Purpose
With the rapid growth of medical knowledge, stakeholders in Undergraduate Medical Education recognize the need to shift teaching strategies towards fostering students' skills in self-directed, continuous learning and practical application of knowledge, rather than just memorization. We have developed a new format for clinically contextualized, group-based learning we refer to as Case-Directed Learning (CDL), designed for integration with traditional pedagogies. This was a design-based research project seeking to define optimal characteristics of CDL lessons.

Methods
Over the past year, CDL exercises have been developed and implemented in the first-year pre-clinical curriculum. Medical students (n=120) were asked to complete longitudinal surveys assessing achievement of ARCS (Attention, Relevance, Confidence, Satisfaction) criteria for student development based on CDL participation. Focus groups and directed interviews were conducted with participating students and core faculty involved in CDL delivery to evaluate subjective strengths and areas for improvement in CDL delivery. Finally, summatively assessed deliverables were evaluated to objectively assess achievement of predetermined learning objectives.

Results
Survey results demonstrated significant improvement over two questions (p=0.026, 0.007) in learners’ perceptions within the satisfaction domain over the intervention period, with thematic improvement observed in the attention domain. Summative assessment demonstrated satisfactory achievement of learning objectives, with all student groups achieving passing scores (Mean=95.2%, SD=5.32%). Interviews identified actionable areas for improvement, primarily related to group size and heterogeneity of learner experience while confirming participants’ satisfaction with CDL’s encouragement of critical thinking and social learning skills.

Conclusion
Students and core faculty engaged in CDL were satisfied with this pedagogy’s capacity to encourage deeper and better contextualized learning in the presentation of foundational material regarding basic anatomy and physiology in the pre-clinical curriculum. Overall, CDL appears to represent an effective alternative to existing clinically contextualized pedagogies that can be effectively integrated with traditional pedagogies including lectures and Team-Based Learning activities.