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Case Study Research in Health Professions Education

Sarah A. Bunton, PhD, research director, Medical School Operations, and Shana F. Sandberg, PhD, former senior research analyst,
Center for Workforce Studies, Association of American Medical Colleges

In health professions education and the sciences, case-based teaching strategies—through which instruction and learning
occur through discourse around specific, contextualized cases—are the norm. Case-based reports, in their detailed reporting of
symptoms, diagnosis, treatment, and follow-up of patients, are also contextualized, and have facilitated new disease recognition
and effects of treatments.1 Both case-based teaching and case-based medical reports provide a useful format for discussing
complex symptoms or patients and ethical challenges in context.
Likewise, case study research—a qualitative research strategy that investigators within health professions education may apply—
represents an effective methodology for examining a phenomenon within its real-life context. While case study research has
sometimes been faulted for its lack of representativeness and rigor, it can, when approached with focused design, systematic
data collection, careful analysis, and quality control procedures,2 facilitate evaluation of and insights into the relationships
among innovations or interventions and health care and medical education. In this way, the research yields unique information
that would not be achievable using other approaches.

Considerations for Case Study Research in Health Professions Education

Types of Design Comprise single or multiple cases, and may be (among others):
• Intrinsic cases, selected for their uniqueness to illustrate different approaches to the issue
under study, or
• Instrumental cases, selected for being “typical” cases to help others better understand the
issue under study 3

Types of Answerable A descriptive question: What is happening or has happened?

Questions • What techniques are used to train medical residents in emergency medicine?
• What new roles are health professionals occupying in a teaching hospital?
What? How? Why?
An explanatory question: How or why did something happen?2
• How are nurses involved in implementing quality improvement efforts in a specialty clinic?
• Why is the new medical education program not being received well by students?
Data Sources Versatile; can employ both quantitative and qualitative data, including:
• Direct observations
• Interviews, focus groups
• Records, documents, and artifacts
• Quantitative data, such as survey or test results, to complement qualitative findings
Analysis Dependent on the type of case study, but:
• Data from multiple sources should be integrated to understand overall case (i.e., carefully attend to all evidence)
• The question posed (i.e., research question) should (as in other research techniques) tightly frame the findings
and discussion or explanation
• Consideration of alternative interpretations is an integral part of the process
Potential Limits to generalizability. To mitigate:
Disadvantages and • Be clear about analytic generalizations (not statistical ones, which are not appropriate)
Strategies • Include multiple units within the case or multiple cases, where possible
to Mitigate • Describe findings as contextual; avoid claims of generalizability
Researcher integrity. To check quality:
• Train researcher and participants in data collection
• Triangulate information (check multiple sources for the same thing)
Researcher subjectivity (ethics of process). To mitigate:
• Use protocol, maintain chain of evidence, and ensure transparency of process
• Compare findings with other cases (build on existing knowledge)
Unique Information • In-depth and multifaceted accounts of complex issues and processes (e.g., how a new model of care
Gained Through has been implemented in a health system)
Approach • Insight into relationships (e.g., why a program initiative has not achieved desired results)
• Potential “new avenues for research or theory development”4 (e.g., factors revealed in focus groups can
be included in a survey to measure their effect)
• The facilitation or improvement of effective practices across the academic medicine enterprise
(e.g., identifying barriers to program success could lead to interventions targeting faculty or to
the development of new curricula to address gaps)

References:
1. Aronson JK, Hauben M. Anecdotes that provide definitive evidence. BMJ. 2006;333:1267–1269.
2. Yin RK. Case Study Research: Design and Methods. 3rd ed. Thousand Oaks, CA: Sage Publications; 2003.
3. Crowe S, Cresswell K, Robertson A, Huby G. Avery A, Sheikh A. The case study approach. BMC Med Res Methodol. 2011;11:100.
4. Kanter SL. Case studies in academic medicine. Acad Med. 2010;85:567.
Author contact: sbunton@aamc.org

First published online

1 Academic Medicine, Vol. XX, No. X / XX XXXX

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