Purpose
Medical education has shifted towards active case-based learning and collaborative team-based problem-solving. However, there is variability in case-based small group learning (SG-CBL) and limited literature on effective designs that balance cognitive load and engagement for medical learners. We developed a rubric using evidenced-based principles for effective SG-CBL from the medical education literature to study preclinical SG-CBL design. The purpose of this abstract is to share the rubric tool, initial validation, and preliminary findings from two specific SG-CBL formats at one institution.

Methods
The rubric developed had a 0-4 rating scale (anchored from 0 [lacks criteria] to 4 [Greater 75% meets criteria]). Six components of effective SG-CBL were evaluated: Accountability (“ACC”, 2 criteria), Active learning/engagement (“AL”, 2 criteria), Cognitive load/complexity (“CL”, 3 criteria), Interdependency (“I-D”, 2 criteria), Feedback (“FB”, 1 criterion) and Time Efficiency (“TF”, 1 criterion). To validate and obtain preliminary findings, the rubric was applied to preclinical SG-CBL design at the Lewis Katz School of Medicine at Temple University). The majority (n=89, SG-CBL) were designs where learners accessed cases/materials before SG-CBL. Seven were clinical reasoning (CR-SG-CBL), where learners did not receive cases before SG-CBL and developed their own learning objectives.

Results
Preclinical SG-CBLs (n=96) were rated. Cronbach’s alpha for internal validation=0.93. Results for ACC showed low scores for individual (median [interquartile range]: 0 [0,0]) and group (1 [1,1]) for both types. The CR-SG-CBL consistently rated higher than SG-CBL, with differences being significantly higher for AL I-D, FB, TF (SG-CBL vs CR-SG-CBL, corrected p<0.05).

Conclusion
The rubric was validated and successfully utilized. Preliminary results support the CR-SG-CBL design had higher cognitive load but more engagement, interdependency, and active learning than SG-CBL, where students received materials before session. Preliminary data support that the rubric is a validated and useful tool to evaluate different types of medical school CBL design.