Using Case Studies to Teach

Content in an Introductory
Biochemistry Course

Kathleen Cornely
Department of Chemistry and Biochemistry
Providence College
Providence, RI 02918
This slideshow is posted on my website at http://
www.providence.edu/chm/kcornely/Casebook.htm
 Why use case studies?
 The case study method involves teaching
scientific theory and content in a framework that
students can relate to in their own world.
 Students develop analytical problem-solving skills
and higher-order thinking skills.
 Students practice oral and written communication
skills.
 Uses collaborative/cooperative (rather than
competitive) learning strategies.
 Involves ambiguity.

2
Why use case studies?
 The intellectual exercises carried out
by a student engaged in case-study
analysis are similar to the activities of
a research scientist.
 These exercises are good preparation
and training for students who wish to
be scientists.

3
 Why use case studies in
biochemistry?

“The difficulty of engaging learners in the

processes and problems of science is most
likely to occur in the first year courses
dealing with fundamental topics, as the
learners are not yet prepared to perceive
the relationship between these topics and
the practice of their careers.”
Rivarola, V., and Garcia, M. B. Biochemical Education 28 (2000), p. 30-31.
4
Three types of biochemistry case
studies
 Metabolic case studies
 Inborn errors of metabolism
 Analysis of “real” scientific data
 Taken from introductory biochemistry concepts
found in the current literature
 Case study projects involving current events
 Thalidomide
 Genetically modified foods (Ann Taylor, Wabash
College)
 Olestra
 Anthrax

5
1. Metabolic case studies
 Each case describes the symptoms of a
patient who is under the supervision of a
physician.
 In most cases, the disease suffered by the
patient is an “inborn error of metabolism”; ie
a particular enzyme in a metabolic pathway is
deficient or nonfunctional.
 Students diagnose the patient and determine
the missing enzyme; explain why the enzyme
is responsible for the observed symptoms.
6
Goals and limitations
 Goals
 Provides an exercise which will allow the
students to synthesize information
regarding intermediary metabolism.
 Show how analytical problem-solving
strategies are used in a clinical situation.
 Limitations
 It’s difficult to find such exercises for the
other content areas covered in the course.

7
Expand the case study
method
 Use the case study method throughout
the course, not just during the study of
intermediary metabolism.
 Concerns
 Where do I find such cases?
 Would using the case study method detract
from covering essential content area in
biochemistry?

8
 The “process vs. content”
debate
 Core knowledge…
 Boyer (BAMBED 28 (2000), pp. 292-296) has
suggested a list of “core topics” that should be
covered in an intro biochemistry course.
 Or core skills?
 Ross Feldberg (BAMBED 29 (2001), pp. 222-
224) suggests that instructors make up a skill
set.
 Then address how each topic contributes to the
acquisition of that skill.
9
 One man’s skill set
 How to carry out quantitative calculations related to
pH, buffering, spectrophotometric analysis, kinetics,
dilutions and thermodynamics.
 How to place the various topics covered into an
overall context.
 How to understand and evaluate the nature of
scientific evidence.
 How to read scientific literature to learn more about
specific topics.
 How to read a biochemistry textbook.

Feldberg, R., Biochemistry and Molecular Biology Eduation 29 (2001) 222-224. 10

 “Content” or “directed” case
studies
 First described by physiologists Cliff and Wright (Am. J.
Physiol. 270: S19-S28 (1996))
 They wrote clinical cases designed to teach students basic
principles of anatomy and physiology.
 The cases were built around very specific learning objectives,
rather than being open-ended.
 Questions are straightforward and emphasis is on information that
is available to the student.
 The case study method is used as an alternative to the
lecture to convey scientific content to the students.
 Some instructors are reluctant to use the case study method
because they feel that doing so would decrease the amount of
coverage of the material.

11
2. Analysis of “real” scientific data

 Use the biochemical literature to write

“case studies”, or problem sets that ask
the students to analyze scientific data.
 The case study is used as a vehicle to
convey content; at the same time,
students develop higher-order analytical
problem-solving skills.

12
3. Case study projects
 These types of case studies follow the format
suggested by Clyde F. Herreid.
 Case studies were traditionally used in business and
law; in 1997 Herreid published an article in JCST and
encouraged scientists to do the same.
 Case studies are “stories with a message”.

 Case study problems involve class discussion;

instructor guides students toward the solution of a

problem.
 “The goal of the case study methods is not so

much to teach the content of science (although

that does happen), but to show how the process
of science works.”
13
The Scientist, 28 February 2005
 Case study projects: “Content
and conflict”
 Cases are used to convey scientific principles to
biochemistry students.
 The issues chosen also involve a conflict that the
students must grapple with.
 The case studies described here are timely—they
address issues currently in the news.
 FDA approval of thalidomide
 The use of Olestra as a fat substitute
 Genetically modified foods (Ann Taylor)
 The “anthrax scare” of 2001

15
 Case teaching method
 Students are given the following materials:
 A fictional “story” describing characters on different sides of the dilemma posed
in the case study.
 Scientific background information about the topic.
 Copies of relevant papers and web site references.
 The class is divided into three groups—each “interest group”
has a certain point of view.
 Students read papers and are given specific questions to answer from the point
of view of their assigned interest group.
 Evaluation
 Students hand in written answers to questions posed in the case study.
 Each group prepares a short presentation to the class using the point of view of
their interest group.
 There is time allowed for class discussion. Students are given grades for their
participation.

16
Thalidomide makes a comeback
 Case Synopsis
 An FDA official must decide whether to shut
down buyers’ clubs which imported
thalidomide from foreign countries and
dispensed it to their members for the
treatment of AIDS.
 AIDS activists were pressuring the FDA to
approve thalidomide, since it had shown
promise in the treatment of AIDS and cancer.

Bennett, N., and Cornely, K. J. Chem. Educ. 78 (2001), p. 759-761.

17
 Thalidomide makes a comeback
 Description of interest groups and assignments
 Scientific consultants to the thalidomide victims
 Draw R/D enantiomers of thalidomide.
 Analyze teratogenicity of the pure isomers and a racemic mixture.
 Medical researchers
 Deduce the role of TNF- in HIV.
 Assess role of thalidomide in changes of TNF-.
 Drug designers
 Write mechanism for the acid hydrolysis of thalidomide.
 Assess ability of chemical analogues to inhibit TNF-. production.
 Design analogues that will effectively TNF- production.

18
Thalidomide makes a comeback
 Class discussion—issues to address
 Who is this case of importance to, and what are
their interests?
 Is thalidomide effective for the treatment of AIDS
and cancer?
 What is society’s responsibility to thalidomide
victims?
 Is it possible to design a distribution protocol that
is entirely risk-free?
 Should the FDA official use her authority to shut
down the buyers’ clubs?

19
Is Olestra an effective weight
loss aid?
 Case synopsis
 Olestra was approved by the FDA after a very
lengthy and expensive study process.
 The FDA required Proctor & Gamble to place
warning labels on Olestra-containing food
packages, and to monitor possible ill effects
suffered by users of the product.
 There are groups (most notably the Center for
Science in the Public Interest) and individuals
who oppose the use of Olestra and would like the
FDA to rescind its approval of this food additive.

20
Is Olestra an effective weight
loss aid?
 Description of interest groups and assignments
 Proctor & Gamble scientists
 Explain why the Olestra formulation was changed from liquid
sucrose polyester (SPE) to a semisolid form.
 Analyze biophysical data of different forms of SPE.
 FDA Scientists
 Analyze plasma values of lycopene and -carotene in control and
Olestra-fed volunteers.
 Address the addition of fat-soluble vitamins to Olestra-containing
products.
 Consumer groups
 Discuss FDA approval process.
 Address issues of concern to consumers for this food additive.

21
Is Olestra an effective weight
loss aid?
 Class discussion—issues to address
 Describe the chemistry of Olestra and the
physiology of the fat digestion process.
 Is physical discomfort a serious problem for Olestra
users? Is vitamin depletion?
 What issues did the FDA need to address in its
approval process?
 Is Olestra safe?
 Will the use of Olestra really help individuals lose
weight?

22
 The “anthrax scare” of 2001
 Case Synopsis
 Following the terrorist attacks on the World Trade
Center and the Pentagon, a number of organizations
and individuals were the targets of bioterrorism
involving weaponized anthrax contained in letters.
 Scientists have yet to conclusively identify all of the
strains involved.
 The response by public health officials was
inadequate.
 Antibiotic prescription by physicians and use by many
individuals was almost certainly inappropriate in most
cases.

23
 The “anthrax scare” of 2001
 Description of interest groups and assignments
 Microbiologists
 Describe the mechanism of antibiotics in general and Ciprofloxacin in
particular. Address the ramifications of large-scale antibiotic therapy.
 Address issues concerning vaccinations.
 Biochemists
 Interpret experimental data from Nature Biotechnology (2001) 19, 958-
96 in which a polyvalent inhibitor of the anthrax toxin was designed.
 Describe why antitoxins are preferable to antibiotics.
 Geneticists
 Design various protocols—for example, how to prepare a library for one
of the anthrax plasmids.
 Assess the effect of mutations of various toxin proteins.

24
The “anthrax scare” of 2001
 Class discussion—issues to address
 Detailed biochemical mechanism for anthrax
infection.
 Using what you know about the mechanism, how
would you design drugs to treat anthrax-infected
individuals?
 What are the responsibilities of (a) physicians and
(b) the public concerning antibiotic use?
 What kinds of measures should be put in place to
prevent bioterrorist attacks? What should be the
appropriate response when the attacks do occur?
 Is the attention paid to these issues appropriate?

25
Summary
 Well-designed case studies can convey
scientific content as well as addressing
societal issues.
 The instructional goals of the case study
exercises were met by the students.
 Written work was of high quality.
 Oral presentations were well-researched and
effectively delivered.
 Students report a high level of enjoyment of
the case study exercise.

26
Summary
‘Instructors reflect on the teaching-
learning process and design new
problems that exercise their students’
higher order thinking skills as well as
their own.”

White, H. B. BAMBED 28 (2000) P. 211.

27
 Metabolic case studies—resources
 Scriver, C. R., Beaudet, A. L., Sly, W. S., and Valle, D., eds. (consulting
eds. Stanbury, Wyngaarden and Fredrickson) The Metabolic Basis of
Inherited Disease, 1989, McGraw-Hill.
 Montgomery, R., Conway, T. W., and Spector, A. Biochemistry: A
Case-Oriented Approach (1990), The C. V. Mosby Company, St. Louis.
 Devlin, T. M. (ed.) Textbook of Biochemistry with Clinical Correlations
(1992) Wiley-Liss, NY.
 Halperin, M. L., and Rolleston, F. S. Clinical Detective Stories: A
Problem-Based Approach to Clinical Cases in Energy and Acid Base
Metabolism (1993) Portland Press, London.
 Ludueña, R. F. Learning Biochemistry: 100 Case Oriented Problems
(1995) Wiley-Liss, NY.
 Higgins, S. J., Turner, A. J., and Wood, E. J. (1994) Biochemistry for
the Medical Sciences: An Integrated Case Approach, Wiley and Sons,
NY.
 Glew and Ninomiya. Clinical Studies in Medical Biochemistry (1997),
Oxford Publishing.
 Write your own using The Metabolic Basis of Inherited Disease (ed
Stanbury, Wyngaarden and Frederickson), McGraw-Hill, as a resource.
28
 Analysis of scientific data—
resources
 Cases in Biochemistry”, published in 1999
by John Wiley & Sons, has been updated
and can be found at
http://www.providence.edu/chm/kcornely/Casebook.htm
 Jozsef Szeberenyi regularly publishes these
types of exercises in
Biochemistry and Molecular Biology Educati
on
; these are in multiple-choice format.
29
 Case study projects—resources
Hal White has compiled a list of articles
published in Biochemistry and Molecular
Biology Education (formerly Biochemical
Education) and has posted the citations on his
web site:

http://www.udel.edu/chem/white/teaching/BiochEd/articles.html

30
 Case study projects—resources
 Clyde Herreid and Nancy Schiller have compiled a list of
case studies developed at their annual case-writing
workshops held at University of Buffalo.

http://ublib.buffalo.edu/libraries/projects/cases/case.html
 P. K. Rangachari of McMaster University has posted
several of his case studies on his web site.

http://www.fhs.mcmaster.ca/pbls/writing/

31
Interested in other cases?
 Case-study and problem-based learning
exercises are regularly featured in
columns in these journals:
 Biochemistry and Molecular Biology Educati
on (BAMBED)
 Journal of College Science Teaching
 Journal of Chemical Education

32
Have you written your own
cases?
 Submit to the above-mentioned journals
and web sites.
 Consider publishing on BioMolecules
Alive, the new ASBMB and BEN-
sponsored digital library.

33