Enhancing hematology education through structured case-based learning and formal assessment: An approach to address learning gaps in clinical training Free

Background: Traditional hematology-oncology clinical education relies heavily on bedside rounds and case discussions. Contemporary challenges including increased patient volumes and time constraints on attendings and learners have created significant limitations in the classic educational model. Educational research demonstrates that case-based learning is the most effective method for clinical knowledge acquisition and retention, yet formal assessment mechanisms for evaluating the extent and effectiveness of case-based learning in hematology-oncology training are notably absent. This gap prevents optimization of educational outcomes and fails to ensure competency development among medical students, residents, and fellows rotating through hematology services.

Purpose: Develop and pilot a structured, evidence-based intervention that enhances case-based learning in hematology-oncology through systematic question generation, formal assessment, and provision of clinical scripts. Long-term objectives include measuring learner engagement, knowledge retention, and problem-solving skill development through this approach.

Methods: We implemented a structured intervention consisting of: (1) Post-rounds identification of key learning topics from current cases; (2) Development of targeted questions addressing knowledge gaps; (3) Next-day 5-minute didactic presentations covering previous day's topics; (4) Distribution of written multiple-choice questions to learners with required responses; (5) Provision of correct answers with detailed explanations; and (6) Development of concise, evidence-based clinical scripts to guide future problem-solving approaches. HIPAA-compliant Doximity platform was used to record information from pre-rounds, rounds with patients, and then used to help generate AI-based multiple-choice questions directed by the attending physician. A comprehensive survey with 11 questions was distributed after the rotation to assess learner perceptions, engagement levels, and educational effectiveness. The intervention was piloted within our hematology-oncology service at the Medical University of South Carolina, involving medical residents and fellows during their clinical rotation on the nonmalignant hematology service.

Results: Average years of rounding experience was 5.6 (range 4-8). Concerns with the current rounding model included feelings of fragmentation (64%) and lack of clear educational objectives (18%). All participants reported improvement in learning with the intervention, achieving an average improvement of 44% (40-60%). Time spent on education increased from 25% (17-37%) to 71% (range 62-92%). Specific components within the intervention were evaluated and rated, including value of multiple-choice questions, summaries of pre-round discussions, and clinical scripts generated, which increased by 32%, 25.8%, and 52%, respectively. Retention of information was documented to increase from a baseline of 46% (range 30-70%) to 71% (range 47-92%) with implementation of the intervention. Qualitative feedback emphasized the importance of clear documentation and record of learning objectives through case-based multiple-choice questions. Additionally, varying styles among attending physicians was noted as a specific concern and created variability in achieving learning objectives. Participants voiced inconsistency and lack of clear expectations for learning in the current system. Many felt that short presentations by team members guided by attending physicians enhanced the learning environment. Concerns over adjusting to this new model potentially eliminating some learner autonomy were also noted.

Conclusions: This study demonstrates that a structured, case-based educational intervention with formal assessment mechanisms can significantly enhance learning outcomes in clinical hematology. The learner feedback and measured improvements in knowledge retention suggest this approach addresses the limitations of traditional bedside teaching approaches. Future studies will focus on large-scale implementation, training attendings, and quantitative knowledge assessment to further validate this approach. This evidence-based educational framework provides a replicable model for enhancing hematology education that can be adapted across different institutional settings and training levels, potentially improving the quality and standardization of hematology education nationwide.