Supporting Case-Based Reasoning in Pharmacy Through Case Sequencing

Pharmacists are often required to solve ill-structured problems aimed at achieving optimal health outcomes at the patient, population, and institutional levels. Given the complexity of pharmacists' clinical decisions, educators are exploring ways to foster complex problem-solving and higher order thinking in the classroom. One emerging strategy includes problem-based learning (PBL), which asks learners to collaboratively solve ill-structured cases that are representative of the types of problems faced by practitioners. Case-based reasoning argues that understanding and interpretation of a case is incremental and dynamic; that is, the lessons learned from one case might change in view of new experiences and across a case-based curriculum. While much of the literature is focused on how learners solve a single problem, it is unclear how learners construct their knowledge across multiple cases presented in PBL. To address this gap, this study focused on learners' perception of case sequencing and how that design influenced the development of their internal case library. Because we are focused on formative assessment, we used qualitative analysis to understand the nuances of our design and explored its implications for programmatic changes. The feedback from the participants focused on index generation, index prioritization, alignment with prior knowledge, and reflection. Implications for theory and practice are discussed.