Case-based learning

Spring 2009 ]

Innovative course prepares students to cope with complexity

Imagine yourself as a candidate for the master’s degree in public health at Harvard. Your task: Acquire the skills and leadership traits to solve complex public health issues. Your timeline: Nine or 24 months, depending upon your program. Your goal: A career making the world a better place.

Instead of taking the traditional path of lecture courses in five core areas-environmental health, health services administration, the influence of social behavior on health, biostatistics, and epidemiology-a group of 59 incoming degree candidates opted to pilot an experimental curriculum last fall. Within a single course taught by 10 faculty members at the Harvard School of Public Health (HSPH), these intrepid students explored the same core disciplines in an entirely new way: by devising solutions to the following real-world challenges, presented as “cases”:

spr09CASEjk“I feel I can now use my knowledge in the community I’m serving. In contrast, many of my peers who took the traditional courses in biostatistics and epidemiology say they were learning theories and memorizing formulas but weren’t sure what to do with them. In the case in which we analyzed the risks of covering a dump site with artificial turf, we used a national health database to explore connections between disease and certain chemicals in that turf. Now that I have some practice, I feel I could actually analyze biostatistical data on potential toxin-disease links myself.”
-Justine Kaplan

Slow the epidemic of childhood obesity in the budget-strapped state of California; Halt the trafficking of women and girls as sex slaves in India, a country with high rates of HIV/AIDS; Clarify for a health-conscious public the benefits and risks of eating fish, many species of which are tainted with mercury; Weigh safety and cost concerns when deciding how best to manage a contaminated playing field that had once been the site of a town dump; Guide the Federal Republic of Germany through the design and implementation of major health system reforms.

The pilot course, known as Foundations of Public Health, borrows heavily from the case method of instruction long used at Harvard’s business and public policy schools. The new approach aims to do more than impart facts and theories to students, whose learning style traditionally has been relatively passive.

Says HSPH Dean Julio Frenk: “Our overarching goal is to train students for leadership roles in a complex and interconnected world in which new and unexpected public health problems quickly become shared problems.

“We must adapt our teaching methods to the times. The Foundations course is a bold and, I believe, a highly promising experiment.”

“It is a creative way to engage students in what I believe is the most important goal of public health education: learning how to solve problems,” says former HSPH Dean Barry R. Bloom. Both Bloom and HSPH Dean for Academic Affairs James H. Ware called for a transformation of the master’s degree curriculum in 2006.

spr09CASEme“I think I learned TEN times more practical information in this class than I would have in the traditional course path.At the end of the first module, the childhood obesity case, it was hard to grasp all that we were learning because we were discussing so much in every class and not following a lecture every day. I know many of us wondered whether we would learn all of the important concepts we’d need. Then we presented our projects to each other, and a select number presented via a video connection to public health officials in California who were wrestling with the same problem. Every comment seemed to reiterate something I’d learned in class. My enthusiasm for the course took off from there.
-Melody Eckardt

Learning case-by-case

While many HSPH graduates opt for careers as academics or in research, at least as many others go on to professional positions in government, non-profits, hospitals and health systems, and other organizations. Some of these latter alumni report that, while they valued their HSPH training, they felt initially unprepared for the varied, often messy challenges they faced after graduating.

“Working in teams, public speaking, making decisions when the evidence is ambiguous or inconclusive, persuasive argument, political analysis; what makes a leader, and how does a leader behave?-these are all things our students need to know,” says HSPH Professor of Management Nancy Kane, who shaped and led the Foundations course in her role as associate dean for educational programs. A graduate of Harvard Business School, Kane says the potential benefits of an integrated case-based core curriculum have not been assessed before at a U.S. school of public health, although some schools do offer case-based courses.

In the Foundations course, no student had occasion to sit back while faculty experts lectured. Largely banished were PowerPoint slides. Instead, students did their reading, writing, and work on problem sets outside of class, often working in teams, as practicing professionals must. During two four-hour classes each week, they engaged in instructor-guided discussion and analysis. Class participation counted for 25 percent of their grade.

spr09CASEtj“What I found most helpful was the opportunity to find my voice. Discovering all the disciplines together allowed me to see how public health can work in a holistic way.
The sex trafficking case really brought this out for me. We were to design a program that would make significant impact on the evils of sex trafficking. Everyone had a deep emotional response to the issue. Through discussions with my group on possible actions, and with my classmates about the intricacies of Indian culture, one message jumped out at me: Life brings brokenness for many reasons, but the tools of public health can be combined to uplift whole populations. To give people a second chance.”
-Travis Johnson

Reality check
Students learned from one another, in and out of class. “We sat in the cafeteria for long meetings and hashed out issues in a much more in-depth way than you could ever have time for in class,” says student Michaela Kerrissey. “It’s a great sign that whenever I saw another Foundations student around school, we immediately started discussing the ins and outs of the latest case.”

As each case unfolded, visiting professionals recounted their own relevant experiences. Later they critiqued students’ proposed action plans. Often, these public health veterans offered a reality check on ideas that were too politically risky or too impractical to set in motion, or, as in the case of California’s childhood obesity problem, too costly given the state’s budget crisis.

Assignments were tough but satisfying, as in the fish-and mercury-contamination case, says student Haitham Ahmed. “We experienced firsthand the frustration of trying to present a unified message, summarize a large body of evidence, and transfer it clearly into layman’s terms,” he says.

The experiment, which ended in December, has been judged a success. In a survey, 93 percent of participants said they would recommend the course to others. According to Kane, their thoughtful, constructive feedback and engagement in the planning for next fall will make the course even better.

spr09CASEap“I got a lot out of discussions in which people challenged each others’ ideas. That was probably my favorite thing about the course. At first I found the course intimidating, as generally I’m shy and don’t speak in large crowds. But I did get into the groove and really surprised myself. For the obesity case, I’m really good with the details of organizing and designing our poster. For the sex trafficking case, I wanted to work on my public speaking skills, so I volunteered to give the class presentation.”
-Andrea Pelletier

Faculty invigorated
Just as enthusiastic about the case-based course are its faculty members. Having to collaborate with other experts outside of her discipline was challenging, says Melissa Perry, associate professor of environmental health. Yet “I absolutely loved teaching in this way. I felt inspired and energized. The classes passed very, very quickly.”

Listening to other faculty “pushed me out of my comfort zone,” Perry adds, noting that the course was “more intellectually demanding” than lectures for both faculty and students.

Jay Silverman, associate professor of Society, Human Development, and Health, and co-instructor Michele Decker, a research associate and 2008 doctorate recipient, agree that the experience of leading the sex trafficking case was worth far more than the time they invested. “Teaching by the case method is vastly more fun than giving lectures,” Silverman says.

“The case-based discussions improved my own teaching tremendously,” he says. “I can see that in students’ evaluations of another of my courses. They’ve never been better.”

“Students were so charged up that by the end of class, we had to cut them off,” Decker adds. “They had lots of innovative, exciting ideas.”

Although some glitches are inevitable in any new course, Kane is delighted at the maiden flight of “Foundations.”

“The world’s problems don’t come to you in nice neat packages,” says Kane. “We’re hoping students develop through this new, ‘active learning’ approach a strong professional identity and leadership abilities, expanded capacity for effective, ethical decision making, and the capacity for ongoing learning.”

Karin Kiewra is the associate director of Development Communications at HSPH and editor of the Review.