Teacher.</i> 2012; 34(6): e421-44. ↩
  • Yadav, A.; Lundeberg, M.; DeSchryver, M.; Dirkin, K.; Schiller, N.A.; Maier, K. and Herreid, C.F. (2007). Teaching Science with Case Studies: A National Survey of Faculty Perceptions of the Benefits and Challenges of Using Cases. <i>Journal of College Science Teaching; </i>Sept/Oct 2007; 37(1). ↩
  • Popil, I. (2011). Promotion of critical thinking by using case studies as teaching method. Nurse Education Today, 31(2), 204–207. <a href=""></a> ↩
  • Weimer, M. (2013). Learner-Centered Teaching: Five Key Changes to Practice. Second Edition. Jossey-Bass. ↩
  • Herreid, C.F. (2006). “Clicker” Cases: Introducing Case Study Teaching Into Large Classrooms. <i>Journal of College Science Teaching. </i>Oct 2006, 36(2). <a href=""></a> ↩
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Comparative case study methodology and teacher education.

  • Meera Pathmarajah Meera Pathmarajah University of San Francisco
  • Published online: 30 September 2019

Case study researchers have traditionally focused on micro-level analysis of a “bounded” case, yet this approach has come under methodological scrutiny in a world where phenomena are rarely isolated from globalization’s expansive reach. Social science and policy-oriented research in particular are nearly always subject to local and global histories as well as socio-cultural, political, and economic trends. Furthermore, the experience of individuals, organizations, and institutions are often tangled in interconnected webs of influence, such that a case study that does not trace these underlying relationships is likely to be analyzing only the tip of a phenomenological iceberg. Hence critical scholars call for the need to repurpose traditional case study research methods to embrace shifting contextual factors that surround a research project at multiple levels. Comparative case study methods answer this call by making socio-cultural and political analysis an explicit part of the research process. They expand the researcher’s methodological lens by advancing the analysis of processes across three axes: the horizontal (through distinct research sites), the vertical (through scales; e.g., local vs national) and the transversal (over time; e.g., historically). The methodology is particularly useful for social science research and policy studies, where complex interactions between actors and institutions are tied to socio-cultural, political, and economic contexts. Teacher education research is an area where comparative case studies can potentially contribute to policy formulation. Using the example of case study research on teacher education in India, the comparative case study methodology is shown to be an effective research tool. Through insights into the socio-cultural and political context surrounding pedagogical reform, case study research can generate corrective measures to improve policy effectiveness.

  • qualitative methods
  • teacher education
  • learner-centered pedagogy
  • research methods
  • ethnography
  • comparative case study research
  • constructivism

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Case Study Analysis in the Classroom

Case Study Analysis in the Classroom Becoming a Reflective Teacher

  • Renee W. Campoy - Murray State University, USA
  • Description

" Case Study Analysis in the Classroom encourages students to consider best practices in teaching and to solve problems concerning students who are gifted, underachieving, resistant to classroom learning, or who have special needs. This book is a valuable way to introduce students to the complex world of teaching and learning." –Arthur T. Costigan, Queen's College, City University of New York

Stories of students in need, or of teachers who are struggling, draw readers into the process of solving classroom problems in a manner that traditional textbook formats are unable to match. Presented in an engaging and stimulating manner, Case Study Analysis in the Classroom: Becoming a Reflective Teacher provides beginning teachers a variety of typical classroom problems to analyze and solve. Solving the case study problems helps new teachers develop the knowledge bases they need to solve real problems in their own classrooms. More than a book of cases, it is an important starting point for students learning about case study research, especially the analysis of cases and their potential uses in the classroom. In addition, readers will also be guided through the process of reflective problem solving, developing an educational philosophy, and writing their own case studies.

Author Renee Campoy has written cases that tackle challenging and controversial problems. Her approach rests on the foundation that authentic learning and growth are best achieved through ideas that challenge assumptions and preconceived notions about education. A matrix of case studies is included that groups the cases by grade level, case focus, and primary educational topic, allowing students and instructors at all levels to customize their use of the book. Case study topics include

* Low academic achievement * Learning disabilities * Low motivation * Misbehaving and disruptive students * Reluctant readers * High-stakes assessment * Inappropriate scaffolding * Cultural conflict * Socioeconomic issues * Attention deficit/hyperactive disorder * Parent conferences * Bilingual education

To support the problem solving process, each case study includes a rubric that provides feedback to the reader about the quality of their solution. The rubric is research based and written according to the King and Kitchener model of reflective judgment. This approach encourages teachers to apply their classroom experiences, knowledge of content, and understanding of learning theory during classroom problem solving.

Case Study Analysis in the Classroom is well suited as a text for courses throughout education curricula, including educational foundations, research methods, field experience and practicum, and instructional strategies courses. It will also be an invaluable desk reference for practicing teachers and administrators who need additional guidance on classroom problem solving.

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  • The book provides examples of case studies for analysis and a structure that the reader can use to develop his or her own classroom case studies.
  • The overall focus of the book is on teacher education as a process in which the pre-service teacher constructs a personal educational practice that is constantly evolving (as opposed to learning a set formula that can be applied in the classroom).
  • The case studies included in the work provide a rich source of material for discussion in education classrooms.
  • End-of-chapter strategy sheets, writing activities, quizzes, and other instructional activities help the reader integrate the chapter material into his or her teaching.
  • Campoy writes in a supportive and sometimes humorous tone that does not intimidate the reader; the "we've all been there" style assures the pre-service reader that she or he can become a reflective practitioner and teaching professional.

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case studies in teacher education

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case studies in teacher education

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Encyclopedia of Teacher Education pp 1–6 Cite as

Teaching Case Study Methods in Comparative Education

  • Lesley Bartlett 2 ,
  • Diana Famakinwa 2 &
  • Regina Fuller 2  
  • Living reference work entry
  • First Online: 14 September 2019

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What are the limitations in how case studies are conceptualized and conducted in the field of Comparative and International Education? How may comparative case studies address those limitations? This entry addresses those questions, reviews the basic tenets of comparative case studies, and offers two examples of CCS to show the opportunities and constraints of the methodological approach. The entry concludes with implications for teaching case study methods in comparative education.

Case Studies and Comparison

Case studies are widely used in educational research and by scholars who embrace very different epistemological positions. However, the methodological literature on case studies does not reflect these divergent theories of knowledge. While those working in the neo- or post-positivist paradigm may emulate social science traditions, other qualitative approaches on the continuum of paradigms, particularly critical and constructivist ones, adhere to a more inductive...

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Bartlett, L., & Vavrus, F. (2017). Rethinking case study research: A comparative approach . New York: Routledge.

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Maxwell, J. (2013). Qualitative research design: An interactive approach . Thousand Oaks: Sage.

Merriam, S. (2009). Qualitative research: A guide to design and implementation . San Francisco: Jossey-Bass.

Stake, R. (1994). The art of case study research . Thousand Oaks: Sage.

Stake, R. (2003). Case studies. In N. K. Denzin & Y. S. Lincoln (Eds.), Strategies of qualitative inquiry (2nd ed., pp. 134–164). Thousand Oaks: Sage.

Vavrus, F., & Bartlett, L. (2009). Critical approaches to comparative education . New York: Palgrave Macmillan.

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Yin, R. (2014). Case study research (5th ed.). Thousand Oaks: Sage.

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Lesley Bartlett, Diana Famakinwa & Regina Fuller

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Bartlett, L., Famakinwa, D., Fuller, R. (2019). Teaching Case Study Methods in Comparative Education. In: Peters, M. (eds) Encyclopedia of Teacher Education. Springer, Singapore.

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Received : 21 March 2019

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  • Published: 15 February 2024

Virtual reality cricothyrotomy - a case-control study on gamification in emergency education

  • I Speck 1 ,
  • V Burkhardt 1 ,
  • Flayyih O 2 ,
  • C Huber 2 ,
  • A Widder 1 ,
  • F Everad 1 &
  • C Offergeld 1  

BMC Medical Education volume  24 , Article number:  148 ( 2024 ) Cite this article

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Metrics details

Cricothyrotomy is an invasive and rare emergency intervention to secure the airway in a “cannot intubate, cannot ventilate” situation. This leads to lack of routine. Cricothyrotomy is performed only hesitantly. Therefore, we aim to improve teaching by including a virtual reality (VR) cricothyrotomy as a learning tool.

We programmed the VR cricothyrotomy in the C# programming language on the open-source Unity platform. We could include 149 students that we randomly assigned to either a study group (VR cricothyrotomy) or control group (educational video). We asked the study group to subjectively rate the VR cricothyrotomy. To evaluate our intervention (VR cricothyrotomy) we took the time participants needed to perform a cricothyrotomy on a plastic model of a trachea and evaluated the correct procedural steps.

The majority of students that performed the VR simulation agreed that they improved in speed (81%) and procedural steps (92%). All participants completed the cricothyrotomy in 47s ± 16s and reached a total score of 8.7 ± 0.7 of 9 possible points. We saw no significant difference in time needed to perform a cricothyrotomy between study and control group ( p  > 0.05). However, the total score of correct procedural steps was significantly higher in the study group than in the control group ( p  < 0.05).


Virtual reality is an innovative learning tool to improve teaching of emergency procedures. The VR cricothyrotomy subjectively and objectively improved correct procedural steps. Digitized education fills an educational gap between pure haptic experience and theoretical knowledge. This is of great value when focusing on extension of factual knowledge.

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DRKS00031736, registered on the 20th April 2023.

Peer Review reports

The cricothyrotomy is an invasive measure in emergency medicine to secure the airway. If all previous attempts to manage the airway, such as mask ventilation or intubation (“cannot intubate, cannot ventilate”) fail a cricothyrotomy must be performed to secure ventilation [ 1 ]. The target structure is the cricothyroid ligament, which connects the thyroid cartilage and the cricoid cartilage.

Since cricothyrotomy is a rare intervention [ 2 ] and is only performed as an emergency procedure, it is difficult to teach and learn how to perform this intervention. Cricothyrotomy is performed only hesitantly despite indication, as routine is often lacking and people tend to shy away from surgical interventions [ 1 ]. It is therefore even more important to teach and learn cricothyrotomy in the best possible way.

At the University of Freiburg, the procedure of open cricothyrotomy has been taught after theoretical introduction on a pig trachea, over which an artificial skin made of sponge rubber (MEYCO® Moosipren, Germany) is stretched (Fig.  1 ). The puncture cricothyrotomy procedure is practiced on plastic trachea models (VBM Medizintechnik GmBH, Frova Crico-Trainer, Germany) also covered with sponge rubber.

figure 1

Course of study interventions

However, these practical exercises only reflect the emergency situation of a cricothyrotomy to a limited extent. It is practiced in a calm atmosphere, without time pressure, and without representation of an affected person. Therefore, we extended the current curriculum by a virtual reality (VR) simulation of a cricothyrotomy. In the VR simulation, the cricothyrotomy is performed on a virtual patient within a time limit of 2 min.

To elevate the learning outcome of the VR simulation we included elements of gamification; the use of elements from the video game industry in a completely different context [ 3 ]. However, the goal of gamification is not to offer a game, but to achieve a greater learning effect using strategies from the gaming industry [ 4 ].

The number of studies on gamification is still insufficient especially in the field of Otorhinolaryngology and several authors recommend that further studies should be conducted [ 5 , 6 ]. A recent survey of 2021 from Favier et al. [ 7 ] investigated the current use of simulation-based skill training in otolaryngology curricula all over the world. The results regarding the most acquired skills for young otolaryngologist residents yielded tracheotomy (50.4%), emergency cricothyrotomy (48.9%) and rigid bronchoscopy (47.5%). This depicts the need of a VR training of an emergency cricothyrotomy in an otolaryngologist curriculum.

We therefore aimed to examine the subjective and objective implications of a VR cricothyrotomy as an additional teaching tool in the curriculum of students of human medicine.

VR cricothyrotomy

The VR cricothyrotomy was programmed in the C# programming language on the open-source Unity platform ( ). The virtual environment is designed through the Blender program ( ), which is an open-source program for three-dimensional objects, through which many three-dimensional models can be designed in the virtual world (e.g. medical tools, healthcare rooms, etc…). Using the open-source Steam VR extension we created the system for holding 3D objects. In this scenario, a virtual patient is essential, and therefore we applied the makehuman program ( ). “Make human community” is an open-source program in which virtual humans of any age or shape can be designed in a very detailed way. The virtual patient was exported to the Blender program. Additionally, we implemented a point system rating the intervention of the participant during the VR cricothyrotomy.

During the VR cricothyrotomy scenario the participants were located in a VR room that contained a tray with medical supplies (Fig.  2 A), a patient in a “cannot intubate, cannot ventilate” situation (Fig.  2 B), and a poster board to control the scenario (Fig.  2 C).

figure 2

Virtual reality room

The participants have 2 min time to perform the following steps: (A) palpation of the throat, (B) vertical skin incision, (C) horizontal severance of the cricothyroid ligament, (D) keep the trachea open with the handle of the scalpel, (E) insertion of endotracheal tube, (F) ventilation (Supplement 1 ).

The total score was 100 points. Errors in the cricothyrotomy procedure were punished with loss of points: -10 points for hand disinfection, -10 points for using gloves, -10 points for reading patient history, -10 points for horizontal skin incision, -30 points for vertical incision of the cricothyroid ligament, and − 40 points for failing to keep the trachea open with the handle of the scalpel.

Participants and study interventions

We could include 149 students of human medicine of 178 students participating in the summer term 2023. The included students all studied in the 4th medical school year. Additional information, like age or gender, were not collected. All students underwent the educational stations concerning open cricothyrotomy, puncture cricothyrotomy, tracheostomy management and epistaxis (Fig.  1 ). The participants were randomly assigned to either a study group or control group (Fig.  3 ).

figure 3

Course of study interventions for study group and control group

The study group was asked to evaluate the VR cricothyrotomy with a questionnaire based on the Münster questionnaire for evaluation - additional module role-playing games (Table  1 ) [ 8 ]. The control group watched an educational video including the following information: (1) indication of cricothyrotomy, (2) steps of cricothyrotomy, (3) possible sources of error, and (4) videos of VR cricothyrotomy.

Both groups were tested on puncture cricothyrotomy and open cricothyrotomy two days after intervention (VR simulation or educational video). The puncture cricothyrotomy was performed on the plastic model of a trachea (VBM Medizintechnik GmBH, Frova Crico-Trainer, Germany) covered with a beige foam rubber (MEYCO® Moosipren, Germany) used during training. We took the time participants needed to perform the puncture cricothyrotomy and evaluated the correct procedural steps. Participants were asked to describe the steps performed while doing them. Every correctly performed step equalled one point: (1) choosing the puncture set, (2) palpation of the throat, (3) identification of the thyroid cartilage, (4) identification of the cricoid cartilage, (5) identification of the cricothyroid ligament, (6) puncture of the trachea, and (7) ventilation. The open cricothyrotomy was simulated on a laminated sheet of paper showing the larynx. The participants were instructed to draw the alignment of the skin incision (vertical) and the severance of the cricothyroid ligament (horizontal). Each correct alignment was awarded with one point. The total score from both assignments was 9 points.

Statistical analysis

We performed statistical data analysis with the statistics program Gnu R (Version 2022.12.0). We applied the Shapiro-Wilk test to determine whether the data has been drawn from a normally distributed population. As a normal distribution was not present, we used Wilcoxon signed rank tests. To investigate the objective benefit we compared the total score and time between participants in the study and control group. In addition, we calculated the correlation between time and subjective improvement of time (Q5) and total score and subjective improvement of procedure (Q6) as well as transfer of theoretical knowledge (Q1). To validate the impact of gaming experience we compared time and total score between subjects with and without gaming experience, using Wilcoxon signed rank tests.


The majority of students (Q1: 96%, n  = 71) that performed the VR simulation very strongly agreed, strongly agreed or agreed with the statement: “I was able to transfer my theoretical knowledge of performing a cricothyrotomy to the VR simulation” (Fig.  4 ). Most students very strongly agreed, strongly agreed or agreed that the task was clear (Q2: 97%, n  = 72), that the goals were made clear (Q3: 100%, n  = 74) and that the feedback was useful (Q9: 92%, n  = 68). Improvement in speed (Q5: 81%, n  = 60) and procedure (Q6: 92%, n  = 68) was subjectively achieved by most students. Approximately two thirds of the students thought that the VR simulation was realistic (Q8: 65%, n  = 48), whereas approximately a quarter of the students perceived the VR simulation as unrealistic (Q8: 22%, n  = 16).

figure 4

Evaluation of VR simulation

Objective results

Our participants completed the puncture cricothyrotomy in 47s ± 16s and reached a total score of 8.7 ± 0.7 of 9 possible points.

The study group needed less time to perform the puncture cricothyrotomy than the control group (study group: 44s ± 15s vs. control group: 50s ± 17s). This difference only reached trend levels ( p  = 0.09). The time was not correlated with the subjective improvement of time through the VR simulation (Q5) in the study group ( p  > 0.05, r 2 =-0.07).

The study group reached a higher total score in the cricothyrotomy than the control group (study group: 8.9 ± 0.4 vs. control group: 8.5 ± 0.9). The difference reached statistical significance ( p  = 0.04, Fig.  5 ). Students of the study group outperformed students of the control group in each category. The score differed on a trend level in the categories: (3) identification of the thyroid cartilage ( p  = 0.08), (5) identification of the Lig. cricothyroideum ( p  = 0.09), and (6) puncture of the trachea ( p  = 0.08). The total score was not significantly correlated with the subjective improvement in procedure (Q6: p  > 0.05 r 2 =-0.14) or transfer of theoretical knowledge (Q1: p  > 0.05 r 2 =-0.11).

figure 5

Total scores of students in the study group and control group

Prior gaming experience did not significantly affect time or total score (both p  > 0.05).

In the present study, we investigated the subjective and objective implications of introducing a VR cricothyrotomy into our curriculum for students of human medicine.

Introducing VR simulation of cricothyrotomy, we saw a significant increase in correct procedural steps performed by the students that received VR cricothyrotomy training compared to students that only watched an educational video (control group). The students in the study group were also faster than the students in the control group – however, this difference did not reach significance. Our results are similar to Sankaranarayanan et al. [ 9 ], who trained a group of 10 medical students with the VAST-CCT (virtual airway skills trainer - cricothyroidotomy) - a virtual reality simulator for training in critical airways. After two weeks of training both groups performed the procedure on a TraumaMan (Simulab, Seattle, Washington). Students in the study group showed faster and better performance in cricothyrotomy compared with the control group [ 9 ]. After training with a VAST-CCT the time improved from 193.2 to 42.1 s. These findings match with ours regarding a better performance of the study group during the puncture cricothyrotomy. However, we did not see a significantly faster performance of the procedure, merely a trend in favor of the study group (44s vs. 50s). This could be explained by the smaller study group ( n  = 10 vs. n  = 75), the longer training set up of two weeks and the comparison of pre- and post-intervention times in the study of Sankaranarayanan et al. [ 9 ]. In the present study we did not test the time on a model of an open cricothyrotomy but on a plastic model of puncture cricothyrotomy. We only tested the open cricothyrotomy on laminated paper limiting our value of the present study. In future studies we plan to perform the testing on either an plastic model for open cricothyrotomy or pig trachea. Additionally the control group of the present study was shown an educational video whereas the control group in the study of Sankaranarayanan et al. [ 9 ] received no intervention. It is to further note, that both our study and our control group are closer to the post-intervention time of (42.1 vs. 44/50s) than the pre-intervention time (139s).

A disadvantage of the VR simulation is the missing haptic input. Therefore, we see the VR simulation as an addition to manikin-based training and training on a pig trachea. Takayesu et al. [ 10 ] showed that cadaver-based training is superior to training on manikins and can reproduce difficult airway situations. Unfortunately, training on cadavers for more than 150 students per semester is not feasible. Therefore, our curriculum only included training on pig trachea.

In our evaluation, the majority of students (very strongly) agreed that the VR simulation improved their speed and procedure of the cricothyrotomy and helped them to transfer theoretical knowledge. This result is in agreement with a survey on 217 medical students in the USA, of which 80% were convinced that video games can have a learning effect and 77% even stated that they would like to use a “multiplayer online healthcare simulation” [ 11 ] in their free time if they could achieve a personal goal. VR is a valuable addition to the field of medical training because it offers a safe and standardized environment [ 5 , 12 , 13 ].

Gaming elements included in VR training should promote and consolidate the transfer of knowledge. Table  2 describes the gaming elements used in the present study and gives reasons for gaming elements not applied in the present study.

We included a point system to give feedback to the VR cricothyrotomy performed by the participant. Additionally, a short storyline was included. As we focused on the particle aspect of the exercise, we did not include theoretical questions in the VR simulation. Another reason to exclude theoretical information is that the VR simulation was integrated into an overall curriculum that contains theoretical background of the cricothyrotomy. If a VR simulation stands alone theoretical information could be included. The VR simulation can be used repeatedly to improve the cricothyrotomy. In this scenario, a progress bar and awards should be included to improve feedback and therefore the learning outcome of the participants. Comparing the time needed in each run could serve as a progress bar of sorts and could also result in an award for the best time achieved. The comparison between participants in form of social interaction could also improve competitiveness between participants and therefore improve the learning experience. However, an overload of gaming element could also distract form the learning outcome. Including more gaming elements, in future studies can show us the importance of each gaming element to the learning outcome.

Virtual reality is an innovative learning tool to improve teaching of emergency procedures. In our study, which matches investigations of others. The VR cricothyrotomy subjectively and objectively improved correct procedural steps. Digitized education fills an educational gap between pure haptic experience and theoretical knowledge. This makes VR a powerful tool to improve traditional teaching methods and increase student motivation and learning outcomes.

Data availability

The datasets analysed during the current study are available from the corresponding author on reasonable request.


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The authors thank the peer students of the Department of Otorhinolaryngology - Head and Neck Surgery and Lukas Gondorf. The author I.S. holds a scholarship from the Berta-Ottenstein-Programme for Clinician Scientists, Faculty of Medicine, University of Freiburg. The Berta-Ottenstein-Programme for Clinician Scientists was not involved in conduction of the research and preparation of the manuscript.

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I Speck, A Merk, V Burkhardt, A Widder, F Everad & C Offergeld

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I.S. helped conceptualize the study, designed the study schedule, created the educational video, helped in data collection, analysed and interpreted the data, and drafted the manuscript.A.M. collected the data, helped in creating the education video, helped in analysing the data and revised the manuscript.V.B. revised the manuscript.O.F. created the virtual reality cricothyrotomy.C.H. helped conceptualize the virtual reality cricothyrotomy and revised the manuscript.A.W. helped conceptualize the virtual reality cricothyrotomy and revised the manuscript.F.L. helped in data collection and revised the manuscript.C.O. conceptualize the study, helped in designing the study schedule, helped in interpreting data, and substantially revised the manuscript.

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The present study was approved by the ethics committee of the University of Freiburg (Application No. 23-1167-S1) and all included participants gave informed written consent before inclusion.

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Speck, I., Merk, A., Burkhardt, V. et al. Virtual reality cricothyrotomy - a case-control study on gamification in emergency education. BMC Med Educ 24 , 148 (2024).

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