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Case Study-Based Learning

Enhancing learning through immediate application.

By the Mind Tools Content Team

If you've ever tried to learn a new concept, you probably appreciate that "knowing" is different from "doing." When you have an opportunity to apply your knowledge, the lesson typically becomes much more real.

Adults often learn differently from children, and we have different motivations for learning. Typically, we learn new skills because we want to. We recognize the need to learn and grow, and we usually need – or want – to apply our newfound knowledge soon after we've learned it.

A popular theory of adult learning is andragogy (the art and science of leading man, or adults), as opposed to the better-known pedagogy (the art and science of leading children). Malcolm Knowles , a professor of adult education, was considered the father of andragogy, which is based on four key observations of adult learners:

• Adults learn best if they know why they're learning something.
• Adults often learn best through experience.
• Adults tend to view learning as an opportunity to solve problems.
• Adults learn best when the topic is relevant to them and immediately applicable.

This means that you'll get the best results with adults when they're fully involved in the learning experience. Give an adult an opportunity to practice and work with a new skill, and you have a solid foundation for high-quality learning that the person will likely retain over time.

So, how can you best use these adult learning principles in your training and development efforts? Case studies provide an excellent way of practicing and applying new concepts. As such, they're very useful tools in adult learning, and it's important to understand how to get the maximum value from them.

What Is a Case Study?

Case studies are a form of problem-based learning, where you present a situation that needs a resolution. A typical business case study is a detailed account, or story, of what happened in a particular company, industry, or project over a set period of time.

The learner is given details about the situation, often in a historical context. The key players are introduced. Objectives and challenges are outlined. This is followed by specific examples and data, which the learner then uses to analyze the situation, determine what happened, and make recommendations.

The depth of a case depends on the lesson being taught. A case study can be two pages, 20 pages, or more. A good case study makes the reader think critically about the information presented, and then develop a thorough assessment of the situation, leading to a well-thought-out solution or recommendation.

Why Use a Case Study?

Case studies are a great way to improve a learning experience, because they get the learner involved, and encourage immediate use of newly acquired skills.

They differ from lectures or assigned readings because they require participation and deliberate application of a broad range of skills. For example, if you study financial analysis through straightforward learning methods, you may have to calculate and understand a long list of financial ratios (don't worry if you don't know what these are). Likewise, you may be given a set of financial statements to complete a ratio analysis. But until you put the exercise into context, you may not really know why you're doing the analysis.

With a case study, however, you might explore whether a bank should provide financing to a borrower, or whether a company is about to make a good acquisition. Suddenly, the act of calculating ratios becomes secondary – it's more important to understand what the ratios tell you. This is how case studies can make the difference between knowing what to do, and knowing how, when, and why to do it.

Then, what really separates case studies from other practical forms of learning – like scenarios and simulations – is the ability to compare the learner's recommendations with what actually happened. When you know what really happened, it's much easier to evaluate the "correctness" of the answers given.

When to Use a Case Study

As you can see, case studies are powerful and effective training tools. They also work best with practical, applied training, so make sure you use them appropriately.

Remember these tips:

• Case studies tend to focus on why and how to apply a skill or concept, not on remembering facts and details. Use case studies when understanding the concept is more important than memorizing correct responses.
• Case studies are great team-building opportunities. When a team gets together to solve a case, they'll have to work through different opinions, methods, and perspectives.
• Use case studies to build problem-solving skills, particularly those that are valuable when applied, but are likely to be used infrequently. This helps people get practice with these skills that they might not otherwise get.
• Case studies can be used to evaluate past problem solving. People can be asked what they'd do in that situation, and think about what could have been done differently.

Ensuring Maximum Value From Case Studies

The first thing to remember is that you already need to have enough theoretical knowledge to handle the questions and challenges in the case study. Otherwise, it can be like trying to solve a puzzle with some of the pieces missing.

Here are some additional tips for how to approach a case study. Depending on the exact nature of the case, some tips will be more relevant than others.

• Read the case at least three times before you start any analysis. Case studies usually have lots of details, and it's easy to miss something in your first, or even second, reading.
• Once you're thoroughly familiar with the case, note the facts. Identify which are relevant to the tasks you've been assigned. In a good case study, there are often many more facts than you need for your analysis.
• If the case contains large amounts of data, analyze this data for relevant trends. For example, have sales dropped steadily, or was there an unexpected high or low point?
• If the case involves a description of a company's history, find the key events, and consider how they may have impacted the current situation.
• Consider using techniques like SWOT analysis and Porter's Five Forces Analysis to understand the organization's strategic position.
• Stay with the facts when you draw conclusions. These include facts given in the case as well as established facts about the environmental context. Don't rely on personal opinions when you put together your answers.

Writing a Case Study

You may have to write a case study yourself. These are complex documents that take a while to research and compile. The quality of the case study influences the quality of the analysis. Here are some tips if you want to write your own:

• Write your case study as a structured story. The goal is to capture an interesting situation or challenge and then bring it to life with words and information. You want the reader to feel a part of what's happening.
• Present information so that a "right" answer isn't obvious. The goal is to develop the learner's ability to analyze and assess, not necessarily to make the same decision as the people in the actual case.
• Do background research to fully understand what happened and why. You may need to talk to key stakeholders to get their perspectives as well.
• Determine the key challenge. What needs to be resolved? The case study should focus on one main question or issue.
• Define the context. Talk about significant events leading up to the situation. What organizational factors are important for understanding the problem and assessing what should be done? Include cultural factors where possible.
• Identify key decision makers and stakeholders. Describe their roles and perspectives, as well as their motivations and interests.
• Make sure that you provide the right data to allow people to reach appropriate conclusions.
• Make sure that you have permission to use any information you include.

A typical case study structure includes these elements:

• Executive summary. Define the objective, and state the key challenge.
• Opening paragraph. Capture the reader's interest.
• Scope. Describe the background, context, approach, and issues involved.
• Presentation of facts. Develop an objective picture of what's happening.
• Description of key issues. Present viewpoints, decisions, and interests of key parties.

Because case studies have proved to be such effective teaching tools, many are already written. Some excellent sources of free cases are The Times 100 , CasePlace.org , and Schroeder & Schroeder Inc . You can often search for cases by topic or industry. These cases are expertly prepared, based mostly on real situations, and used extensively in business schools to teach management concepts.

Case studies are a great way to improve learning and training. They provide learners with an opportunity to solve a problem by applying what they know.

There are no unpleasant consequences for getting it "wrong," and cases give learners a much better understanding of what they really know and what they need to practice.

Case studies can be used in many ways, as team-building tools, and for skill development. You can write your own case study, but a large number are already prepared. Given the enormous benefits of practical learning applications like this, case studies are definitely something to consider adding to your next training session.

Knowles, M. (1973). 'The Adult Learner: A Neglected Species [online].' Available here .

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What is the Case Study Method?

Overview Dropdown up

Overview dropdown down, celebrating 100 years of the case method at hbs.

The 2021-2022 academic year marks the 100-year anniversary of the introduction of the case method at Harvard Business School. Today, the HBS case method is employed in the HBS MBA program, in Executive Education programs, and in dozens of other business schools around the world. As Dean Srikant Datar's says, the case method has withstood the test of time.

Case Discussion Preparation Details Expand All Collapse All

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How Cases Unfold In the Classroom

How cases unfold in the classroom dropdown up, how cases unfold in the classroom dropdown down, preparation guidelines expand all collapse all, read the professor's assignment or discussion questions read the professor's assignment or discussion questions dropdown down, read the first few paragraphs and then skim the case read the first few paragraphs and then skim the case dropdown down, reread the case, underline text, and make margin notes reread the case, underline text, and make margin notes dropdown down, note the key problems on a pad of paper and go through the case again note the key problems on a pad of paper and go through the case again dropdown down, how to prepare for case discussions dropdown up, how to prepare for case discussions dropdown down, read the professor's assignment or discussion questions, read the first few paragraphs and then skim the case, reread the case, underline text, and make margin notes, note the key problems on a pad of paper and go through the case again, case study best practices expand all collapse all, prepare prepare dropdown down, discuss discuss dropdown down, participate participate dropdown down, relate relate dropdown down, apply apply dropdown down, note note dropdown down, understand understand dropdown down, case study best practices dropdown up, case study best practices dropdown down, participate, what can i expect on the first day dropdown down.

Most programs begin with registration, followed by an opening session and a dinner. If your travel plans necessitate late arrival, please be sure to notify us so that alternate registration arrangements can be made for you. Please note the following about registration:

HBS campus programs – Registration takes place in the Chao Center.

India programs – Registration takes place outside the classroom.

Other off-campus programs – Registration takes place in the designated facility.

What happens in class if nobody talks? Dropdown down

Professors are here to push everyone to learn, but not to embarrass anyone. If the class is quiet, they'll often ask a participant with experience in the industry in which the case is set to speak first. This is done well in advance so that person can come to class prepared to share. Trust the process. The more open you are, the more willing you’ll be to engage, and the more alive the classroom will become.

Does everyone take part in "role-playing"? Dropdown down

Professors often encourage participants to take opposing sides and then debate the issues, often taking the perspective of the case protagonists or key decision makers in the case.

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What the Case Study Method Really Teaches

• Nitin Nohria

Seven meta-skills that stick even if the cases fade from memory.

It’s been 100 years since Harvard Business School began using the case study method. Beyond teaching specific subject matter, the case study method excels in instilling meta-skills in students. This article explains the importance of seven such skills: preparation, discernment, bias recognition, judgement, collaboration, curiosity, and self-confidence.

During my decade as dean of Harvard Business School, I spent hundreds of hours talking with our alumni. To enliven these conversations, I relied on a favorite question: “What was the most important thing you learned from your time in our MBA program?”

• Nitin Nohria is the George F. Baker Professor of Business Administration, Distinguished University Service Professor, and former dean of Harvard Business School.

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Teaching by the Case Method

• Preparing to Teach
• Leading in the Classroom
• Providing Assessment & Feedback
• Sample Class

Case Method in Practice

Chris Christensen described case method teaching as "the art of managing uncertainty"—a process in which the instructor serves as "planner, host, moderator, devil's advocate, fellow-student, and judge," all in search of solutions to real-world problems and challenges.

Unlike lectures, case method classes unfold without a detailed script. Successful instructors simultaneously manage content and process, and they must prepare rigorously for both. Case method teachers learn to balance planning and spontaneity. In practice, they pursue opportunities and "teachable moments" that emerge throughout the discussion, and deftly guide students toward discovery and learning on multiple levels. The principles and techniques are developed, Christensen says, "through collaboration and cooperation with friends and colleagues, and through self-observation and reflection."

This section of the Christensen Center website explores the Case Method in Practice along the following dimensions:

• Providing Assessment and Feedback

Each subsection provides perspectives and guidance through a written overview, supplemented by video commentary from experienced case method instructors. Where relevant, links are included to downloadable documents produced by the Christensen Center or Harvard Business School Publishing. References for further reading are provided as well.

An additional subsection, entitled Resources, appears at the end. It combines references from throughout the Case Method in Practice section with additional information on published materials and websites that may be of interest to prospective, new, and experienced case method instructors.

Note: We would like to thank Harvard Business School Publishing for permission to incorporate the video clips that appear in the Case Method in Practice section of our website. The clips are drawn from video excerpts included in Participant-Centered Learning and the Case Method: A DVD Case Teaching Tool (HBSP, 2003).

Christensen Center Tip Sheets

• Characteristics of Effective Case Method Teaching
• Elements of Effective Class Preparation
• Guidelines for Effective Observation of Case Instructors
• In-Class Assessment of Discussion-Based Teaching
• Questions for Class Discussions
• Teaching Quantitative Material
• Strategies and Tactics for Sensitive Topics

Curriculum Innovation

The case method has evolved so students may act as decision-makers in new engaging formats:

Game Simulations

Multimedia cases, ideo: human-centered service design.

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Case Method Teaching and Learning

What is the case method? How can the case method be used to engage learners? What are some strategies for getting started? This guide helps instructors answer these questions by providing an overview of the case method while highlighting learner-centered and digitally-enhanced approaches to teaching with the case method. The guide also offers tips to instructors as they get started with the case method and additional references and resources.

On this page:

What is case method teaching.

• Case Method at Columbia

Why use the Case Method?

Case method teaching approaches, how do i get started.

• Additional Resources

The CTL is here to help!

For support with implementing a case method approach in your course, email [email protected] to schedule your 1-1 consultation .

Cite this resource: Columbia Center for Teaching and Learning (2019). Case Method Teaching and Learning. Columbia University. Retrieved from [today’s date] from https://ctl.columbia.edu/resources-and-technology/resources/case-method/  

Case method 1 teaching is an active form of instruction that focuses on a case and involves students learning by doing 2 3 . Cases are real or invented stories 4  that include “an educational message” or recount events, problems, dilemmas, theoretical or conceptual issue that requires analysis and/or decision-making.

Case-based teaching simulates real world situations and asks students to actively grapple with complex problems 5 6 This method of instruction is used across disciplines to promote learning, and is common in law, business, medicine, among other fields. See Table 1 below for a few types of cases and the learning they promote.

Table 1: Types of cases and the learning they promote.

For a more complete list, see Case Types & Teaching Methods: A Classification Scheme from the National Center for Case Study Teaching in Science.

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Case Method Teaching and Learning at Columbia

The case method is actively used in classrooms across Columbia, at the Morningside campus in the School of International and Public Affairs (SIPA), the School of Business, Arts and Sciences, among others, and at Columbia University Irving Medical campus.

Faculty Spotlight:

Professor Mary Ann Price on Using Case Study Method to Place Pre-Med Students in Real-Life Scenarios

Read more  

Professor De Pinho on Using the Case Method in the Mailman Core

Case method teaching has been found to improve student learning, to increase students’ perception of learning gains, and to meet learning objectives 8 9 . Faculty have noted the instructional benefits of cases including greater student engagement in their learning 10 , deeper student understanding of concepts, stronger critical thinking skills, and an ability to make connections across content areas and view an issue from multiple perspectives 11 . 

Through case-based learning, students are the ones asking questions about the case, doing the problem-solving, interacting with and learning from their peers, “unpacking” the case, analyzing the case, and summarizing the case. They learn how to work with limited information and ambiguity, think in professional or disciplinary ways, and ask themselves “what would I do if I were in this specific situation?”

The case method bridges theory to practice, and promotes the development of skills including: communication, active listening, critical thinking, decision-making, and metacognitive skills 12 , as students apply course content knowledge, reflect on what they know and their approach to analyzing, and make sense of a case. 

Though the case method has historical roots as an instructor-centered approach that uses the Socratic dialogue and cold-calling, it is possible to take a more learner-centered approach in which students take on roles and tasks traditionally left to the instructor. 

Cases are often used as “vehicles for classroom discussion” 13 . Students should be encouraged to take ownership of their learning from a case. Discussion-based approaches engage students in thinking and communicating about a case. Instructors can set up a case activity in which students are the ones doing the work of “asking questions, summarizing content, generating hypotheses, proposing theories, or offering critical analyses” 14 . 

The role of the instructor is to share a case or ask students to share or create a case to use in class, set expectations, provide instructions, and assign students roles in the discussion. Student roles in a case discussion can include: 

• discussion “starters” get the conversation started with a question or posing the questions that their peers came up with; 
• facilitators listen actively, validate the contributions of peers, ask follow-up questions, draw connections, refocus the conversation as needed; 
• recorders take-notes of the main points of the discussion, record on the board, upload to CourseWorks, or type and project on the screen; and 
• discussion “wrappers” lead a summary of the main points of the discussion. 

Prior to the case discussion, instructors can model case analysis and the types of questions students should ask, co-create discussion guidelines with students, and ask for students to submit discussion questions. During the discussion, the instructor can keep time, intervene as necessary (however the students should be doing the talking), and pause the discussion for a debrief and to ask students to reflect on what and how they learned from the case activity. 

Note: case discussions can be enhanced using technology. Live discussions can occur via video-conferencing (e.g., using Zoom ) or asynchronous discussions can occur using the Discussions tool in CourseWorks (Canvas) .

Table 2 includes a few interactive case method approaches. Regardless of the approach selected, it is important to create a learning environment in which students feel comfortable participating in a case activity and learning from one another. See below for tips on supporting student in how to learn from a case in the “getting started” section and how to create a supportive learning environment in the Guide for Inclusive Teaching at Columbia . 

Table 2. Strategies for Engaging Students in Case-Based Learning

Approaches to case teaching should be informed by course learning objectives, and can be adapted for small, large, hybrid, and online classes. Instructional technology can be used in various ways to deliver, facilitate, and assess the case method. For instance, an online module can be created in CourseWorks (Canvas) to structure the delivery of the case, allow students to work at their own pace, engage all learners, even those reluctant to speak up in class, and assess understanding of a case and student learning. Modules can include text, embedded media (e.g., using Panopto or Mediathread ) curated by the instructor, online discussion, and assessments. Students can be asked to read a case and/or watch a short video, respond to quiz questions and receive immediate feedback, post questions to a discussion, and share resources. 

For more information about options for incorporating educational technology to your course, please contact your Learning Designer .

To ensure that students are learning from the case approach, ask them to pause and reflect on what and how they learned from the case. Time to reflect  builds your students’ metacognition, and when these reflections are collected they provides you with insights about the effectiveness of your approach in promoting student learning.

Well designed case-based learning experiences: 1) motivate student involvement, 2) have students doing the work, 3) help students develop knowledge and skills, and 4) have students learning from each other.  

Designing a case-based learning experience should center around the learning objectives for a course. The following points focus on intentional design. 

Identify learning objectives, determine scope, and anticipate challenges. 

• Why use the case method in your course? How will it promote student learning differently than other approaches? 
• What are the learning objectives that need to be met by the case method? What knowledge should students apply and skills should they practice? 
• What is the scope of the case? (a brief activity in a single class session to a semester-long case-based course; if new to case method, start small with a single case). 
• What challenges do you anticipate (e.g., student preparation and prior experiences with case learning, discomfort with discussion, peer-to-peer learning, managing discussion) and how will you plan for these in your design? 
• If you are asking students to use transferable skills for the case method (e.g., teamwork, digital literacy) make them explicit. 

Determine how you will know if the learning objectives were met and develop a plan for evaluating the effectiveness of the case method to inform future case teaching. 

• What assessments and criteria will you use to evaluate student work or participation in case discussion? 
• How will you evaluate the effectiveness of the case method? What feedback will you collect from students? 
• How might you leverage technology for assessment purposes? For example, could you quiz students about the case online before class, accept assignment submissions online, use audience response systems (e.g., PollEverywhere) for formative assessment during class? 

Select an existing case, create your own, or encourage students to bring course-relevant cases, and prepare for its delivery

• Where will the case method fit into the course learning sequence? 
• Is the case at the appropriate level of complexity? Is it inclusive, culturally relevant, and relatable to students? 
• What materials and preparation will be needed to present the case to students? (e.g., readings, audiovisual materials, set up a module in CourseWorks). 

Plan for the case discussion and an active role for students

• What will your role be in facilitating case-based learning? How will you model case analysis for your students? (e.g., present a short case and demo your approach and the process of case learning) (Davis, 2009). 
• What discussion guidelines will you use that include your students’ input? 
• How will you encourage students to ask and answer questions, summarize their work, take notes, and debrief the case? 
• If students will be working in groups, how will groups form? What size will the groups be? What instructions will they be given? How will you ensure that everyone participates? What will they need to submit? Can technology be leveraged for any of these areas? 
• Have you considered students of varied cognitive and physical abilities and how they might participate in the activities/discussions, including those that involve technology? 

Student preparation and expectations

• How will you communicate about the case method approach to your students? When will you articulate the purpose of case-based learning and expectations of student engagement? What information about case-based learning and expectations will be included in the syllabus?
• What preparation and/or assignment(s) will students complete in order to learn from the case? (e.g., read the case prior to class, watch a case video prior to class, post to a CourseWorks discussion, submit a brief memo, complete a short writing assignment to check students’ understanding of a case, take on a specific role, prepare to present a critique during in-class discussion).

Andersen, E. and Schiano, B. (2014). Teaching with Cases: A Practical Guide . Harvard Business Press. 

Bonney, K. M. (2015). Case Study Teaching Method Improves Student Performance and Perceptions of Learning Gains†. Journal of Microbiology & Biology Education , 16 (1), 21–28. https://doi.org/10.1128/jmbe.v16i1.846

Davis, B.G. (2009). Chapter 24: Case Studies. In Tools for Teaching. Second Edition. Jossey-Bass. 

Garvin, D.A. (2003). Making the Case: Professional Education for the world of practice. Harvard Magazine. September-October 2003, Volume 106, Number 1, 56-107.

Golich, V.L. (2000). The ABCs of Case Teaching. International Studies Perspectives. 1, 11-29. 

Golich, V.L.; Boyer, M; Franko, P.; and Lamy, S. (2000). The ABCs of Case Teaching. Pew Case Studies in International Affairs. Institute for the Study of Diplomacy. 

Heath, J. (2015). Teaching & Writing Cases: A Practical Guide. The Case Center, UK. 

Herreid, C.F. (2011). Case Study Teaching. New Directions for Teaching and Learning. No. 128, Winder 2011, 31 – 40. 

Herreid, C.F. (2007). Start with a Story: The Case Study Method of Teaching College Science . National Science Teachers Association. Available as an ebook through Columbia Libraries. 

Herreid, C.F. (2006). “Clicker” Cases: Introducing Case Study Teaching Into Large Classrooms. Journal of College Science Teaching. Oct 2006, 36(2). https://search.proquest.com/docview/200323718?pq-origsite=gscholar  

Krain, M. (2016). Putting the Learning in Case Learning? The Effects of Case-Based Approaches on Student Knowledge, Attitudes, and Engagement. Journal on Excellence in College Teaching. 27(2), 131-153. 

Lundberg, K.O. (Ed.). (2011). Our Digital Future: Boardrooms and Newsrooms. Knight Case Studies Initiative. 

Popil, I. (2011). Promotion of critical thinking by using case studies as teaching method. Nurse Education Today, 31(2), 204–207. https://doi.org/10.1016/j.nedt.2010.06.002

Schiano, B. and Andersen, E. (2017). Teaching with Cases Online . Harvard Business Publishing. 

Thistlethwaite, JE; Davies, D.; Ekeocha, S.; Kidd, J.M.; MacDougall, C.; Matthews, P.; Purkis, J.; Clay D. (2012). The effectiveness of case-based learning in health professional education: A BEME systematic review . Medical Teacher. 2012; 34(6): e421-44. 

Yadav, A.; Lundeberg, M.; DeSchryver, M.; Dirkin, K.; Schiller, N.A.; Maier, K. and Herreid, C.F. (2007). Teaching Science with Case Studies: A National Survey of Faculty Perceptions of the Benefits and Challenges of Using Cases. Journal of College Science Teaching; Sept/Oct 2007; 37(1). 

Weimer, M. (2013). Learner-Centered Teaching: Five Key Changes to Practice. Second Edition. Jossey-Bass.

Additional resources 

Teaching with Cases , Harvard Kennedy School of Government. 

Features “what is a teaching case?” video that defines a teaching case, and provides documents to help students prepare for case learning, Common case teaching challenges and solutions, tips for teaching with cases. 

Promoting excellence and innovation in case method teaching: Teaching by the Case Method , Christensen Center for Teaching & Learning. Harvard Business School. 

National Center for Case Study Teaching in Science . University of Buffalo. 

A collection of peer-reviewed STEM cases to teach scientific concepts and content, promote process skills and critical thinking. The Center welcomes case submissions. Case classification scheme of case types and teaching methods:

• Different types of cases: analysis case, dilemma/decision case, directed case, interrupted case, clicker case, a flipped case, a laboratory case. 
• Different types of teaching methods: problem-based learning, discussion, debate, intimate debate, public hearing, trial, jigsaw, role-play. 

Columbia Resources

Resources available to support your use of case method: The University hosts a number of case collections including: the Case Consortium (a collection of free cases in the fields of journalism, public policy, public health, and other disciplines that include teaching and learning resources; SIPA’s Picker Case Collection (audiovisual case studies on public sector innovation, filmed around the world and involving SIPA student teams in producing the cases); and Columbia Business School CaseWorks , which develops teaching cases and materials for use in Columbia Business School classrooms.

Center for Teaching and Learning

The Center for Teaching and Learning (CTL) offers a variety of programs and services for instructors at Columbia. The CTL can provide customized support as you plan to use the case method approach through implementation. Schedule a one-on-one consultation. 

Office of the Provost

The Hybrid Learning Course Redesign grant program from the Office of the Provost provides support for faculty who are developing innovative and technology-enhanced pedagogy and learning strategies in the classroom. In addition to funding, faculty awardees receive support from CTL staff as they redesign, deliver, and evaluate their hybrid courses.

The Start Small! Mini-Grant provides support to faculty who are interested in experimenting with one new pedagogical strategy or tool. Faculty awardees receive funds and CTL support for a one-semester period.

Explore our teaching resources.

• Blended Learning
• Contemplative Pedagogy
• Inclusive Teaching Guide
• FAQ for Teaching Assistants
• Metacognition

CTL resources and technology for you.

• Overview of all CTL Resources and Technology
• The origins of this method can be traced to Harvard University where in 1870 the Law School began using cases to teach students how to think like lawyers using real court decisions. This was followed by the Business School in 1920 (Garvin, 2003). These professional schools recognized that lecture mode of instruction was insufficient to teach critical professional skills, and that active learning would better prepare learners for their professional lives. ↩
• Golich, V.L. (2000). The ABCs of Case Teaching. International Studies Perspectives. 1, 11-29. ↩
• Herreid, C.F. (2007). Start with a Story: The Case Study Method of Teaching College Science . National Science Teachers Association. Available as an ebook through Columbia Libraries. ↩
• Davis, B.G. (2009). Chapter 24: Case Studies. In Tools for Teaching. Second Edition. Jossey-Bass. ↩
• Andersen, E. and Schiano, B. (2014). Teaching with Cases: A Practical Guide . Harvard Business Press. ↩
• Lundberg, K.O. (Ed.). (2011). Our Digital Future: Boardrooms and Newsrooms. Knight Case Studies Initiative. ↩
• Heath, J. (2015). Teaching & Writing Cases: A Practical Guide. The Case Center, UK. ↩
• Bonney, K. M. (2015). Case Study Teaching Method Improves Student Performance and Perceptions of Learning Gains†. Journal of Microbiology & Biology Education , 16 (1), 21–28. https://doi.org/10.1128/jmbe.v16i1.846 ↩
• Krain, M. (2016). Putting the Learning in Case Learning? The Effects of Case-Based Approaches on Student Knowledge, Attitudes, and Engagement. Journal on Excellence in College Teaching. 27(2), 131-153. ↩
• Thistlethwaite, JE; Davies, D.; Ekeocha, S.; Kidd, J.M.; MacDougall, C.; Matthews, P.; Purkis, J.; Clay D. (2012). The effectiveness of case-based learning in health professional education: A BEME systematic review . Medical Teacher. 2012; 34(6): e421-44. ↩
• Yadav, A.; Lundeberg, M.; DeSchryver, M.; Dirkin, K.; Schiller, N.A.; Maier, K. and Herreid, C.F. (2007). Teaching Science with Case Studies: A National Survey of Faculty Perceptions of the Benefits and Challenges of Using Cases. Journal of College Science Teaching; Sept/Oct 2007; 37(1). ↩
• Popil, I. (2011). Promotion of critical thinking by using case studies as teaching method. Nurse Education Today, 31(2), 204–207. https://doi.org/10.1016/j.nedt.2010.06.002 ↩
• Weimer, M. (2013). Learner-Centered Teaching: Five Key Changes to Practice. Second Edition. Jossey-Bass. ↩
• Herreid, C.F. (2006). “Clicker” Cases: Introducing Case Study Teaching Into Large Classrooms. Journal of College Science Teaching. Oct 2006, 36(2). https://search.proquest.com/docview/200323718?pq-origsite=gscholar ↩

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What the Case Study Method Really Teaches

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D uring my decade as dean of Harvard Business School, I spent hundreds of hours talking with our alumni. To enliven these conversations, I relied on a favorite question: “What was the most important thing you learned from your time in our MBA program?”

Alumni responses varied but tended to follow a pattern. Almost no one referred to a specific business concept they learned. Many mentioned close friendships or the classmate who became a business or life partner. Most often, though, alumni highlighted a personal quality or skill such as “increased self-confidence” or “the ability to advocate for a point of view” or “knowing how to work closely with others to solve problems.” And when I asked how they developed these capabilities, they inevitably mentioned the magic of the case method.

Harvard Business School pioneered the use of case studies to teach management in 1921. As we commemorate 100 years of case teaching, much has been written about the effectiveness of this method. I agree with many of these observations. Cases expose students to real business dilemmas and decisions. Cases teach students to size up business problems quickly while considering the broader organizational, industry, and societal context. Students recall concepts better when they are set in a case, much as people remember words better when used in context. Cases teach students how to apply theory in practice and how to induce theory from practice. The case method cultivates the capacity for critical analysis, judgment, decision-making, and action.

“Cases teach students how to apply theory in practice and how to induce theory from practice. The case method cultivates the capacity for critical analysis, judgment, decision-making, and action.”

There is a word that aptly captures the broader set of capabilities our alumni reported they learned from the case method. That word is meta-skills, and these meta-skills are a benefit of case study instruction that those who’ve never been exposed to the method may undervalue.

Educators define meta-skills as a group of long-lasting abilities that allow someone to learn new things more quickly. When parents encourage a child to learn to play a musical instrument, for instance, beyond the hope of instilling musical skills (which some children will master and others may not), they may also appreciate the benefit the child derives from deliberate, consistent practice. This meta-skill is valuable for learning many other things beyond music.

In the same vein, let me suggest seven vital meta-skills students gain from the case method:

1. Preparation

There is no place for students to hide in the moments before the famed “ cold call ”—when the teacher can ask any student at random to open the case discussion. Decades after they graduate, students will vividly remember cold calls when they or someone else froze with fear, or when they rose to nail the case even in the face of a fierce grilling by the professor.

The case method creates high-powered incentives for students to prepare. Students typically spend several hours reading, highlighting, and debating cases before class, sometimes alone and sometimes in groups. The number of cases to be prepared can be overwhelming by design.

Learning to be prepared—to read materials in advance, prioritize, identify the key issues, and have an initial point of view—is a meta-skill that helps people succeed in a broad range of professions and work situations. We have all seen how the prepared person, who knows what they are talking about, can gain the trust and confidence of others in a business meeting. The habits of preparing for a case discussion can transform a student into that person.

2. Discernment

Many cases are long. A typical case may include history, industry background, a cast of characters, dialogue, financial statements, source documents, or other exhibits. Some material may be digressive or inessential. Cases often have holes—critical pieces of information that are missing.

The case method forces students to identify and focus on what’s essential, ignore the noise, skim when possible, and concentrate on what matters, meta-skills required for every busy executive confronted with the paradox of simultaneous information overload and information paucity. As one alumnus pithily put it, “The case method helped me learn how to separate the wheat from the chaff.”

“The case method forces students to identify and focus on what’s essential, ignore the noise, skim when possible, and concentrate on what matters.”

3. Bias Recognition

Students often have an initial reaction to a case stemming from their background or earlier work and life experiences. For instance, people who have worked in finance may be biased to view cases through a financial lens. However, effective general managers must understand and empathize with various stakeholders, and if someone has a natural tendency to favor one viewpoint over another, discussing dozens of cases will help reveal that bias. Armed with this self-understanding, students can correct that bias or learn to listen more carefully to classmates whose different viewpoints may help them see beyond their own biases.

Recognizing and correcting personal bias can be an invaluable meta-skill in business settings when leaders inevitably have to work with people from different functions, backgrounds, and perspectives.

4. Judgment

Cases put students into the role of the case protagonist and force them to make and defend a decision. The format leaves room for nuanced discussion, but not for waffling: Teachers push students to choose an option, knowing full well that there is rarely one correct answer.

Indeed, most cases are meant to stimulate a discussion rather than highlight effective or ineffective management practice. Across the cases they study, students get feedback from their classmates and their teachers about when their decisions are more or less compelling. It enables them to develop the judgment of making decisions under uncertainty, communicating that decision to others, and gaining their buy-in—all essential leadership skills. Leaders earn respect for their judgment. It is something students in the case method get lots of practice honing.

5. Collaboration

It is better to make business decisions after extended give-and-take, debate, and deliberation. As in any team sport, people get better at working collaboratively with practice. Discussing cases in small study groups, and then in the classroom, helps students practice the meta-skill of collaborating with others. Our alumni often say they came away from the case method with better skills to participate in meetings and lead them.

Orchestrating a good collaborative discussion in which everyone contributes, every viewpoint is carefully considered, and yet a thoughtful decision is made in the end is the arc of any good case discussion. Although teachers play the primary role in this collaborative process during their time at the school, it is an art that students of the case method internalize and get better at when they get to lead discussions.

6. Curiosity

Cases expose students to lots of different situations and roles. Across cases, they get to assume the role of entrepreneur, investor, functional leader, or CEO in a range of different industries and sectors. Each case offers an opportunity for students to see what resonates with them, what excites them, what bores them, and which roles they could imagine inhabiting in their careers.

Cases stimulate curiosity about the range of opportunities in the world and the many ways that students can make a difference as leaders. This curiosity serves them well throughout their lives. It makes them more agile, more adaptive, and more open to doing a wider range of things in their careers.

“Cases stimulate curiosity about the range of opportunities in the world and the many ways that students can make a difference as leaders.”

7. Self-Confidence

Students must inhabit roles during a case study that far outstrip their prior experience or capability, often as leaders of teams or entire organizations in unfamiliar settings. “What would you do if you were the case protagonist?” is the most common question in a case discussion. Even though they are imaginary and temporary, these “stretch” assignments increase students' self-confidence that they can rise to the challenge.

In our program, students can study 500 cases over two years, and the range of roles they are asked to assume increases the range of situations they believe they can tackle. Speaking up in front of 90 classmates feels risky at first, but students become more comfortable taking that risk over time. Knowing that they can hold their own in a highly curated group of competitive peers enhances student confidence. Often, alumni describe how discussing cases made them feel prepared for much bigger roles or challenges than they’d imagined they could handle before their MBA studies. Self-confidence is difficult to teach or coach, but the case study method seems to instill it in people.

The Lifelong Benefits of Case Method Instruction

There may well be other ways of learning these meta-skills, such as the repeated experience gained through practice or guidance from a gifted coach. However, under the direction of a masterful teacher, the case method can engage students and help them develop powerful meta-skills like no other form of teaching. This quickly became apparent when case teaching was introduced in 1921—and it’s even truer today.

For educators and students, recognizing the value of these meta-skills can offer perspective on the broader goals of their work together. Returning to the example of music lessons, it may be natural for a music teacher or their students to judge success by a simple measure: Does the student learn to play the instrument well? But when everyone involved recognizes the broader meta-skills that instrumental instruction can instill—and that even those who bumble their way through Bach may still derive lifelong benefits from their instruction—it may lead to a deeper appreciation of this work.

For recruiters and employers, recognizing the long-lasting set of benefits that accrue from studying via the case method can be a valuable perspective in assessing candidates and plotting their potential career trajectories.

And while we must certainly use the case method’s centennial to imagine yet more powerful ways of educating students in the future, let us be sure to assess these innovations for the meta-skills they might instill as much as the subject matter mastery they might enable.

This article was originally posted by HBR.org .

Nitin Nohria is the former dean of Harvard Business School.

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The Case Study Teaching Method

It is easy to get confused between the case study method and the case method , particularly as it applies to legal education. The case method in legal education was invented by Christopher Columbus Langdell, Dean of Harvard Law School from 1870 to 1895. Langdell conceived of a way to systematize and simplify legal education by focusing on previous case law that furthered principles or doctrines. To that end, Langdell wrote the first casebook, entitled A Selection of Cases on the Law of Contracts , a collection of settled cases that would illuminate the current state of contract law. Students read the cases and came prepared to analyze them during Socratic question-and-answer sessions in class.

The Harvard Business School case study approach grew out of the Langdellian method. But instead of using established case law, business professors chose real-life examples from the business world to highlight and analyze business principles. HBS-style case studies typically consist of a short narrative (less than 25 pages), told from the point of view of a manager or business leader embroiled in a dilemma. Case studies provide readers with an overview of the main issue; background on the institution, industry, and individuals involved; and the events that led to the problem or decision at hand. Cases are based on interviews or public sources; sometimes, case studies are disguised versions of actual events or composites based on the faculty authors’ experience and knowledge of the subject. Cases are used to illustrate a particular set of learning objectives; as in real life, rarely are there precise answers to the dilemma at hand.

Our suite of free materials offers a great introduction to the case study method. We also offer review copies of our products free of charge to educators and staff at degree-granting institutions.

For more information on the case study teaching method, see:

• Martha Minow and Todd Rakoff: A Case for Another Case Method
• HLS Case Studies Blog: Legal Education’s 9 Big Ideas
• Teaching Units: Problem Solving , Advanced Problem Solving , Skills , Decision Making and Leadership , Professional Development for Law Firms , Professional Development for In-House Counsel
• Educator Community: Tips for Teachers

Watch this informative video about the Problem-Solving Workshop:

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How to Use Case Studies in Your Employee Training Sessions

Case studies can be powerful tools for learning and training. They're evidence-based stories that showcase the outcomes you want, so using them as the basis for your training can make the training itself more engaging and more effective. The question is, how can you use a case study to enhance your training for learners? There are several options.

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Table of Contents

Design a case study to fit the training, develop training to fit a case study, use a longitudinal case study to demonstrate outcomes of training, use miniature case studies to prove individual points, thread a case study throughout training, ask trainees to predict case study outcomes, discuss potential alternative outcomes in case studies, turn a case study into an immersive simulation, create a framework case study and encourage trainees to fill it out.

First up, you have one major decision to make. Do you design training around a case study, or do you design a case study to fit your training? Both perspectives are equally valid as long as the study results and the training program goals are aligned.

Let’s say you choose to design a case study to fit your desired training. For example, you're trying to implement the  Delivering Exceptional Phone Service  reproducible training course for your customer service team. To back up the training, you want a case study that showcases how putting the techniques taught in the course into practice will bolster positive outcomes with customer service.

You have two options here.

• The first is simply writing a case study based on your own experiences, accentuating the necessary details relevant to the training, and pruning it down to the bare essentials to prove your point.
• The other option is to seek out existing case studies performed by renowned research firms that support your points.

In either case, you can then use the case study as a "real world" example of how the techniques in the training can be put to actual use and how they tangibly impact positive outcomes. Make sure to highlight specific aspects of the case study and how they relate to the practices put forth in the training module for better retention.

Your second option, as an alternative, is to develop your training to fit an already existing case study.

The process looks a little something like this:

• Begin by finding a case study that results in the outcomes you're seeking. For example,  this case study from Train Like a Champion  focuses on getting training to produce long-term results, something that every company can benefit from implementing.
• Next, review the case study. Look for salient details and mechanisms used to achieve the outcomes you desire. Ideally, the case study itself will support those mechanisms and expound upon how to use them.
• Finally, develop a training module that integrates the case study and its data, as well as the mechanisms you uncovered, to train your employees to achieve those same outcomes.

You can accompany the training module with the case study, with details and data uncovered along the way, or you can use it as a companion piece or use it as cited sources or proof for the claims you're making. None of these choices are inherently wrong, so pick the ones that work best with your staff and your means of training to create a better learning experience.

Longitudinal case studies are case studies that look at and measure specific data about their subjects over a long period. Such case studies can follow individuals throughout a particular period of years, their careers, or their entire lives. For example, longitudinal studies are often used in medicine to help study the long-term effects of various substances and illnesses.

A longitudinal case study can be a powerful tool for building training. You can point to specific, hard evidence that certain kinds of training not only improve short-term results and benefits for employees, clients, and companies but can increase the value of employees throughout their careers.

Using this kind of case study can be an essential part of encouraging your employees to take the training seriously. After all, it's one thing to encourage employees to participate in training because it benefits customers or the company, but it's quite a different incentive if you can showcase how that training will improve their career prospects.

The tricky part about this is that case studies can prove many different points because different people have different career trajectories and leverage different skills in different ways. That is why it can be essential to begin with training modules such as  What's My Leadership Style  to help employees identify which individuals to follow in the case study and which outcomes are most relevant to their specific situations.

If finding specific, relevant longitudinal studies isn't possible, an alternative approach involves leveraging small-scale case studies to reinforce key points throughout your training process. For example, throughout a comprehensive  customer service training  course, you can use specific case studies that highlight varied responses to an irate customer, showcasing how different approaches lead to distinct outcomes. These case studies provide tangible examples to support decisions about adopting a placating, resistant, or combative tone in customer interactions.

The benefit to this option is that there are, in general, many more small-scale case studies than there are more extensive, longitudinal case studies. Moreover, it's much easier to find them and use them to prove your points. Long-term case studies can have surprising outcomes, and they can have findings that contradict your studies and policies. That can be difficult to reconcile unless you're willing to wholly adjust your training and direction.

The biggest potential drawback to this option is that there are many small-scale case studies, many of which can have contradictory outcomes. With the vast pool of small-scale case studies available, there is a risk of cherry-picking examples that selectively support a specific viewpoint, regardless of their overall value. This practice could compromise the integrity of the training content and may not provide a holistic representation of the topic at hand. Trainers should exercise caution and ensure that the chosen case studies are relevant, unbiased, and contribute substantively to the overall learning objectives.

If you think back to some of the more effective textbook designs for schools in higher education, you may find a through-line. Many effective textbooks include an ongoing, long-term set of examples, or "characters," they follow along the way. For example, in courses where you learn a language, a textbook will often have a set of characters who interact in varying situations to showcase quirks of language, particularly conversational use of the language.

A case study can be used in this manner for your training. Fortunately, many comprehensive and overarching training courses have these kinds of examples and case studies built into them.

The goal is to allow your trainees to explore training in a multifaceted way. That might include links to studies, links to infoboxes, video interviews, and much more.

An added benefit of this training method is that you can make a single training module much more comprehensive in terms of answers to common and uncommon questions. Training employees from a point of knowledge can be surprisingly challenging because it can be tricky to judge even what the trainees don't know. Providing in-depth, interlinked, embedded answers to questions for trainees to explore helps bring everyone to the same page.

One thing that sets effective training apart from ineffective training is the level of interactivity. When training is interactive and engaging, trainees learn much more from it by participating in "real-life" examples and demos of the training in action. This approach enables participants to apply their knowledge in real-life situations, promoting a deeper understanding and emphasizing their problem-solving ability to choose appropriate resolutions.

One way to help encourage engagement in training is with a case study that puts that training into action. Divide the case study between setup and resolution, and have the trainees read the setup portion of the training. Cut it off as the individuals in the case study are making their decisions based on the training (or ignoring the training).

Then, ask the trainees to predict what the outcomes will be. Encourage them to write down their predictions. Then, you can progress with the case study and reveal the actual results of the training. While some case studies may follow predictable paths, introducing occasional curveballs keeps participants on their toes. These unexpected twists challenge trainees’ critical thinking skills and their ability to adapt their problem-solving strategies. You can then discuss why they made the predictions that they did and what led them to their decisions, whether right or wrong.

This interactive approach not only transforms training into a participatory experience but also creates a platform for meaningful discussions.

Like the above, you can leverage case studies and predictions to speculate. How would the outcome have changed if the individual in the case study made a different choice or acted differently?

What changes would your employees make?

"After reading a case study together or independently, you can have your participants write a different ending to the case study. For example, if you read a story about a woman who improved her communication skills after attending a workshop (just like the one your students might be in), have them write what would happen if she didn't attend the workshop. Have them write what would happen if she was engaged/not engaged. Ask them to consider what is going on in the woman's life that might impact her ability to communicate appropriately or efficiently during the time of training. Writing a different outcome prompts participants to consider the whole story and not just the parts that are presented to them." –  TrainingCourseMaterial

For an interesting case study of your own, you can ask your trainees to read a situation and convey how they would act in that situation before implementing the training in the first place. Then, progress through the training modules. When finished, ask the trainee to revisit, see how accurate their behavior is to the goal, and ask them what changes, if any, they would make.

Once again, studies show that the best training is training produced in the form of an immersive simulation.  

Look for industry case studies about particular incidents.  Several agencies  produce comprehensive investigations into the circumstances behind industrial accidents, often in factory, warehouse, or shipping processes. These case studies can form the basis of a scenario wherein you ask your employees to role-play how they would respond if the incident occurred in your facility.

You can then use the realities of the investigation to enforce consequences in the simulated disaster. For example, say you're training employees to handle a chemical spill in a warehouse. The established procedures outline specific actions to be taken. Within the simulation, introduce a scenario where one employee is found unconscious within the chemical spill. This introduces a critical decision point: will someone attempt a rescue, and if so, will they do so without proper preparation? You can then remove this individual from the training scenario because their actions led to them being incapacitated.

There are many such examples. Always remember that most, if not all, industrial and commercial regulations are built on the back of people dying because of loopholes or unforeseen circumstances.

This approach allows employees to engage with the training material in a hands-on, realistic manner. It not only reinforces the importance of adhering to established protocols but also highlights the potential repercussions of deviating from proper procedures. The immersive nature of these simulations helps employees internalize the lessons, making the training more impactful and applicable to their day-to-day responsibilities.

Finally, another way to use case studies for training is to turn your trainees into case studies themselves. Build a framework or a template of a case study, with questions about the scenario, their responses, the training, and their behavior after the training. Encourage trainees to fill out these case study templates, then participate in training, and fill them out again. For added value, track these employees for months afterward to see where they've gone, how they've implemented their training, and how it has improved their careers.

The use of case studies can be a powerful training tool, but they can only be effective if coupled with practical training modules. After all, you can't know how to reach your goals without knowing where you are. That's why we offer dozens of training options in our reproducible training library, as well as dozens more assessments (both instructor-led and self-guided) to help establish baselines and build awareness.

Check out our training library, and find case studies that align with your company values and learning objectives.

To learn more about how to help your employees, check out our  What’s My Leadership Style  course. This course is a management development tool, leadership style assessment, and online training workshop. This comprehensive tool is designed to pinpoint an individual's leadership style, offering valuable insights for organizational leaders, managers, and supervisors. By utilizing this tool, professionals can enhance their performance and cultivate the skills necessary to evolve into effective and impactful leaders within their respective roles.

Do you have any questions or concerns about using case studies in your employee training sessions to provide the best outcomes for your learners? If so, please feel free to leave a comment down below, and we'll get back to you! We make it a point to reply to every message we receive, and we would be more than happy to assist you or your company however we possibly can.

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About our author

Bradford r. glaser.

Brad is President and CEO of HRDQ, a publisher of soft-skills learning solutions, and HRDQ-U, an online community for learning professionals hosting webinars, workshops, and podcasts. His 35+ years of experience in adult learning and development have fostered his passion for improving the performance of organizations, teams, and individuals.

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Simulations Vs. Case Studies: Which Is the Better Training Method?

Online corporate training has become a vital tool for upskilling workforces in today’s fast-paced business environment. So, you are well aware of its growing popularity and its potential to drive organizational success. Now, online education platforms utilize multiple types of training methods — delivered via digital platforms and technologies — like LMS platforms . They offer various learning experiences, including e-learning modules, webinars, virtual classrooms, and interactive assessments. This shift to e learning courses is driven by factors such as cost-effectiveness, scalability, and flexibility.

In fact, the global e-learning market is projected to reach $325 billion by 2025 — highlighting the recognition of online corporate training and development methods as an effective means of fostering employee development.

Table of Contents

Importance of Choosing the Right Types of Training Methods

Selecting the appropriate training and development methods is crucial for maximum effectiveness. Different methodologies have unique characteristics and advantages that cater to specific learning objectives and styles. You can optimize engagement, retention, and skill acquisition by aligning your L&D framework with desired outcomes and workforce needs.

In online corporate training, the debate often centers around simulations and case studies. Both types of training methods offer distinct benefits, and understanding their nuances is essential for informed decision-making.

Join us as we explore simulations and case studies, analyzing their strengths, limitations, and effectiveness as types of training methods. By the end, you will gain insights to determine which approach unlocks your workforce’s full potential and drives organizational success.

Exploring Simulations as a Training Method

Simulations are interactive learning experiences replicating real-world scenarios in a controlled virtual environment. They allow learners to actively engage and make decisions, experiencing the consequences of their actions. Simulating realistic situations provides a safe space for employees to practice and refine their skills without real-world risks.

Advantages of Simulations in Corporate Training

Simulations offer several advantages that make them a highly effective training method in online corporate training.

Immersive Learning Experience

Simulations create a sense of immersion, transporting learners into realistic scenarios that mirror their actual work environments. This immersive experience enhances engagement and increases knowledge retention . Learners can apply theoretical knowledge to practical situations, developing critical thinking and problem-solving skills.

Real-life Scenario Simulation

Simulations enable employees to apply their knowledge and skills in a simulated real-life context. By facing realistic challenges and making decisions based on their expertise, learners gain valuable experience without the potential risks of real-world scenarios. This practical application strengthens their abilities and prepares them for actual workplace challenges.

Active Engagement and Interactivity

Simulations promote active engagement through hands-on participation. Learners actively interact with the simulation, making choices and observing the outcomes. This interactivity enhances the learning experience, fostering a deeper understanding of concepts and improving knowledge retention.

Examples of Successful Simulations in Corporate Training

Numerous organizations have successfully implemented simulations in their online corporate training programs. For instance, in the healthcare industry, medical professionals can use virtual patient simulations to diagnose and treat various conditions.

In fact, a study found that surgeons who trained using simulations had a 29% increase in speed and a 9 times lower likelihood of experiencing a stall during surgery.

In the aviation sector, pilots undergo flight simulations to enhance their skills in different scenarios, such as adverse weather conditions or system failures. These real-world examples demonstrate the effectiveness of simulations in training professionals across various industries.

Exploring Case Studies as Types of Training Methods

Case studies are in-depth examinations of actual or hypothetical scenarios that present complex business challenges. They aim to give learners a deep understanding of the situation and encourage them to analyze, evaluate, and develop solutions based on their knowledge and expertise. Embedding case studies in LMS platforms bridges the gap between theory and practice, allowing learners to apply their skills in a realistic context.

Benefits of Case Studies in Online Corporate Training

Case studies offer several key benefits that make them a powerful training method in online corporate learning.

Practical Application of Knowledge

One of the primary advantages of case studies is their emphasis on practical application. By analyzing and working through realistic scenarios, learners can directly apply their knowledge and skills to solve complex business problems. This practical application enhances their understanding and enables them to effectively transfer their knowledge to real-world situations.

Analysis and Problem-Solving Skills Development

Case studies require learners to critically analyze the presented information, identify critical issues, and devise appropriate strategies or solutions. This analytical approach fosters the development of problem-solving skills, enabling employees to approach challenges with a systematic and strategic mindset.

Through case studies, learners can assess complex situations, evaluate multiple perspectives, and make informed decisions. In fact, 35% of students prefer case studies to master and solve difficult concepts .

Decision-Making and Critical Thinking Enhancement

Case studies stimulate decision-making and critical thinking by presenting learners with real or hypothetical scenarios requiring thoughtful analysis and judgment. Engaging in case studies encourages employees to think critically, consider various factors, weigh potential outcomes, and make sound decisions. This process enhances their decision-making skills and cultivates a mindset of thoughtful and strategic reasoning.

Showcasing Examples of Effective Case Studies in Corporate Training

Numerous organizations have successfully integrated case studies into their online corporate training programs.

For example, a technology company may present a case study on a successful product launch, allowing learners to analyze the marketing strategy, identify key factors contributing to its success, and propose improvements for future endeavors.

Similarly, in the finance sector, case studies can be used to simulate complex financial scenarios, requiring learners to assess risks, evaluate investment opportunities, and devise effective financial strategies.

Comparing the Two Types of Training Methods: Simulations and Case Studies

When it comes to corporate training and development methods, comparing simulations and case studies can help you determine which method is better suited to meet your specific training objectives. And as a knowledgeable professional, you understand the importance of evaluating different approaches to ensure optimal learning outcomes for your workforce.

Identifying Similarities Between Simulations and Case Studies

Although simulations and case studies are distinct types of training methods, they share similarities in their overall purpose and application. Both methods provide learners with practical, real-world scenarios encouraging active engagement and decision-making.

Simulations and case studies foster a deep understanding of complex situations, promoting critical thinking, problem-solving, and analytical skills.

Contrasting Features and Approaches of Simulations and Case Studies

While simulations and case studies have common objectives, they differ in their approach and execution.

Difference 1

• Simulations are immersive, interactive experiences replicating real-life scenarios, allowing learners to participate and make decisions in a controlled virtual environment actively.
• On the other hand, case studies involve in-depth analysis of actual or hypothetical business situations, requiring learners to evaluate information and propose solutions critically.

Difference 2

• Simulations focus on experiential learning, providing a dynamic and engaging environment for skill development.
• On the contrary, case studies emphasize the application of knowledge, encouraging learners to analyze and solve complex business challenges through critical thinking and problem-solving.

Evaluating Their Effectiveness Based on Specific Training Objectives

To determine which method is better suited for your training objectives, evaluating their effectiveness in specific areas is essential.

Skill Acquisition and Application

Simulations excel in skill acquisition and application. By providing a realistic environment for practice, learners can develop hands-on expertise and experience the consequences of their decisions. Simulations allow for immediate feedback and iterative learning, enabling employees to refine their skills and enhance their ability to apply knowledge effectively.

In fact, using simulations can lead to significantly improved learning outcomes (76% higher score) compared with traditional teaching.

On the other hand, case studies emphasize applying existing knowledge to complex situations. Learners can understand how theoretical concepts translate into practical solutions through detailed analysis and reflection. Case studies foster critical thinking and problem-solving skills, enabling employees to approach similar situations in the future confidently.

As per studies, passive learning via group-based case studies results in learners enjoying lectures more and acquiring a higher percentage of knowledge.

Knowledge Retention and Transfer

Simulations are known for their ability to enhance knowledge retention and transfer. By engaging learners in practical scenarios, simulations facilitate a deeper understanding of concepts and their real-world applications. The interactive nature of simulations promotes active learning, resulting in higher retention rates and the ability to transfer learned skills to new contexts.

Case studies also promote knowledge retention and transfer by encouraging learners to analyze and apply theoretical knowledge to real-life scenarios. The detailed examination of cases reinforces key concepts and facilitates the integration of knowledge into practical situations, enabling employees to transfer their learning to their day-to-day work.

Engagement and Motivation

Both simulations and case studies can significantly increase learner engagement and motivation. Simulations provide an immersive, interactive experience that captures learners’ attention and stimulates active participation. The dynamic nature of simulations keeps learners engaged and motivated to explore and learn from the experience.

Similarly, case studies offer a captivating learning experience by presenting complex business challenges and inviting learners to analyze and propose solutions critically. The practical relevance of case studies enhances learner motivation as they see the direct applicability of their efforts to real-world situations.

Addressing Limitations and Challenges of Both Types of Training Methods

As you consider the implementation of simulations and case studies in your LMS platforms, it is crucial to be aware of the potential limitations and challenges associated with each method. By understanding these factors, you can proactively address them to optimize the effectiveness of your training initiatives.

Discussing Potential Drawbacks of Simulations

• Cost and resource-intensive: Developing high-quality simulations can be complex and costly, requiring skilled professionals and specialized software. Additionally, simulations may require significant time and resources for maintenance and updates.
• Technical requirements: Simulations often rely on advanced technology, such as virtual reality (VR) or augmented reality (AR) devices, which may require additional investments and infrastructure. Ensuring access to the necessary hardware and software can be a logistical challenge.
• Complexity and learning curve: Simulations can be intricate and require a learning curve for participants to become familiar with the interface and functionalities. This may result in an initial adjustment period and potential frustration for some learners.

Recognizing Limitations of Case Studies in Certain Contexts

• Time constraints: In-depth case studies may require a significant time commitment, making them less suitable for training programs with limited timeframes. Balancing the depth of analysis with the available time can be a challenge.
• Lack of real-time feedback: Unlike simulations, case studies often lack the immediate feedback and iterative learning opportunities that simulations provide. This may impact the speed of skill acquisition and hinder the ability to correct and adjust decision-making in real time.
• Contextual relevance: Ensuring that the selected case studies align closely with your organization’s industry, challenges, and goals is vital. Irrelevant or outdated case studies may not effectively engage learners or address their specific needs.

Analyzing How to Mitigate Challenges and Enhance Effectiveness

To address these limitations and challenges, consider the following strategies:

• Customization and scalability: Tailor simulations to your organization’s needs, focusing on relevant scenarios and incorporating industry-specific challenges. Consider leveraging scalable simulation LMS platforms that allow for customization and future adaptability.
• Comprehensive pre-training: Prioritize thorough onboarding and training for participants to familiarize them with the simulation interface and functionalities. Provide clear instructions and resources to reduce the learning curve and maximize engagement.
• Diverse case selection: Select a range of case studies that cover various industries, business challenges, and skill sets. This ensures a comprehensive learning experience and allows learners to apply their knowledge to different contexts.
• Facilitated discussions and reflection: Incorporate facilitated discussions and guided reflection sessions alongside case studies. Encourage learners to critically analyze and discuss the presented scenarios, promoting more profound understanding and engagement.
• Continuous improvement and feedback loops: Regularly evaluate the effectiveness of both simulations and case studies through participant feedback , performance assessments , and data analytics . Use these insights to identify areas for improvement and optimize the training experience over time.

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Combining Simulations and Case Studies for Optimal Training

As you strive to achieve optimal training outcomes, it is worth considering the benefits of combining simulations and case studies in a blended training approach . By leveraging the strengths of both types of training methods, you can create a dynamic and comprehensive learning experience that maximizes skill acquisition, knowledge retention, and engagement.

Exploring the Concept of Blended Training Approaches

Blended training approaches integrate numerous training and development methods to create a cohesive and robust training program. These approaches acknowledge that no single approach can address all learning objectives and that combining techniques can offer a more holistic learning experience.

Highlighting the Complementary Nature of Simulations and Case Studies

Simulations and case studies, when combined, offer a powerful synergy that enhances the learning process. Consider the following ways in which these methods complement each other:

• Enhanced real-world application: Simulations provide a controlled environment for learners to apply theoretical knowledge to realistic scenarios, while case studies offer real-world examples that deepen understanding and encourage the practical application of concepts.
• Dynamic engagement: Simulations engage learners through interactive and immersive experiences, fostering active participation and skill development. On the other hand, case studies encourage critical thinking and analysis, challenging learners to apply their knowledge to solve complex business challenges.
• Contextual learning: Simulations can create industry-specific scenarios that closely align with your organization’s context, allowing learners to practice skills and decision-making within a relevant framework. With their diverse examples, case studies expose learners to various industries and contexts, broadening their perspectives and adaptability.

Proposing Strategies for Integrating Both Methods Effectively

To integrate simulations and case studies effectively, consider the following strategies:

• Determine learning objectives: Identify the specific skills, knowledge, and competencies you aim to develop in your training program. Align simulations and case studies with these objectives to ensure a targeted and purposeful learning experience.
• Sequential or parallel integration: Decide whether to implement simulations and case studies sequentially, allowing learners to build upon foundational knowledge or use them concurrently to reinforce learning and provide different perspectives.
• Provide guidance and reflection: Offer clear instructions and guidance to learners throughout the blended training program. Incorporate reflection exercises encouraging learners to analyze their experiences, connect theory with practice, and extract valuable insights.
• Incorporate collaborative elements: Foster collaboration and teamwork by incorporating group discussions, role-playing exercises, or collaborative case study analysis. This encourages knowledge sharing, diverse perspectives, and the development of interpersonal skills.
• Measure effectiveness and adapt: Continuously assess the effectiveness of the blended approach through learner feedback, performance metrics, and evaluation data. Use these insights to refine and adapt the training program to ensure continuous improvement.

By thoughtfully combining simulations and case studies in a blended training approach, you can leverage the complementary nature of these methods to create a robust and comprehensive learning experience. Integrating simulations and case studies enable learners to acquire practical skills, apply knowledge in real-world scenarios, and develop critical thinking abilities, ultimately equipping your workforce with the capabilities needed to excel in today’s dynamic business landscape.

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7 Types of Training Methods (and How to Choose)

By Emily Gore

February 9, 2023

Traditional types of training methods are exactly what they say they are—traditional. Instead of engaging learners by being innovative, creative, fresh, lightweight, and sometimes funny, they often feel like a burden and unwelcome obligation.

Old days’ training methods fall short of everything they can do to maximize learners’ attention and information recall . Additionally, and in corporate settings, they ignore the collateral effects of effective training methods. As a result, companies miss a terrific opportunity to make their employees happier and more productive.

It’s not just the training materials—it’s the training method.

Many organizations focus on creating good-looking training materials. However, design is not all about aesthetics—it’s primarily about function. And if an employee training course doesn’t meet its functional goals, it fails—no matter how pretty the materials are. 

Nowadays, the variety of training methods can seem overwhelming. Therefore, we compiled a list of the best types of training methods for employees. We’ll also give you some advice on how to select the method that best suits your employees.

How Important Is It To Choose the Right Training Method?

Choosing the best option from a long list of training methods for employees can seem daunting. But corporate training is essential for employee onboarding and employee retention. Figuring out what works best for your employees doesn’t have to be difficult. 

Onboarding is a perfect moment to deliver training. A new staff member is bursting with excitement about joining your company. They’re like sponges ready to soak up all the information they possibly can—about the company, the business, or their function.

Existing employees are also eager to extend and develop their skills. In any case, for the sake of learning effectiveness, the training method is as important as the content and activities.

On top of the different levels of employees that need training, we have an indisputable truth: everyone learns differently. Some prefer to learn by watching, others by listening or reading and writing, and others by doing. Some learners change their preference depending on certain conditions. The topic might also influence the appropriateness of one method over the other.

Powered by technology, the types of training methods are numerous. And we didn’t discard any of the traditional training methods yet, because they do have their perks. Let’s explore the features of each training method for employees.

Types of Training Methods

Most training methods target more than one learning style, whereas some focus on one particular style. And that’s okay! Because if you offer training using different types of methods, you’ll satisfy the styles of different employees. And unless the topic calls for a particular training method, you might even offer a variety of methods for a single topic. You can also give your staff options to learn in different ways depending on the circumstances. For instance, they might wish to learn by listening on one day and by watching on another.

Below are seven of the best types of employee training methods:

• Case Studies
• Instructor-Led Training
• Interactive Training
• On-the-Job Training
• Video-Based Training

Check out the details and benefits of each type!

1. Case Studies

This type of training is great for developing critical thinking, problem-solving, and analytical skills. The scenarios can be real or imaginary, but in the context of employee training, they all illustrate situations at work.

Learners read the case studies and then analyze and solve them individually or in a group. Some solutions might be better than others, depend on assumptions, and be either optimal or the best possible given the circumstances.

Although case studies allow your staff to learn at their own pace, they’re most useful for less complex topics.

2. Coaching

Mentorship—another name for coaching—should be an impactful and memorable learning experience. At least, that’s the expectation of mentors and mentorees.

When your experienced staff dedicates time and effort to coaching new employees, those new employees will feel valued and supported. Put some emphasis on the time and effort required by mentors, and remember that it pays off.

Although coaching and on-the-job training might seem similar, coaching:

• Focuses on the mentor-mentoree relationship
• Is more inspiring
• Is most likely to make the employee comfortable asking questions

You can also deliver coaching sessions online—making them even more accessible.

3. eLearning

You might know this one by online training. It’s computer-based training that’s delivered from a distance, online. The advantages?

• Learners can go through the content and activities at their own pace.
• There’s no need to hire an instructor.
• It scales beautifully, so the number of simultaneous learners can increase tremendously.

Oftentimes, this type of training:

• Resembles classroom training
• Uses visuals with a voiceover
• Complements lessons with videos and reading materials

As you don’t have an instructor monitoring engagement levels, you must use other means to do it. Quizzes and other types of interactive activities are wonderful for that purpose. They also allow you to appraise the progress of each employee and the effectiveness of the training.

4. Instructor-Led Training

Whether it’s in-person or online, an instructor-led training session is very much based on the dynamics of a classroom.

• Led by an instructor
• With a presentation—just like a lecture

Although an academic-like classroom experience may not seem thrilling to some learners, the method has some significant pros.

• Learners can ask the instructor questions that the materials don’t cover in real-time.
• Instructors can monitor learners’ progress and engagement.
• Learners and instructors can build a relationship with each other.
• Complex topics are sometimes easier to teach in a classroom.

On the other hand, whether they’re online or physical, classrooms—or instructor-led training sessions—have some cons.

• A high number of learners prevents the instructor from interacting one-on-one with all of them.
• Learners can’t learn at their own pace since there are multiple learners in the (in-person or virtual) room.

5. Interactive Training

Anything interactive has the potential to grab our attention. And training is no different! That’s why interactive training is highly engaging and effective. Learners absorb more information, retain it faster, and recall it for longer periods of time.

The success of interactive training comes from being practical rather than theoretical. So, employees learn by applying knowledge in a realistic setting.

Here are three examples of interactive training:

• Game-based training. Using rewards like points increases motivation levels, and this type of training can make learning fun.
• Roleplaying. A facilitator manages the process of acting out different work scenarios with the learners. It’s especially effective for client or customer interaction training as it explores difficult situations in a controlled environment.
• Simulations. These can be appropriate for learning specialized, complex skills, like for medicine or aviation training. Simulations set up real work scenarios for the learners, so augmented or virtual reality can be great simulation tools.

6. On-the-Job Training

Also known as hands-on training, on-the-job training is all about the practical skills that a job requires. Therefore, the employee learns by going through the experience of executing real activities at work.

On-the-job training reduces the time before the employee starts performing their job function. It can take different forms, such as:

• Internships. Interns obtain guidance, support, and training from the company that hired them. And the more prior knowledge they have of what the job entails, the better for their future success.
• Rotations. Job rotations boost employee motivation, satisfaction, cooperation, and commitment to the company. By exposing the employee to different business areas of your company, they develop skills they might not otherwise have and a deeper understanding of and commitment to the company as a whole. This increases retention levels and your employees’ chances of moving up in their own department or in another.
• Shadowing. New hires observe existing employees while they work, ask questions, and sometimes help with tasks. By doing that, new hires understand how they’ll have to do their work before they actually have to do it.

Employee engagement—or interest and involvement—is vital for the success of on-the-job training. Engagement is typically heightened with on-the-job training since it’s individual and the learning activities intimately relate to the employee’s job.

On-the-job training produces results quickly and is also appropriate for teaching and developing leadership skills.

7. Video-Based Training

Speed and efficiency—these are the keywords that propelled video as an employee training vehicle. Additionally, it became popular because it can be way more interesting than traditional training methods. It’s highly engaging and can be entertaining as well!

Animations raise information recall to impressive levels. Live-action videos are great for demonstrations. Webinars and screen recordings of step-by-step procedures can take a simple list and turn it into an entertaining, story-based how-to.

Video-based training is easily accessible and repeatable—the employee can watch the video as many times as they need. Also, it doesn’t require an instructor.

Now that you know each one of the types of training methods for employees, are you ready to choose? Here are some tips on making the right choice for your organization!

How To Choose the Right Employee Training Method

To choose a training method, you should analyze your training needs from two perspectives.

• Coaching is perfect for teaching leadership, emotional intelligence, or change-management skills.
• eLearning is especially useful for teaching company policies.
• Roleplaying works well for teaching how to deal with employees who don’t follow company policies.
• Video-based training is great for teaching new knowledge, such as industry or technological trends.
• Older employees might feel more comfortable with instructor-led training.
• Millennials often prefer training methods compatible with mobile devices, such as games and video.
• Any online training is most effective when employees are remotely located, are senior-level staff with limited availability, or travel a lot.

Training Methods for All Tastes and Needs

Long story short, employee training is continuous, and companies need it to thrive and prosper. Without developing their employees’ skills, companies can’t face the competition.

Choosing the right training method for your employees is integral to effective training. And you might find value from using varied training methods. It all depends on why you’re delivering the training program and to whom.

The suitability of your training methods to your goals and audience is indispensable to the success of your training program. Finding the right training method makes your employees more skilled and aligned with their job and your company.

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Case Study Teaching Method Improves Student Performance and Perceptions of Learning Gains †

Associated data.

• Appendix 1: Example assessment questions used to assess the effectiveness of case studies at promoting learning
• Appendix 2: Student learning gains were assessed using a modified version of the SALG course evaluation tool

Following years of widespread use in business and medical education, the case study teaching method is becoming an increasingly common teaching strategy in science education. However, the current body of research provides limited evidence that the use of published case studies effectively promotes the fulfillment of specific learning objectives integral to many biology courses. This study tested the hypothesis that case studies are more effective than classroom discussions and textbook reading at promoting learning of key biological concepts, development of written and oral communication skills, and comprehension of the relevance of biological concepts to everyday life. This study also tested the hypothesis that case studies produced by the instructor of a course are more effective at promoting learning than those produced by unaffiliated instructors. Additionally, performance on quantitative learning assessments and student perceptions of learning gains were analyzed to determine whether reported perceptions of learning gains accurately reflect academic performance. The results reported here suggest that case studies, regardless of the source, are significantly more effective than other methods of content delivery at increasing performance on examination questions related to chemical bonds, osmosis and diffusion, mitosis and meiosis, and DNA structure and replication. This finding was positively correlated to increased student perceptions of learning gains associated with oral and written communication skills and the ability to recognize connections between biological concepts and other aspects of life. Based on these findings, case studies should be considered as a preferred method for teaching about a variety of concepts in science courses.

INTRODUCTION

The case study teaching method is a highly adaptable style of teaching that involves problem-based learning and promotes the development of analytical skills ( 8 ). By presenting content in the format of a narrative accompanied by questions and activities that promote group discussion and solving of complex problems, case studies facilitate development of the higher levels of Bloom’s taxonomy of cognitive learning; moving beyond recall of knowledge to analysis, evaluation, and application ( 1 , 9 ). Similarly, case studies facilitate interdisciplinary learning and can be used to highlight connections between specific academic topics and real-world societal issues and applications ( 3 , 9 ). This has been reported to increase student motivation to participate in class activities, which promotes learning and increases performance on assessments ( 7 , 16 , 19 , 23 ). For these reasons, case-based teaching has been widely used in business and medical education for many years ( 4 , 11 , 12 , 14 ). Although case studies were considered a novel method of science education just 20 years ago, the case study teaching method has gained popularity in recent years among an array of scientific disciplines such as biology, chemistry, nursing, and psychology ( 5 – 7 , 9 , 11 , 13 , 15 – 17 , 21 , 22 , 24 ).

Although there is now a substantive and growing body of literature describing how to develop and use case studies in science teaching, current research on the effectiveness of case study teaching at meeting specific learning objectives is of limited scope and depth. Studies have shown that working in groups during completion of case studies significantly improves student perceptions of learning and may increase performance on assessment questions, and that the use of clickers can increase student engagement in case study activities, particularly among non-science majors, women, and freshmen ( 7 , 21 , 22 ). Case study teaching has been shown to improve exam performance in an anatomy and physiology course, increasing the mean score across all exams given in a two-semester sequence from 66% to 73% ( 5 ). Use of case studies was also shown to improve students’ ability to synthesize complex analytical questions about the real-world issues associated with a scientific topic ( 6 ). In a high school chemistry course, it was demonstrated that the case study teaching method produces significant increases in self-reported control of learning, task value, and self-efficacy for learning and performance ( 24 ). This effect on student motivation is important because enhanced motivation for learning activities has been shown to promote student engagement and academic performance ( 19 , 24 ). Additionally, faculty from a number of institutions have reported that using case studies promotes critical thinking, learning, and participation among students, especially in terms of the ability to view an issue from multiple perspectives and to grasp the practical application of core course concepts ( 23 ).

Despite what is known about the effectiveness of case studies in science education, questions remain about the functionality of the case study teaching method at promoting specific learning objectives that are important to many undergraduate biology courses. A recent survey of teachers who use case studies found that the topics most often covered in general biology courses included genetics and heredity, cell structure, cells and energy, chemistry of life, and cell cycle and cancer, suggesting that these topics should be of particular interest in studies that examine the effectiveness of the case study teaching method ( 8 ). However, the existing body of literature lacks direct evidence that the case study method is an effective tool for teaching about this collection of important topics in biology courses. Further, the extent to which case study teaching promotes development of science communication skills and the ability to understand the connections between biological concepts and everyday life has not been examined, yet these are core learning objectives shared by a variety of science courses. Although many instructors have produced case studies for use in their own classrooms, the production of novel case studies is time-consuming and requires skills that not all instructors have perfected. It is therefore important to determine whether case studies published by instructors who are unaffiliated with a particular course can be used effectively and obviate the need for each instructor to develop new case studies for their own courses. The results reported herein indicate that teaching with case studies results in significantly higher performance on examination questions about chemical bonds, osmosis and diffusion, mitosis and meiosis, and DNA structure and replication than that achieved by class discussions and textbook reading for topics of similar complexity. Case studies also increased overall student perceptions of learning gains and perceptions of learning gains specifically related to written and oral communication skills and the ability to grasp connections between scientific topics and their real-world applications. The effectiveness of the case study teaching method at increasing academic performance was not correlated to whether the case study used was authored by the instructor of the course or by an unaffiliated instructor. These findings support increased use of published case studies in the teaching of a variety of biological concepts and learning objectives.

Student population

This study was conducted at Kingsborough Community College, which is part of the City University of New York system, located in Brooklyn, New York. Kingsborough Community College has a diverse population of approximately 19,000 undergraduate students. The student population included in this study was enrolled in the first semester of a two-semester sequence of general (introductory) biology for biology majors during the spring, winter, or summer semester of 2014. A total of 63 students completed the course during this time period; 56 students consented to the inclusion of their data in the study. Of the students included in the study, 23 (41%) were male and 33 (59%) were female; 40 (71%) were registered as college freshmen and 16 (29%) were registered as college sophomores. To normalize participant groups, the same student population pooled from three classes taught by the same instructor was used to assess both experimental and control teaching methods.

Course material

The four biological concepts assessed during this study (chemical bonds, osmosis and diffusion, mitosis and meiosis, and DNA structure and replication) were selected as topics for studying the effectiveness of case study teaching because they were the key concepts addressed by this particular course that were most likely to be taught in a number of other courses, including biology courses for both majors and nonmajors at outside institutions. At the start of this study, relevant existing case studies were freely available from the National Center for Case Study Teaching in Science (NCCSTS) to address mitosis and meiosis and DNA structure and replication, but published case studies that appropriately addressed chemical bonds and osmosis and diffusion were not available. Therefore, original case studies that addressed the latter two topics were produced as part of this study, and case studies produced by unaffiliated instructors and published by the NCCSTS were used to address the former two topics. By the conclusion of this study, all four case studies had been peer-reviewed and accepted for publication by the NCCSTS ( http://sciencecases.lib.buffalo.edu/cs/ ). Four of the remaining core topics covered in this course (macromolecules, photosynthesis, genetic inheritance, and translation) were selected as control lessons to provide control assessment data.

To minimize extraneous variation, control topics and assessments were carefully matched in complexity, format, and number with case studies, and an equal amount of class time was allocated for each case study and the corresponding control lesson. Instruction related to control lessons was delivered using minimal slide-based lectures, with emphasis on textbook reading assignments accompanied by worksheets completed by students in and out of the classroom, and small and large group discussion of key points. Completion of activities and discussion related to all case studies and control topics that were analyzed was conducted in the classroom, with the exception of the take-home portion of the osmosis and diffusion case study.

Data collection and analysis

This study was performed in accordance with a protocol approved by the Kingsborough Community College Human Research Protection Program and the Institutional Review Board (IRB) of the City University of New York (CUNY IRB reference 539938-1; KCC IRB application #: KCC 13-12-126-0138). Assessment scores were collected from regularly scheduled course examinations. For each case study, control questions were included on the same examination that were similar in number, format, point value, and difficulty level, but related to a different topic covered in the course that was of similar complexity. Complexity and difficulty of both case study and control questions were evaluated using experiential data from previous iterations of the course; the Bloom’s taxonomy designation and amount of material covered by each question, as well as the average score on similar questions achieved by students in previous iterations of the course was considered in determining appropriate controls. All assessment questions were scored using a standardized, pre-determined rubric. Student perceptions of learning gains were assessed using a modified version of the Student Assessment of Learning Gains (SALG) course evaluation tool ( http://www.salgsite.org ), distributed in hardcopy and completed anonymously during the last week of the course. Students were presented with a consent form to opt-in to having their data included in the data analysis. After the course had concluded and final course grades had been posted, data from consenting students were pooled in a database and identifying information was removed prior to analysis. Statistical analysis of data was conducted using the Kruskal-Wallis one-way analysis of variance and calculation of the R 2 coefficient of determination.

Teaching with case studies improves performance on learning assessments, independent of case study origin

To evaluate the effectiveness of the case study teaching method at promoting learning, student performance on examination questions related to material covered by case studies was compared with performance on questions that covered material addressed through classroom discussions and textbook reading. The latter questions served as control items; assessment items for each case study were compared with control items that were of similar format, difficulty, and point value ( Appendix 1 ). Each of the four case studies resulted in an increase in examination performance compared with control questions that was statistically significant, with an average difference of 18% ( Fig. 1 ). The mean score on case study-related questions was 73% for the chemical bonds case study, 79% for osmosis and diffusion, 76% for mitosis and meiosis, and 70% for DNA structure and replication ( Fig. 1 ). The mean score for non-case study-related control questions was 60%, 54%, 60%, and 52%, respectively ( Fig. 1 ). In terms of examination performance, no significant difference between case studies produced by the instructor of the course (chemical bonds and osmosis and diffusion) and those produced by unaffiliated instructors (mitosis and meiosis and DNA structure and replication) was indicated by the Kruskal-Wallis one-way analysis of variance. However, the 25% difference between the mean score on questions related to the osmosis and diffusion case study and the mean score on the paired control questions was notably higher than the 13–18% differences observed for the other case studies ( Fig. 1 ).

Case study teaching method increases student performance on examination questions. Mean score on a set of examination questions related to lessons covered by case studies (black bars) and paired control questions of similar format and difficulty about an unrelated topic (white bars). Chemical bonds, n = 54; Osmosis and diffusion, n = 54; Mitosis and meiosis, n = 51; DNA structure and replication, n = 50. Error bars represent the standard error of the mean (SEM). Asterisk indicates p < 0.05.

Case study teaching increases student perception of learning gains related to core course objectives

Student learning gains were assessed using a modified version of the SALG course evaluation tool ( Appendix 2 ). To determine whether completing case studies was more effective at increasing student perceptions of learning gains than completing textbook readings or participating in class discussions, perceptions of student learning gains for each were compared. In response to the question “Overall, how much did each of the following aspects of the class help your learning?” 82% of students responded that case studies helped a “good” or “great” amount, compared with 70% for participating in class discussions and 58% for completing textbook reading; only 4% of students responded that case studies helped a “small amount” or “provided no help,” compared with 2% for class discussions and 22% for textbook reading ( Fig. 2A ). The differences in reported learning gains derived from the use of case studies compared with class discussion and textbook readings were statistically significant, while the difference in learning gains associated with class discussion compared with textbook reading was not statistically significant by a narrow margin ( p = 0.051).

The case study teaching method increases student perceptions of learning gains. Student perceptions of learning gains are indicated by plotting responses to the question “How much did each of the following activities: (A) Help your learning overall? (B) Improve your ability to communicate your knowledge of scientific concepts in writing? (C) Improve your ability to communicate your knowledge of scientific concepts orally? (D) Help you understand the connections between scientific concepts and other aspects of your everyday life?” Reponses are represented as follows: Helped a great amount (black bars); Helped a good amount (dark gray bars); Helped a moderate amount (medium gray bars); Helped a small amount (light gray bars); Provided no help (white bars). Asterisk indicates p < 0.05.

To elucidate the effectiveness of case studies at promoting learning gains related to specific course learning objectives compared with class discussions and textbook reading, students were asked how much each of these methods of content delivery specifically helped improve skills that were integral to fulfilling three main course objectives. When students were asked how much each of the methods helped “improve your ability to communicate knowledge of scientific concepts in writing,” 81% of students responded that case studies help a “good” or “great” amount, compared with 63% for class discussions and 59% for textbook reading; only 6% of students responded that case studies helped a “small amount” or “provided no help,” compared with 8% for class discussions and 21% for textbook reading ( Fig. 2B ). When the same question was posed about the ability to communicate orally, 81% of students responded that case studies help a “good” or “great” amount, compared with 68% for class discussions and 50% for textbook reading, while the respective response rates for helped a “small amount” or “provided no help,” were 4%, 6%, and 25% ( Fig. 2C ). The differences in learning gains associated with both written and oral communication were statistically significant when completion of case studies was compared with either participation in class discussion or completion of textbook readings. Compared with textbook reading, class discussions led to a statistically significant increase in oral but not written communication skills.

Students were then asked how much each of the methods helped them “understand the connections between scientific concepts and other aspects of your everyday life.” A total of 79% of respondents declared that case studies help a “good” or “great” amount, compared with 70% for class discussions and 57% for textbook reading ( Fig. 2D ). Only 4% stated that case studies and class discussions helped a “small amount” or “provided no help,” compared with 21% for textbook reading ( Fig. 2D ). Similar to overall learning gains, the use of case studies significantly increased the ability to understand the relevance of science to everyday life compared with class discussion and textbook readings, while the difference in learning gains associated with participation in class discussion compared with textbook reading was not statistically significant ( p = 0.054).

Student perceptions of learning gains resulting from case study teaching are positively correlated to increased performance on examinations, but independent of case study author

To test the hypothesis that case studies produced specifically for this course by the instructor were more effective at promoting learning gains than topically relevant case studies published by authors not associated with this course, perceptions of learning gains were compared for each of the case studies. For both of the case studies produced by the instructor of the course, 87% of students indicated that the case study provided a “good” or “great” amount of help to their learning, and 2% indicated that the case studies provided “little” or “no” help ( Table 1 ). In comparison, an average of 85% of students indicated that the case studies produced by an unaffiliated instructor provided a “good” or “great” amount of help to their learning, and 4% indicated that the case studies provided “little” or “no” help ( Table 1 ). The instructor-produced case studies yielded both the highest and lowest percentage of students reporting the highest level of learning gains (a “great” amount), while case studies produced by unaffiliated instructors yielded intermediate values. Therefore, it can be concluded that the effectiveness of case studies at promoting learning gains is not significantly affected by whether or not the course instructor authored the case study.

Case studies positively affect student perceptions of learning gains about various biological topics.

Finally, to determine whether performance on examination questions accurately predicts student perceptions of learning gains, mean scores on examination questions related to case studies were compared with reported perceptions of learning gains for those case studies ( Fig. 3 ). The coefficient of determination (R 2 value) was 0.81, indicating a strong, but not definitive, positive correlation between perceptions of learning gains and performance on examinations, suggesting that student perception of learning gains is a valid tool for assessing the effectiveness of case studies ( Fig. 3 ). This correlation was independent of case study author.

Perception of learning gains but not author of case study is positively correlated to score on related examination questions. Percentage of students reporting that each specific case study provided “a great amount of help” to their learning was plotted against the point difference between mean score on examination questions related to that case study and mean score on paired control questions. Positive point differences indicate how much higher the mean scores on case study-related questions were than the mean scores on paired control questions. Black squares represent case studies produced by the instructor of the course; white squares represent case studies produced by unaffiliated instructors. R 2 value indicates the coefficient of determination.

The purpose of this study was to test the hypothesis that teaching with case studies produced by the instructor of a course is more effective at promoting learning gains than using case studies produced by unaffiliated instructors. This study also tested the hypothesis that the case study teaching method is more effective than class discussions and textbook reading at promoting learning gains associated with four of the most commonly taught topics in undergraduate general biology courses: chemical bonds, osmosis and diffusion, mitosis and meiosis, and DNA structure and replication. In addition to assessing content-based learning gains, development of written and oral communication skills and the ability to connect scientific topics with real-world applications was also assessed, because these skills were overarching learning objectives of this course, and classroom activities related to both case studies and control lessons were designed to provide opportunities for students to develop these skills. Finally, data were analyzed to determine whether performance on examination questions is positively correlated to student perceptions of learning gains resulting from case study teaching.

Compared with equivalent control questions about topics of similar complexity taught using class discussions and textbook readings, all four case studies produced statistically significant increases in the mean score on examination questions ( Fig. 1 ). This indicates that case studies are more effective than more commonly used, traditional methods of content delivery at promoting learning of a variety of core concepts covered in general biology courses. The average increase in score on each test item was equivalent to nearly two letter grades, which is substantial enough to elevate the average student performance on test items from the unsatisfactory/failing range to the satisfactory/passing range. The finding that there was no statistical difference between case studies in terms of performance on examination questions suggests that case studies are equally effective at promoting learning of disparate topics in biology. The observations that students did not perform significantly less well on the first case study presented (chemical bonds) compared with the other case studies and that performance on examination questions did not progressively increase with each successive case study suggests that the effectiveness of case studies is not directly related to the amount of experience students have using case studies. Furthermore, anecdotal evidence from previous semesters of this course suggests that, of the four topics addressed by cases in this study, DNA structure and function and osmosis and diffusion are the first and second most difficult for students to grasp. The lack of a statistical difference between case studies therefore suggests that the effectiveness of a case study at promoting learning gains is not directly proportional to the difficulty of the concept covered. However, the finding that use of the osmosis and diffusion case study resulted in the greatest increase in examination performance compared with control questions and also produced the highest student perceptions of learning gains is noteworthy and could be attributed to the fact that it was the only case study evaluated that included a hands-on experiment. Because the inclusion of a hands-on kinetic activity may synergistically enhance student engagement and learning and result in an even greater increase in learning gains than case studies that lack this type of activity, it is recommended that case studies that incorporate this type of activity be preferentially utilized.

Student perceptions of learning gains are strongly motivating factors for engagement in the classroom and academic performance, so it is important to assess the effect of any teaching method in this context ( 19 , 24 ). A modified version of the SALG course evaluation tool was used to assess student perceptions of learning gains because it has been previously validated as an efficacious tool ( Appendix 2 ) ( 20 ). Using the SALG tool, case study teaching was demonstrated to significantly increase student perceptions of overall learning gains compared with class discussions and textbook reading ( Fig. 2A ). Case studies were shown to be particularly useful for promoting perceived development of written and oral communication skills and for demonstrating connections between scientific topics and real-world issues and applications ( Figs. 2B–2D ). Further, student perceptions of “great” learning gains positively correlated with increased performance on examination questions, indicating that assessment of learning gains using the SALG tool is both valid and useful in this course setting ( Fig. 3 ). These findings also suggest that case study teaching could be used to increase student motivation and engagement in classroom activities and thus promote learning and performance on assessments. The finding that textbook reading yielded the lowest student perceptions of learning gains was not unexpected, since reading facilitates passive learning while the class discussions and case studies were both designed to promote active learning.

Importantly, there was no statistical difference in student performance on examinations attributed to the two case studies produced by the instructor of the course compared with the two case studies produced by unaffiliated instructors. The average difference between the two instructor-produced case studies and the two case studies published by unaffiliated instructors was only 3% in terms of both the average score on examination questions (76% compared with 73%) and the average increase in score compared with paired control items (14% compared with 17%) ( Fig. 1 ). Even when considering the inherent qualitative differences of course grades, these differences are negligible. Similarly, the effectiveness of case studies at promoting learning gains was not significantly affected by the origin of the case study, as evidenced by similar percentages of students reporting “good” and “great” learning gains regardless of whether the case study was produced by the course instructor or an unaffiliated instructor ( Table 1 ).

The observation that case studies published by unaffiliated instructors are just as effective as those produced by the instructor of a course suggests that instructors can reasonably rely on the use of pre-published case studies relevant to their class rather than investing the considerable time and effort required to produce a novel case study. Case studies covering a wide range of topics in the sciences are available from a number of sources, and many of them are free access. The National Center for Case Study Teaching in Science (NCCSTS) database ( http://sciencecases.lib.buffalo.edu/cs/ ) contains over 500 case studies that are freely available to instructors, and are accompanied by teaching notes that provide logistical advice and additional resources for implementing the case study, as well as a set of assessment questions with a password-protected answer key. Case study repositories are also maintained by BioQUEST Curriculum Consortium ( http://www.bioquest.org/icbl/cases.php ) and the Science Case Network ( http://sciencecasenet.org ); both are available for use by instructors from outside institutions.

It should be noted that all case studies used in this study were rigorously peer-reviewed and accepted for publication by the NCCSTS prior to the completion of this study ( 2 , 10 , 18 , 25 ); the conclusions of this study may not apply to case studies that were not developed in accordance with similar standards. Because case study teaching involves skills such as creative writing and management of dynamic group discussion in a way that is not commonly integrated into many other teaching methods, it is recommended that novice case study teachers seek training or guidance before writing their first case study or implementing the method. The lack of a difference observed in the use of case studies from different sources should be interpreted with some degree of caution since only two sources were represented in this study, and each by only two cases. Furthermore, in an educational setting, quantitative differences in test scores might produce meaningful qualitative differences in course grades even in the absence of a p value that is statistically significant. For example, there is a meaningful qualitative difference between test scores that result in an average grade of C− and test scores that result in an average grade of C+, even if there is no statistically significant difference between the two sets of scores.

In the future, it could be informative to confirm these findings using a larger cohort, by repeating the study at different institutions with different instructors, by evaluating different case studies, and by directly comparing the effectiveness of the case studying teaching method with additional forms of instruction, such as traditional chalkboard and slide-based lecturing, and laboratory-based activities. It may also be informative to examine whether demographic factors such as student age and gender modulate the effectiveness of the case study teaching method, and whether case studies work equally well for non-science majors taking a science course compared with those majoring in the subject. Since the topical material used in this study is often included in other classes in both high school and undergraduate education, such as cell biology, genetics, and chemistry, the conclusions of this study are directly applicable to a broad range of courses. Presently, it is recommended that the use of case studies in teaching undergraduate general biology and other science courses be expanded, especially for the teaching of capacious issues with real-world applications and in classes where development of written and oral communication skills are key objectives. The use of case studies that involve hands-on activities should be emphasized to maximize the benefit of this teaching method. Importantly, instructors can be confident in the use of pre-published case studies to promote learning, as there is no indication that the effectiveness of the case study teaching method is reliant on the production of novel, customized case studies for each course.

SUPPLEMENTAL MATERIALS

Acknowledgments.

This article benefitted from a President’s Faculty Innovation Grant, Kingsborough Community College. The author declares that there are no conflicts of interest.

† Supplemental materials available at http://jmbe.asm.org

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Please note you do not have access to teaching notes, case-method teaching: advantages and disadvantages in organizational training.

Journal of Management Development

ISSN : 0262-1711

Article publication date: 21 September 2018

Issue publication date: 7 November 2018

The purpose of this paper is to introduce case-method teaching (CMT), its advantages and disadvantages for the process of organizational training within organizations, as well as to compare its advantages and disadvantages with current training methods.

Design/methodology/approach

The authors applied a systematic literature review to define, identify and compare CMT with current methods.

In CMT, participants get involved with real-world challenges from an action perspective instead of analyzing them from a distance. Also, different reactions of the participants to the same challenge aid instructors to identify the individual differences of participants toward the challenge. Although CMT is still not considered as a popular organizational training method, the advantages of CMT may encourage organizational instructors to further apply it. Improving the long-term memory, enhancing the quality of decision making and understanding the individual differences of individuals are the advantages of CMT.

Research limitations/implications

A lack of sufficient empirical researchers and the high cost of conducting this method may prevent practitioners to apply it.

Originality/value

The review suggested that CMT is able to bring dilemmas from the real world into training settings. Also, it helps organizations to identify the individual reactions before they make a decision.

• Advantages and disadvantages
• Case-method teaching
• Organizational training

Acknowledgements

The authors would like to sincerely thank Dr Mojtaba Amanollah Nejad and Dr Geeske Scholz who helped to improve this paper.

Radi Afsouran, N. , Charkhabi, M. , Siadat, S.A. , Hoveida, R. , Oreyzi, H.R. and Thornton III, G.C. (2018), "Case-method teaching: advantages and disadvantages in organizational training", Journal of Management Development , Vol. 37 No. 9/10, pp. 711-720. https://doi.org/10.1108/JMD-10-2017-0324

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Home » Management Case Studies » Case Study of Nestle: Training and Development

Case Study of Nestle: Training and Development

Nestle is world’s leading food company, with a 135-year history and operations in virtually every country in the world. Nestle’s principal assets are not office buildings, factories, or even brands. Rather, it is the fact that they are a global organization comprised of many nationalities, religions, and ethnic backgrounds all working together in one single unifying corporate culture .

Culture at Nestle and Human Resources Policy

Nestle culture unifies people on all continents. The most important parts of Nestle’s business strategy and culture are the development of human capacity in each country where they operate. Learning is an integral part of Nestle’s culture. This is firmly stated in The Nestle Human Resources Policy, a totally new policy that encompasses the guidelines that constitute a sound basis for efficient and effective human resource management . People development is the driving force of the policy, which includes clear principles on non-discrimination, the right of collective bargaining as well as the strict prohibition of any form of harassment. The policy deals with recruitment , remuneration and training and development and emphasizes individual responsibility, strong leadership and a commitment to life-long learning as required characteristics for Nestle managers.

Training Programs at Nestle

The willingness to learn is therefore an essential condition to be employed by Nestle. First and foremost, training is done on-the-job. Guiding and coaching is part of the responsibility of each manager and is crucial to make each one progress in his/her position. Formal training programs are generally purpose-oriented and designed to improve relevant skills and competencies . Therefore they are proposed in the framework of individual development programs and not as a reward.

Literacy Training

Most of Nestle’s people development programs assume a good basic education on the part of employees. However, in a number of countries, we have decided to offer employees the opportunity to upgrade their essential literacy skills. A number of Nestle companies have therefore set up special programs for those who, for one reason or another, missed a large part of their elementary schooling.

These programs are especially important as they introduce increasingly sophisticated production techniques into each country where they operate. As the level of technology in Nestle factories has steadily risen, the need for training has increased at all levels. Much of this is on-the-job training to develop the specific skills to operate more advanced equipment. But it’s not only new technical abilities that are required. It’s sometimes new working practices. For example, more flexibility and more independence among work teams are sometimes needed if equipment is to operate at maximum efficiency .

“Sometimes we have debates in class and we are afraid to stand up. But our facilitators tell us to stand up because one day we might be in the parliament!” (Maria Modiba, Production line worker, Babelegi factory, Nestle South Africa).

Nestle Apprenticeship Program

Apprenticeship programs have been an essential part of Nestle training where the young trainees spent three days a week at work and two at school. Positive results observed but some of these soon ran into a problem. At the end of training, many students were hired away by other companies which provided no training of their own.

“My two elder brothers worked here before me. Like them, for me the Nestle Apprenticeship Program in Nigeria will not be the end of my training but it will provide me with the right base for further advancement. We should have more apprentices here as we are trained so well!” (John Edobor Eghoghon, Apprentice Mechanic, Agbara Factory, Nestle Nigeria) (adsbygoogle = window.adsbygoogle || []).push({}); “It’s not only a matter of learning bakery; we also learn about microbiology, finance, budgeting, costs, sales, how to treat the customer, and so on. That is the reason I think that this is really something that is going to give meaning to my life. It will be very useful for everything.” (Jair Andres Santa, Apprentice Baker, La Rosa Factory Dosquebradas, Nestle Columbia).

Local Training

Two-thirds of all Nestle employees work in factories, most of which organize continuous training to meet their specific needs. In addition, a number of Nestle operating companies run their own residential training centers. The result is that local training is the largest component of Nestle’s people development activities worldwide and a substantial majority of the company’s 240000 employees receive training every year. Ensuring appropriate and continuous training is an official part of every manager’s responsibilities and, in many cases; the manager is personally involved in the teaching. For this reason, part of the training structure in every company is focused on developing managers own coaching skills. Additional courses are held outside the factory when required, generally in connection with the operation of new technology.

The variety of programs is very extensive. They start with continuation training for ex-apprentices who have the potential to become supervisors or section leaders, and continue through several levels of technical, electrical and maintenance engineering as well as IT management. The degree to which factories develop “home-grown” specialists varies considerably, reflecting the availability of trained people on the job market in each country. On-the-job training is also a key element of career development in commercial and administrative positions. Here too, most courses are delivered in-house by Nestle trainers but, as the level rises, collaboration with external institutes increases.

“As part of the Young Managers’ Training Program I was sent to a different part of the country and began by selling small portions of our Maggi bouillon cubes to the street stalls, the ‘sari sari’ stores, in my country. Even though most of my main key accounts are now supermarkets, this early exposure were an invaluable learning experience and will help me all my life.” (Diane Jennifer Zabala, Key Account Specialist, Sales, Nestle Philippines). “Through its education and training program, Nestle manifests its belief that people are the most important asset. In my case, I was fortunate to participate in Nestle’s Young Managers Program at the start of my Nestle career, in 1967. This foundation has sustained me all these years up to my present position of CEO of one of the top 12 Nestle companies in the world.” (Juan Santos, CEO, Nestle Philippines)

Virtually every national Nestle company organizes management-training courses for new employees with High school or university qualifications. But their approaches vary considerably. In Japan, for example, they consist of a series of short courses typically lasting three days each. Subjects include human assessment skills, leadership and strategy as well as courses for new supervisors and new key staff. In Mexico, Nestle set up a national training center in 1965. In addition to those following regular training programs, some 100 people follow programs for young managers there every year. These are based on a series of modules that allows tailored courses to be offered to each participant. Nestle India runs 12-month programs for management trainees in sales and marketing, finance and human resources, as well as in milk collection and agricultural services. These involve periods of fieldwork, not only to develop a broad range of skills but also to introduce new employees to company organization and systems. The scope of local training is expanding. The growing familiarity with information technology has enabled “distance learning” to become a valuable resource, and many Nestle companies have appointed corporate training assistants in this area. It has the great advantage of allowing students to select courses that meet their individual needs and do the work at their own pace, at convenient times. In Singapore, to quote just one example, staff is given financial help to take evening courses in job-related subjects. Fees and expenses are reimbursed for successfully following courses leading to a trade certificate, a high school diploma, university entrance qualifications, and a bachelor’s degree.

International Training

Nestle’s success in growing local companies in each country has been highly influenced by the functioning of its International Training Centre, located near company’s corporate headquarters in Switzerland. For over 30 years, the Rive-Reine International Training Centre has brought together managers from around the world to learn from senior Nestle managers and from each other.Country managers decide who attends which course, although there is central screening for qualifications, and classes are carefully composed to include people with a range of geographic and functional backgrounds. Typically a class contains 15—20 nationalities. The Centre delivers some 70 courses, attended by about 1700 managers each year from over 80 countries. All course leaders are Nestle managers with many years of experience in a range of countries. Only 25% of the teaching is done by outside professionals, as the primary faculty is the Nestle senior management. The programs can be broadly divided into two groups:

• Management courses: these account for about 66% of all courses at Rive-Reine. The participants have typically been with the company for four to five years. The intention is to develop a real appreciation of Nestle values and business approaches. These courses focus on internal activities.
• Executive courses: these classes often contain people who have attended a management course five to ten years earlier. The focus is on developing the ability to represent Nestle externally and to work with outsiders. It emphasizes industry analysis, often asking: “What would you do if you were a competitor?”

Nestle’s overarching principle is that each employee should have the opportunity to develop to the maximum of his or her potential. Nestle do this because they believe it pays off in the long run in their business results, and that sustainable long-term relationships with highly competent people and with the communities where they operate enhance their ability to make consistent profits. It is important to give people the opportunities for life-long learning as at Nestle that all employees are called upon to upgrade their skills in a fast-changing world. By offering opportunities to develop , they not only enrich themselves as a company, they also make themselves individually more autonomous, confident, and, in turn, more employable and open to new positions within the company. Enhancing this virtuous circle is the ultimate goal of their training efforts at many different levels through the thousands of training programs they run each year.

External Links:

• Employee and Career Development (Nestle Global)

Related posts:

• Case Study of Dell: Employee Training and Development
• Case Study of IBM: Employee Training through E-Learning
• Case Study: Nestle’s Growth Strategy
• Role of Case Studies in Employee Training and Development
• Different Employee Training and Development Methods
• Training and Development – Meaning, Definition and Need
• Skill Development Training Methods
• Four Major Theories of Training and Development
• HRM Functions: Training and Management Development
• Outsourcing of Training and Development

4 thoughts on “ Case Study of Nestle: Training and Development ”

Very nice case study

one question, when is this case study published? please ,thank you. i am doing this for final year project. as references

Post date: 03-09-2010

How does Nestle evaluate the effectiveness of training programs? Explain your reasons

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Exploring the significant problems confronting secondary schools history education: a baseline study

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• Fekede Sileshi Fufa   ORCID: orcid.org/0000-0001-6035-8205 1 ,
• Abera Husen Tulu   ORCID: orcid.org/0000-0002-0408-9028 2 &
• Ketebo Abdiyo Ensene   ORCID: orcid.org/0000-0001-8492-9340 1  

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The purpose of this baseline study is to determine the significant problems confronting history education in secondary school. The researchers employed qualitative research methods and case study design. The techniques that were employed to acquire credible data were document analysis, interviews, and classroom observation. Six experienced history education teachers and eight top-ten students from Sebeta town public secondary school were interviewed, and academic achievement statistics of 174 students in history education were analyzed. In addition eight lesson observations were carried out to validate the information gleaned from the interviews and document analysis. The study's findings show that the primary challenges influencing history education in Sebeta town public secondary schools were teaching strategy, a lack of awareness about implementing participatory teaching methods, a lack of comprehensiveness of the contents of history education teaching materials, and the issue of the bulkiness and scope of history education texts being covered on time. The findings also indicate the significance of training history education teachers to use participatory teaching tactics, as well as the need for curriculum experts to better coordinate the range of history education content and teaching strategies. The findings of this study will help teachers, practitioners, scholars, policymakers, and educational professionals find solutions to significant problems in secondary school history education, as well as develop effective techniques for teaching history education in secondary schools that involve twenty-first century skills and abilities.

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1 Introduction

History education as an academic discipline has a long history in the world. In the nineteenth century a German historian Leopold von Ranke an indispensable contribution to modernizing history writing [ 1 , p. 2, 2 , p. 171]. Ranke (1795–1886) not only established history as a major discipline, but he also established the idea that all accurate history must be based on primary sources and rigorous methodology [ 1 , p.13, 3 ]. As a result, he is regarded as the father of modern historiography [ 1 , p. 2]. Since the nineteenth century, history education has developed as an independent discipline across the world.

In terms of teaching strategies, evidence shows that teaching approaches play an important role in any subject of study in enhancing students' academic achievements [ 4 , p. 601, 5 ]. Many research findings demonstrate that the approach employed to develop any operation significantly determines the end product [ 6 , p. 7]. Several factors influence students' academic achievement; evidence suggests that teachers are the most essential ones in terms of students’ education and achievements [ 7 , pp. 2633–34]. According to the research findings conducted on student learning, the way teachers engage their pupils is crucial in the teaching and learning process [ 8 , p. 39]. The approaches used by the teacher should be matched to the demands of the students [ 6 , p.7]. Students’ motivation and achievement are mostly dependent on the teachers’ activities [ 9 , p. 15). Several researches have indicated that among the subjects offered in schools, students do have not much interest in history education [ 10 , p. 45]. According to a study conducted on secondary schools, history education has been taught through lectures rather than participatory and student- centred strategies [ 11 , p. 1). According to Kiio [ 11 , pp. 1–2], effective implementation of participatory teaching and learning methodologies can increase students' interest in history education. Issar [ 10 , p. 49] also emphasized the significance of learning history education, stating that learning history education should help students understand the complexities of human lives, the diversity and relationships between different groups, the changes and continuities and connect the past, present, and future events.

Scholars confirm that constructive learning approaches allow students to participate actively in the lessons [ 12 , p. 35]. Since 1980, the theory of social constructivism has been advocated as an effective way of learning and teaching [ 12 , pp. 35–36]. It is a theory developed by Russian psychologist Lev Vygotsky (1896–1934), which holds that individuals are active participants in the creation of their knowledge [ 13 , p.783]. Vygotsky’s social constructivism focuses on pedagogies that encourage active learning, effective and meaningful learning, constructive learning, and learning by doing [ 13 , p.783]. Current research in the field of history education supports the notion that participatory approaches to teaching the subject at the secondary school level are the preferred method for developing the skills required to handle the world's future historiographical needs [ 14 , p. 81]. In several works of literature, interactive teaching approaches are vital in increasing student academic achievement. The purpose of this baseline study is to investigate the significant problems confronting history education in Sebeta government secondary schools.

2 Statement of the problem

History education is frequently a source of public debate, a source of unrest, and a site of struggle over what and how should be taught in schools in Ethiopia [ 15 , p. 2]. National history is taught as a compulsory subject in different countries. Several countries believe that knowing the country’s history is a requirement for all citizens [ 16 , pp. 1–2]. In the case of history education teaching in Ethiopia, for the first time, a history syllabus was included in the education curriculum after 1943 [ 17 , p.87]. However, no specific research on significant problems confronting history education in Ethiopian secondary schools has been conducted. Researchers who have studied the problem of education in Ethiopia have directly and indirectly addressed the issue of history education [ 18 , pp.18–19].

According to research conducted by Resource and Guide [ 19 , p. 8], teaching is important by incorporating 21st-century skills such as critical thinking skills, problem-solving, language proficiency, communication and collaborative skills, cognitive skills, adaptability skills and the ability to make decisions. Furthermore, student-centred teaching method fosters students' comprehension, deep learning, problem-solving, critical thinking, and communication [ 20 , p. 4]. Research conducted on history education has discovered a link between teaching approaches and students' attitudes towards history education [ 21 , p. 3]. A scant study has been conducted on significant problems confronting history education in Ethiopian secondary schools and on approaches more appropriate for teaching history.

This motivated the researchers to conduct research on major problems confronting history education in Ethiopian secondary schools in Sebeta town. To fill this gap, the researchers used a variety of tools to analyze significant problems confront history education in Ethiopian secondary schools in general, and Sebeta town public Secondary School in particular.

Thus, this study attempts to answer the following questions:

What are the most significant problems facing history education at Sebeta town public secondary school?

What are the most common teaching strategies employed at Sebeta town government secondary school?

How is the student’s academic achievement in history at Sebeta public secondary school?

3 Objectives of the study

To find out the most significant problems facing history education at Sebeta Town Government Secondary School.

To identify the most common teaching strategies employed at Sebeta town government secondary school.

To determine a student’s academic achievement in history at Sebeta government secondary school.

4 Literature review

Any research project needs theory to provide direction and help on how things are implemented. Theoretical foundation aids in deciphering the way phenomena happen and the basis of specific actions [ 22 , p. 75]. This research is founded on Vygotsky’s social constructivist learning theory, which supports historical thinking. According to a social learning theory developed by Russian psychologist Lev Vygotsky (1896–1934), individuals are active participants in the development of their knowledge [ 23 , p. 395]. This social constructivism approach places a strong emphasis on pairs and small groups [ 24 , pp.13–15]. According to this theory, students learn primarily through interactions with their classmates, instructors, and parents, whereas teachers are expected to facilitate dialogue in the classroom [ 25 , p. 243]. According to Richard [ 26 , p. 380], good teaching and learning are strongly reliant on interpersonal interaction and conversation, with the primary focus on the student’s understanding of the topic.

Scholarly works reveal that there is very little study on the significant problems confronting history education. The existing scholarly works on teaching approach and students’ learning, on the other hand, demonstrate that there are strong relationships between the effects of teaching strategies and students’ achievement. Sugano and Mamolo [ 27 , p. 827] conducted a study on the “Effects of Teaching Methodologies on Students’ Attitude and Motivation,’’ found that teaching methods had an enormous positive impact (Cohen’s d = 0.379) on student attitude. The study also found that cooperative learning had a greater power than traditional teaching methods in improving students’ positive attitudes, motivation and interest.

History teaching should not only be mastery of the basic content (substantive knowledge) but also enhance the acquisition of subject skills and competencies that will make students learn on their own and manage their own lives and carry it through the adversities of life in society [ 26 , 28 ]. Luka [ 14 , p. VII] discovered in his study, “The Impact of Teaching Methods on Attitudes of Secondary School Students Towards Learning of History in Malawi,” that students in secondary schools have negative attitudes towards learning history. One of the reasons he highlighted is that student-centred techniques of teaching are not regularly used in the subject of history education ( Ibid , [ 29 ]).

Moreover, Mazibuko [ 30 , p. 142] revealed that teaching methods in history education greatly contributed to students' negative perceptions of the subject. He discovered that traditional methods of teaching history utilized by teachers contributed to students decreasing interest in the subject ( Ibid ). Besides, Zhu and Kaiser [ 31 , p. 191] discovered that teaching methods influence students’ motivation, attitudes towards school, willingness to do homework, and confidence in their learning.

In his study on effective teaching in history, Boadu [ 8 , p. 39] discovered that effective teaching of history should bring the subject closer to students’ lives, hearts, and minds. He argued that effective teaching cannot emerge from traditional history teaching, because the teacher lectures on the subject intensely, and students are forced to take and memorize notes.

Silver and Perini [ 32 , p. 16) argued that teachers who use a variety of teaching techniques have well-behaved and motivated students, resulting in high student academic achievement.

Adding to this, according to [ 33 , p. 74], the quality of teaching strategies influences student learning and contributes to a 15 to 20 times improvement in student achievement. These researches highlighted that effective teaching strategies played a crucial influence on student motivation, developing students’ positive attitudes, and improving students’ academic achievement more than traditional teacher-centred approaches. There has been no research undertaken in Ethiopian secondary schools to determine which methodologies could be better appropriate for teaching history. Using the designed study instruments, the researchers examine and determine the significant problems confronting history education in Sebeta government secondary schools.

5 Research methodology

The study was conducted using the constructivist paradigm view with the qualitative research approach. In this study, the researchers utilized a qualitative research approach. The qualitative research approach allows the researchers to conduct an in-depth investigation of the problem under study [ 34 , pp. 177–179, 35 , p. 12]. The qualitative research approach has different specific designs. These are Phenomenology, Ethnography, Narrative inquiry, Case study, Grounded theory and Historical research [ 36 , p. 49]. In this study, the qualitative case study design was used. Case studies are ways to explain, describe, or explore phenomena. According to Hatch [ 37 , p. 37], case studies are the type of qualitative work that investigates a contextualized contemporary phenomenon within specific boundaries. This study was carried out using document analysis, interviews, and classroom observation techniques.

The researchers received the accreditation letter from their institution and submitted it to the relevant authorities to confirm the legality of the research. The letter was then submitted to the Sebeta town’s education office and Sebeta secondary schools to acquire authorization to collect primary data from sampled respondents. The data collection process was started after getting all relevant permits from the authorities. Before interviews with respondents, the researchers described the goal of the study to the participants to acquire their permission. The researchers told participants that the study's primary aim was to collect data for the research titled "The significant problems confronting history education in history education in Sebeta town public secondary schools, Ethiopia." After extensive verbal discussions with the respondents, interviews were conducted with those who expressed full interest in participating in the study.

5.1 Sampling procedure

This study employed a purposive sampling technique. In the first stage, the study site was chosen purposively, which is Sebeta town. In the following step, this baseline study was confined to two out of four government secondary schools in Sebeta town with similar standards, a higher number of students and staff than the others. The schools that were purposely selected for the study are those that have been in existence for a long time, have more experienced staff than others, and are expected to provide firsthand information. Purposive sampling was used to select knowledgeable research participants [ 38 , pp. 512–513]. Because it allows the researcher to select the research participants who were believed informed sources of information, thoughtful, informative, articulate, and experienced with the problem under the study [ 35 , p.142, 39 , pp. 100–114]. The researchers selected individuals who have a good source of information about the issue under study (history education teachers and students [ 39 , p. 100]. In the selected two secondary schools, there are six history education teachers, five males and one female. These teachers were purposefully included in the study. The researchers believed that the experienced teachers who were chosen were useful as a primary source of data because they were familiar with the subject's contents, as well as its problems. Eight top-ten grade ten students from the two schools also took part in the study directly. The researchers believed the top-ten students were able to explain the area of study more accurately than the others. Grade ten students were purposefully chosen for the study. The following are the grounds for choosing grade ten students: First history education in Ethiopia begins in grade nine. Students began studying history education grade nine onwards. Because it is assumed that grade ten students know more about history education contents than grade nine students. Second, it is assumed that grade ten comprises all types of students (higher achievers, moderate, and slow learners), as well as grade 10 students who will choose a major (social sciences and natural sciences) in their future grade eleven. As a result, the researchers opted to gather the finest information from grade ten students to establish their perspectives toward history.

6 Results and discussions

6.1 what are the significant problems facing history education in sebeta town government secondary school, 6.1.1 interviews analysis.

For explanation, the abbreviation SSST stands for “Sebeta Secondary School Teacher”, similarly, BSSST stands for “Burka Sebeta Secondary School Teacher” and the numbers denote the order. As shown in Table  1 , six history education teachers were interviewed for this study. Of the six teachers interviewed, five had more than 15 years of teaching experience. Five of these teachers hold a bachelor's degree and one has an MA in history. Five of the teachers interviewed were male and one was female. During the interviews, the teachers revealed to the researchers that three of the six teachers had an MA in another academic discipline (Table 2 ).

For clarification, the abbreviation SSSS stands for, “Sebeta Secondary School Student”, BSSS, “Burka Sebeta Secondary School Student” and the numbers represent the order. Eight students’ four males and four females from both schools were chosen for the interview of this study.

An interview is one of the data collection instruments that were used to explore the significant problems confronting history education in government secondary schools. An interview allows the researchers to gather information that is directly related to the research objectives [ 40 , p. 411]. It is typically conducted one-on-one with informants who have firsthand experience with the research topic [ 25 , p. 144]. An interview was conducted with six experienced history education teachers, and eight secondary school students to gather adequate data about the topic under investigation.

The researchers began their interview with teachers by asking, “What are the significant problems facing history education in Sebeta town government secondary school?” The researchers interviewed teachers concerning the organization of the history education curriculum. Teacher SSST1’s response to this question is as follows: “I have been teaching history education for 18 years but I have never seen or read the curriculum of history education until today.’’ Furthermore, BSSST1 shared the same point of view saying: “So far, I have not read any history education syllabus or seen what it contains except students’ textbook. There is no available history education syllabus in secondary school for teachers. ” Teacher SSST2 also made a similar note: “We do not have a history syllabus, and the teaching materials that we use to teach students are only students’ textbooks.”

All of the teachers interviewed stated that they did not have a history curriculum and had never utilized it. The researchers found that teachers do not see contents, structures, recommended teaching aids, and methodologies in the history education syllabus and teachers’ guide.

Teachers explained that the history education textbook is divided into three parts: world history, African history, and Ethiopian history. According to the teachers interviewed, the history of the Ethiopian peoples are not written inclusively in students’ textbooks, and Ethiopian history education does not adequately addressed the political, social, and economic history of the Ethiopian people (BSSST1, BSSST2, SSST1, SSSS2, SSST3). However, research work suggests that in multi-ethnic countries, all students should be able to learn about themselves and their culture from the books they learn from Hodkinson et al. [ 41 , p. 3] stated that “all learners must be able to find themselves and their world represented in the books from which they learn.”.

In addition, teachers were asked as history education teaching materials in the same way as other Subjects. To this question, all of the teachers interviewed consistently said no. Teachers claim that “since our country’s political changes, textbooks for all disciplines have been updated three to four times, but history education has not been updated in the same way” (BSSST1, BSSST2, SSST1, SSSS2, SSST3, SSSST4). They demonstrated this to the researchers by referring to the textbook they were using. In this instance, a history grade 10 students’ textbook was published in 2002 GC/1994, reprinted in 2005/1997 and renewed in 2023 after 18 years. According to the teachers interviewed, there has been no detailed reform of history education in terms of adding or removing content, implementing new teaching strategies, or keeping up with the 21st-century world. One interviewed teacher said, ‘’I have been teaching history for 18 years and have not observed any changes in history education contents since I started teaching history education.’’ (SSST1).

The researchers continued their interview with teachers by asking, is the content of the history education curriculum appropriate for the student's abilities? This question is to gather evidence to understand that the content of the history curriculum is appropriate for the student's abilities. Teachers and students were asked this question. When asked about the content of history education in grade ten, teachers made two comments:

Students who did not study history as a subject in elementary school (1st grade to grade eight) may find it more difficult when they begin studying history education as a subject in grade nine (SSST1 and SSST2).

They have been studying in their mother tongue in primary school (grades 1 to 8) and studying in English from grade 9 onwards will make it difficult for students to understand the contents (SSST1 and SSST2). The students interviewed strongly agree with the latter. According to the students, “the content of history is very difficult to understand, history is not like other subjects, it requires proper knowledge of English” SSSS1, SSSS2, BSSSS1 and BSSS2).

Follow-up questions were also raised for teachers, to determine the teaching methods included in the history education curriculum. However, teachers were unable to respond to this question because they were not implementing the teaching practices outlined in the history education curriculum due to a lack of a history syllabus. A well-designed teaching strategy has a crucial role in improving students' academic achievement [ 42 , p. 51–64]. Therefore, teachers teach history using their own teaching and learning methods. When asked what teaching method they used, the teachers stated that they used the lecture teaching method (SSSS1, SSSS2, BSSSS1 and BSSS2). The reason they use lecture methods more than other teaching and learning methods is that the content of history lessons is extensive and the time allocated for history lessons is 80 min per week (SSSS1, SSSS2, BSSSS1 and BSSS2).

6.1.2 Classroom observation analysis

The researchers used lesson observations to obtain firsthand and ‘real' facts and data about the significant problems confronting history education in Sebeta government secondary schools. This is because many people do not want to discuss all topics during an interview [ 43 , p. 117]. The researchers employed the lesson observation checklist, which included activities such as the teacher's teaching strategies, teacher and student activities throughout the session, teacher-student interaction during the lesson, student seating arrangements, and teaching aids used. Using this checklist, the researchers observed the teacher’s teaching practice during the lesson. The researchers observed four different classrooms. The primary aim of this observation was to strengthen the data obtained from teachers and students during an interview. The teachers in all of the classrooms first ask students what they learned in their last class. Aside from that, they only used to give notes and lectures to the students in every class.

Another point that the researchers visited in the classroom was the teachers’ and students’ activities during the lesson. The teachers gave notes, and lectures and many students were busy writing notes. When the teachers lecture the content some students do not pay attention and instead take notes. Some students do not take notes, do not listen and look elsewhere. As observed by the researchers, teacher-student interaction during the lesson is very weak. Based on the observation students' seating arrangements were traditional in that three students' seats occur on a wave which is not convenient for group discussion, group work and collaborative learning.

During classroom observation, there are no teaching aids used in all classrooms visited by the teachers to make the lessons practical.

Finally, based on the findings of the study through classroom observation, traditional methods of teaching and learning in history classrooms are still the dominant teaching strategies in the twenty-first century. Researchers who research teaching strategies confirm that participatory teaching is an effective way to improve students’ academic achievement. Madar and Baban [ 42 , pp. 51–64] also discovered that participatory teaching is a good strategy to develop students’ skills and increase their academic achievements. They added that participatory teaching strategies put students at the centre of the teaching and learning process (p. 51). However, through interviews with teachers, students, and lesson observation, the researchers discovered that teachers are not employing student-centred approaches that are fitting for students' learning and achievement.

The responses of teachers and students are consistent with the literature on strategies for teaching. Researchers who conducted studies on teaching strategies found that the teacher- centred method is a traditional strategy that is not very effective in enhancing student achievement. The findings of this study also agree with Mohammed [ 44 , p. 11] who conducted a study on, “strategies in the teaching of geography …” , and stated that the lecture method of teaching has a negative effect on students’ creativity, critical thinking, ability to produce new ideas, and academic achievement of students. Similarly, this study’s findings also concur with Ezurike [ 45 , pp. 1120–124] conducted a study on, “The Influence of Teacher-Centered and Student-Centered Teaching Methods on Academic Achievement of Students,” which discovered that poor methods, mostly teacher-centred and conventional teaching methods used by teachers, are one of the major factors contributing to students’ poor achievement.

Finally, it is better to conclude that teaching strategies can positively and negatively influence students' academic achievement. If teachers only employ the lecture approach without involving students in the lesson, it may result in low student academic achievement in contrast if teachers employ student-centred strategies students can understand the main point of the lesson and enhance the academic achievement of students.

6.2 How do teaching strategies influence students' academic achievement in Sebeta secondary schools?

To answer this question, the researchers conducted interviews with teachers and students, as well as document reviews and classroom observations. This issue was addressed by both teachers and students. Methods of teaching have a wide range of effects on the academic success of learners. When asked this question, they all had similar answers. According to teachers, good teaching strategies play a significant role in improving students’ academic achievement. They state this as follows:

Using collaborative teaching practices can significantly improve students' academic achievement. Because collaborative instruction is a teaching technique in which students learn together by assisting one another. Higher achiever students support the low achiever learner in this instructional learning process. However, if teachers utilize traditional teaching methods without involving students in the teaching-learning process, students' academic achievement may suffer (BSSST1, SSST2, and SSST3).

However, for a variety of reasons, teachers do not use collaborative teaching strategies to improve the academic achievement of their students. Rather than focusing on improving the academic achievements of students’ teachers are only concerned with completing their content. Furthermore, the student stated that teaching strategy can positively and negatively influence students' academic achievement. According to students:

…if teachers employ interactive teaching strategies during teaching lessons, students can understand the main point of the lesson and profit much from it. In contrast, if teachers exclusively employ the lecture approach without involving students in the lesson, it may result in low student achievement in the subject. Furthermore, students responded with two statements: excellent teaching strategies encourage students’ interest in the subject and are also, critical for improving students' academic achievement (BSSSS1, BSSSS2, SSSS1, SSSS3, and SSSS6).

The teachers were interviewed about teaching methods they implement when teaching a history education lesson. The teachers were asked to mention teaching methods that they always use in teaching history. The majority of the teachers claimed to use lecture approaches when teaching history education lessons. Teachers noted: “huge class sizes and low time allotted to history subjects, making it difficult to apply participator/student-centred methods (BSSST3, SSST, and SSST2). Furthermore, when asked about their teachers’ teaching methods in history class, students stated that “teachers only use teacher-centred strategies (lecture, dictation, note-giving and reading notes on the blackboard)” (BSSSS3, SSSS1, SSSS2).

During the interview all interviewed teachers acknowledged the use of the lecture method in their teaching. The justifications provided for the use of the lecture method include saving time, the convenience of covering content on time and the nature of students. Teachers said, “A lecture method helps the teacher to cover a lot of content in a short period” (SSST1, SSST2, SSST3, SSST4, BSST1, and BSST2). The findings of this study are consistent with the findings of a study conducted by Luka [ 14 , p. 30] on the topic of “the impact of teaching methods on attitudes of secondary school students towards learning of history in Malawi,” which discovered that teachers use boring lecture methods to complete their courses rather than focusing on students' results.

History teachers' perceptions of the use of the participatory approach were very low. Based on the interview conducted with history education teachers they were not interested in using student-center teaching strategies (BSSST1, BSSST2, SSST1, SSST2, SSST3, and SSSST4). Teachers claimed that participatory teaching strategies were time-consuming and unsuitable for large-class settings ( Ibid ). Instead of using participatory teaching strategies teachers choose teacher-centred methods to cover a large portion within a given time.

The researchers interviewed history teachers at Sebeta secondary schools about the challenges that they confront when implementing the participatory approach. The interviewed teachers stated that the time allotted for history education did not correspond to the content (BSSST1, BSSST2, SSST1, SSST2, SSST3, and SSST4). They were unwilling to utilize student-centred teaching methodologies because they believed it would be time-consuming and difficult to cover the contents of the student’s textbooks within the academic year. According to the teachers, the time allotted to history education every week was only two periods (80 min), although history education included more than 246 pages ( Ibid ). Students also stated that teachers frequently employ lecture methods when teaching history lessons. Both teachers and students agree that collaborative learning methods are more beneficial than traditional teaching methods in improving students’ academic achievement (SSST1, SSST2, SSST3, SSST4, BSST1, and BSST2). Teachers claim that "due to the wide range of topics covered in history education, we use lecture methods of teaching rather than participatory approaches" (SSST1, SSST3, BSST1, and BSST2).

6.3 How is the student's academic achievement in history at Sebeta government secondary school? To answer this question, the researchers used document review

6.3.1 document analysis.

Document analysis is part of the qualitative data collection strategy that every researcher engages in throughout the research period. In this research researchers reviewed, history education students’ textbooks, published articles and roasters of students (students’ mark list). The history education achievement of 174 Sebeta government secondary school students scored in grade 9 in 2020/2021 was compared to look at their achievement in grade 10 in 2021/2022. As a result, one student achieved less than 50% out of 100%, 39 students’ scores ranged from 50 to 60 out of 100%, 98 students scored from 61 to 70 out of 100%, 27 students scored between 71 and 80 out of 100%, 8 students scored between 81 and 90 out of 100%, and 1 student scored between 91 and 100, in grade nine. In grade 10, 11 students scored below 50, 103 students scored between 50 and 60, 45 students scored between 61 and 70, 9 students scored between 71 and 80, 4 students scored between 81 and 90, and 2 students scored between 91 and 100 out of 100%.

Based on this analysis, we can witness students’ achievement in two ways. The first is that in grade 9, 138 out of 174 students scored less than 70% out of 100% and the results of students scoring from 70 to 100% declined significantly. The second point to mention is that student achievement in history education has been highly declining at the subsequent grade level. In Grade 10, the number of students scoring less than 50% grew, and 159 out of 174 students scored less than 70% in history education. This indicates students' achievement in history in grade 9 decreased in grade 10. This suggests that students' achievement in history education was inadequate. Following the analysis of student achievement, interviews were conducted with students and teachers to identify why students' achievement in history education was so low.

7 Conclusion and recommendations

Research shows that teaching strategies are a crucial aspect in successful learning because they enable learners to learn, create, and take a proactive attitude towards learning. The significant issues confronting history education have been identified were teaching strategy, a lack of awareness about implementing participatory teaching methods, a lack of comprehensiveness of the contents of history education teaching materials, and the issue of the bulkiness and scope of history education texts being covered on time and Lack of teachers’ understanding of employing creative teaching strategies to improve students’ academic progress. Despite this, the study found that teachers in Sebeta government secondary schools use the teacher-centered lecture approach rather than interactive or student-centered strategies, which are recommended for students' learning. Teachers were cognizant of student-center teaching and learning improved student achievement. Conversely, teachers are hesitant to adopt participatory teaching methodologies due to the vastness of history textbooks and the lack of time provided to history education to cover bulky texts. As a result, they employ teaching approaches that they believe will allow them to complete the history education contents in the allocated time rather than focusing on enhancing students' academic achievement.

Furthermore, the study also found out that teachers are reluctant to use participatory student-centred learning methods because the two periods per week allocated (80 min) to teaching history education are not enough to cover a wide range of history education content. They believe participatory student-center teaching is ineffective in large classrooms and takes more time than the lecture method. Such thinking stems from a lack of understanding (imparting knowledge) on the use of innovative teaching strategies. The researchers examined the lecture teaching approach that students had learned as well as their results. Several students' achievement in history education shows below 70% out of 100% at Sebeta government secondary schools. The main reason for this low achievement is the teachers’ teaching strategies (the use of teacher-centred approach) to teaching history education to complete a wide content within the allotted time. Teachers do not consider which strategies could improve students’ achievement rather than focus on completing their content. This has also resulted in students’ negative attitudes towards the subject.

The outcomes of this study can serve as the foundation for future research in academic and professional studies. This discovery is notable for the fact that teaching and learning approaches influence students' academic achievement in both directions. Accordingly, if teachers only employ the lecture approach without involving students in the lesson, it may result in low student academic achievement in contrast if teachers employ student-centred strategies students can understand the main point of the lesson and enhance the academic achievement of students.

Thus, for future studies intervention exprimental research in history education is required to measure the extent to which participatory methods of instruction increase the academic achievement of students over teacher-centred strategies. More research, according to the researchers, should be conducted using participatory teaching methods in one classroom and lecture methods in others to determine to what extent participatory teaching methods improve the academic achievement of students when compared to teacher-centred strategies. Following the findings, researchers provided the following recommendations: national and regional education experts should collaborate closely in making history education content inclusive, as well as training history education teachers in the use of participatory teaching approaches. Curriculum experts should effectively organize the breadth of history education contents. To ensure that students learn successfully, the relevant authorities should rigorously monitor the state of the teaching and learning processes in general and history education in particular.

Data availability

The data of this study is the primary source, which is the roster of students' results and education policies. The student results/ marks analyzed for this study are from two Sebeta town public secondary schools: Sebeta secondary school and Burka Sebeta secondary school and Ethiopian education policies. So, the data are available from the corresponding author upon reasonable request from anyone.

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Fekede Sileshi Fufa & Ketebo Abdiyo Ensene

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Corresponding Author of the article: Fekede Sileshi Fufa. Abera Husen (PhD, Assistant Professor). Ketebo Abdiyo (PhD, Associate Professor). Authors’ contribution statements 1. Initially, Fekede Sileshi convinced Abera Husen and Ketebo Abdiyo as the study should be conducted. 2. Then, Abera Husen devised the study's theory. 3. Fekede Sileshi and Ketebo Abdiyo verified the analytical methods of the study. 4. Abera Husen encouraged Fekede Sileshi to investigate the study. 5. Ketebo Abdiyo supervised the overall findings of this work.

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Fufa, F.S., Tulu, A.H. & Ensene, K.A. Exploring the significant problems confronting secondary schools history education: a baseline study. Discov Educ 3 , 52 (2024). https://doi.org/10.1007/s44217-024-00132-8

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10 Aggressive Dog Breeds & The Study That Changes Everything

Posted: May 14, 2024 | Last updated: May 14, 2024

Are there really aggressive dog breeds? 

According to a University of Bristol study 1 , it’s more likely the case of aggressive dog owners than aggressive breeds. The study found a dog’s aggression relates more to characteristics of the owner, like age and training methods, than the breed itself.

Dogs owned by people under 25 were nearly twice as likely to be aggressive compared to those with owners over 40. Positive training reduced aggression towards strangers by 50%, but using punishments and negative reinforcement significantly increased aggressive behaviors.

But unfortunately, there have been reports that certain breeds are disproportionately involved in attacks on humans. According to research 2 , here are the dog breeds that are frequently associated with serious attacks:

1. Pit Bulls: The Controversial Canine

Pit Bulls have long been the subject of heated debates regarding their temperament. According to a 2015 study, Pit Bulls were responsible for 82% of dog-bite related fatalities in the U.S., despite making up only 6.6% of the dog population. ( ref )

But many argue that these statistics are skewed due to the breed’s popularity among irresponsible owners who encourage aggressive behavior.

With proper training and socialization, Pit Bulls can be loving and loyal companions. It’s crucial for potential owners to understand the breed’s needs and to provide a stable, nurturing environment.

2. Rottweilers: Powerful and Protective

Rottweilers, known for their strength and loyalty, have also been involved in a significant number of fatal attacks. In 2015, Rottweilers were the second most lethal dog breed, and together with Pit Bulls, they accounted for 91% of dog bite fatalities in the U.S.

As with any large, powerful breed, Rottweilers require consistent training and socialization from an early age. 

3. German Shepherds: Intelligent & Intense

German Shepherds are highly intelligent and often used as police and military dogs due to their trainability and loyalty. But their protective nature and potential for aggression towards strangers can make them dangerous if not properly trained. 

Early socialization and obedience training are essential for German Shepherds (check out these German commands ) to ensure they are well-behaved and can distinguish between real threats and harmless situations. 

4. Doberman Pinschers: Sleek & Strong

Doberman Pinschers are known for their elegance and intelligence, but they have also been involved in several attacks. Most of these incidents occur when the dog is protecting its owner or property.

5. Bullmastiffs: Gentle Giants with a Bite

Weighing up to 130 pounds, Bullmastiffs are imposing dogs that were originally bred as guard dogs. Their size and strength enable them to inflict serious harm if they feel threatened or provoked. Proper training is crucial to prevent aggressive behavior.

Despite their intimidating appearance, Bullmastiffs can be gentle and affectionate with their families. They require an experienced owner who can provide firm leadership and plenty of socialization.

6. Siberian Huskies: Beautiful but Unpredictable

Siberian Huskies are striking dogs known for their wolf-like appearance and piercing blue eyes. While they may look cuddly, they are not always very social unless raised to be.

Huskies have a high prey drive and require plenty of exercise and mental stimulation. 

7. Alaskan Malamutes: Powerful Sled Dogs

Alaskan Malamutes, originally bred for pulling sleds, are strong, independent dogs with a high prey drive. They can be aggressive towards other dogs, which can result in injury to the other dog’s owner or nearby children.  They are not well-suited for apartment living or novice owners.

8. Chow Chows: Fluffy but Fierce

Chow Chows, with their teddy bear-like appearance, may seem like cuddly companions, but they were originally developed in Mongolia and have been known to have aggressive tendencies. Early socialization and training are essential to prevent territorial or aggressive behavior.

9. St. Bernards: Massive & Mighty

St. Bernards are massive dogs that can weigh up to 260 pounds. While they are often portrayed as gentle giants, their size and strength can make their bites lethal if they feel threatened or provoked. 

10. Great Danes: Towering & Temperamental

As with any large breed , Great Danes require an owner who can provide plenty of space, exercise, and consistent training. They can be gentle and loving family pets when raised in a responsible and nurturing environment.

The Human Connection

Aggressive owners may gravitate towards particular breeds, perpetuating a cycle through improper training methods like punishment which can increase aggression up to three-fold, according to the RSPCA ( ref ).

The organization emphasizes that aggression in dogs often stems from:

• Learned behaviors

…that they have picked up from their owners. They also advocate that dogs should not be declared dangerous based solely on their breed or appearance. Each dog should be assessed based on their actual behavior.

Breed Tendencies vs. Individual Behavior

While certain breeds may be over-represented in bite statistics due to their guarding backgrounds, a dog’s likelihood of aggressive or dangerous behavior depends heavily on the owner’s age, experience, training methods and commitment to proper socialization.

Responsible ownership focused on positive reinforcement training is crucial for minimizing risk, regardless of breed. 

Making assumptions about aggression based solely on a dog’s breed is inappropriate, as their behavior is a complex product of situational factors, genetics and their unique history with their owner.

• https://www.smithsonianmag.com/smart-news/owners-not-breeds-predict-whether-dog-will-be-aggressive-180949962/
• https://www.dogsbite.org/reports/13-years-us-dog-bite-fatalities-2005-2017-dogsbite.pdf

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  International Journal of Applied Technologies in Library and Information Management Journal / International Journal of Applied Technologies in Library and Information Management / Vol. 10 No. 1 (2024) / Articles (function() { function async_load(){ var s = document.createElement('script'); s.type = 'text/javascript'; s.async = true; var theUrl = 'https://www.journalquality.info/journalquality/ratings/2405-www-ajol-info-jatlimi'; s.src = theUrl + ( theUrl.indexOf("?") >= 0 ? "&" : "?") + 'ref=' + encodeURIComponent(window.location.href); var embedder = document.getElementById('jpps-embedder-ajol-jatlimi'); embedder.parentNode.insertBefore(s, embedder); } if (window.attachEvent) window.attachEvent('onload', async_load); else window.addEventListener('load', async_load, false); })();  

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Information literacy skills training model for clinicians based on a case study of their information experiences and practices in south-east, nigeria, samuel k. ibenne.

This paper is the outcome of an exploratory case study of Paediatricians in a tertiary hospital in Southeast, Nigeria, which aimed at providing understanding of the relationship between their information experiences, practices and their decisions in patient care. It was conducted using the qualitative method, with data obtained through interviews, diaries and observation. Paediatricians in the cadres of: Consultants, Senior Registrars, Registrars and Residents provided data which was coded thematically with the Nvivo software and analysed using the interpretative method. The findings are that in general: i) there was haphazard approach to information literacy training for the clinicians during professional education resulting in varied information capabilities, and inadequacy of knowledge and skills for good information practice; ii) obtaining medical information from colleagues was the predominant feature of paediatricians' information practices; iii)printed textbooks were the paediatricians preferred source for obtaining medical evidence, however, there was a growing popularity in the use of electronic medical information sources, including at the point of care; iv) there was general perception by the paediatricians that access to, and use of medical information supports patient care and achievement of better treatment outcomes. This perception instilled a sense of value for information use, demonstrated through the clinicians' dedication to the self-provision of information resources; vi) a dearth of medical resources germane to the contextual management of illnesses led to inadequate clinician knowledge in a good number of cases. The study recommends among others that the information literacy skills training (ILST) model developed from the findings, be used as a practical training tool for information literacy for the paediatricians' at the level of residency training to enhance their skills in medical information sourcing and use in patient care.

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• Published: 14 May 2024

Developing a survey to measure nursing students’ knowledge, attitudes and beliefs, influences, and willingness to be involved in Medical Assistance in Dying (MAiD): a mixed method modified e-Delphi study

• Jocelyn Schroeder 1 ,
• Barbara Pesut 1 , 2 ,
• Lise Olsen 2 ,
• Nelly D. Oelke 2 &
• Helen Sharp 2  

BMC Nursing volume  23 , Article number:  326 ( 2024 ) Cite this article

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Medical Assistance in Dying (MAiD) was legalized in Canada in 2016. Canada’s legislation is the first to permit Nurse Practitioners (NP) to serve as independent MAiD assessors and providers. Registered Nurses’ (RN) also have important roles in MAiD that include MAiD care coordination; client and family teaching and support, MAiD procedural quality; healthcare provider and public education; and bereavement care for family. Nurses have a right under the law to conscientious objection to participating in MAiD. Therefore, it is essential to prepare nurses in their entry-level education for the practice implications and moral complexities inherent in this practice. Knowing what nursing students think about MAiD is a critical first step. Therefore, the purpose of this study was to develop a survey to measure nursing students’ knowledge, attitudes and beliefs, influences, and willingness to be involved in MAiD in the Canadian context.

The design was a mixed-method, modified e-Delphi method that entailed item generation from the literature, item refinement through a 2 round survey of an expert faculty panel, and item validation through a cognitive focus group interview with nursing students. The settings were a University located in an urban area and a College located in a rural area in Western Canada.

During phase 1, a 56-item survey was developed from existing literature that included demographic items and items designed to measure experience with death and dying (including MAiD), education and preparation, attitudes and beliefs, influences on those beliefs, and anticipated future involvement. During phase 2, an expert faculty panel reviewed, modified, and prioritized the items yielding 51 items. During phase 3, a sample of nursing students further evaluated and modified the language in the survey to aid readability and comprehension. The final survey consists of 45 items including 4 case studies.

Systematic evaluation of knowledge-to-date coupled with stakeholder perspectives supports robust survey design. This study yielded a survey to assess nursing students’ attitudes toward MAiD in a Canadian context.

The survey is appropriate for use in education and research to measure knowledge and attitudes about MAiD among nurse trainees and can be a helpful step in preparing nursing students for entry-level practice.

Peer Review reports

Medical Assistance in Dying (MAiD) is permitted under an amendment to Canada’s Criminal Code which was passed in 2016 [ 1 ]. MAiD is defined in the legislation as both self-administered and clinician-administered medication for the purpose of causing death. In the 2016 Bill C-14 legislation one of the eligibility criteria was that an applicant for MAiD must have a reasonably foreseeable natural death although this term was not defined. It was left to the clinical judgement of MAiD assessors and providers to determine the time frame that constitutes reasonably foreseeable [ 2 ]. However, in 2021 under Bill C-7, the eligibility criteria for MAiD were changed to allow individuals with irreversible medical conditions, declining health, and suffering, but whose natural death was not reasonably foreseeable, to receive MAiD [ 3 ]. This population of MAiD applicants are referred to as Track 2 MAiD (those whose natural death is foreseeable are referred to as Track 1). Track 2 applicants are subject to additional safeguards under the 2021 C-7 legislation.

Three additional proposed changes to the legislation have been extensively studied by Canadian Expert Panels (Council of Canadian Academics [CCA]) [ 4 , 5 , 6 ] First, under the legislation that defines Track 2, individuals with mental disease as their sole underlying medical condition may apply for MAiD, but implementation of this practice is embargoed until March 2027 [ 4 ]. Second, there is consideration of allowing MAiD to be implemented through advanced consent. This would make it possible for persons living with dementia to receive MAID after they have lost the capacity to consent to the procedure [ 5 ]. Third, there is consideration of extending MAiD to mature minors. A mature minor is defined as “a person under the age of majority…and who has the capacity to understand and appreciate the nature and consequences of a decision” ([ 6 ] p. 5). In summary, since the legalization of MAiD in 2016 the eligibility criteria and safeguards have evolved significantly with consequent implications for nurses and nursing care. Further, the number of Canadians who access MAiD shows steady increases since 2016 [ 7 ] and it is expected that these increases will continue in the foreseeable future.

Nurses have been integral to MAiD care in the Canadian context. While other countries such as Belgium and the Netherlands also permit euthanasia, Canada is the first country to allow Nurse Practitioners (Registered Nurses with additional preparation typically achieved at the graduate level) to act independently as assessors and providers of MAiD [ 1 ]. Although the role of Registered Nurses (RNs) in MAiD is not defined in federal legislation, it has been addressed at the provincial/territorial-level with variability in scope of practice by region [ 8 , 9 ]. For example, there are differences with respect to the obligation of the nurse to provide information to patients about MAiD, and to the degree that nurses are expected to ensure that patient eligibility criteria and safeguards are met prior to their participation [ 10 ]. Studies conducted in the Canadian context indicate that RNs perform essential roles in MAiD care coordination; client and family teaching and support; MAiD procedural quality; healthcare provider and public education; and bereavement care for family [ 9 , 11 ]. Nurse practitioners and RNs are integral to a robust MAiD care system in Canada and hence need to be well-prepared for their role [ 12 ].

Previous studies have found that end of life care, and MAiD specifically, raise complex moral and ethical issues for nurses [ 13 , 14 , 15 , 16 ]. The knowledge, attitudes, and beliefs of nurses are important across practice settings because nurses have consistent, ongoing, and direct contact with patients who experience chronic or life-limiting health conditions. Canadian studies exploring nurses’ moral and ethical decision-making in relation to MAiD reveal that although some nurses are clear in their support for, or opposition to, MAiD, others are unclear on what they believe to be good and right [ 14 ]. Empirical findings suggest that nurses go through a period of moral sense-making that is often informed by their family, peers, and initial experiences with MAID [ 17 , 18 ]. Canadian legislation and policy specifies that nurses are not required to participate in MAiD and may recuse themselves as conscientious objectors with appropriate steps to ensure ongoing and safe care of patients [ 1 , 19 ]. However, with so many nurses having to reflect on and make sense of their moral position, it is essential that they are given adequate time and preparation to make an informed and thoughtful decision before they participate in a MAID death [ 20 , 21 ].

It is well established that nursing students receive inconsistent exposure to end of life care issues [ 22 ] and little or no training related to MAiD [ 23 ]. Without such education and reflection time in pre-entry nursing preparation, nurses are at significant risk for moral harm. An important first step in providing this preparation is to be able to assess the knowledge, values, and beliefs of nursing students regarding MAID and end of life care. As demand for MAiD increases along with the complexities of MAiD, it is critical to understand the knowledge, attitudes, and likelihood of engagement with MAiD among nursing students as a baseline upon which to build curriculum and as a means to track these variables over time.

Aim, design, and setting

The aim of this study was to develop a survey to measure nursing students’ knowledge, attitudes and beliefs, influences, and willingness to be involved in MAiD in the Canadian context. We sought to explore both their willingness to be involved in the registered nursing role and in the nurse practitioner role should they chose to prepare themselves to that level of education. The design was a mixed-method, modified e-Delphi method that entailed item generation, item refinement through an expert faculty panel [ 24 , 25 , 26 ], and initial item validation through a cognitive focus group interview with nursing students [ 27 ]. The settings were a University located in an urban area and a College located in a rural area in Western Canada.

Participants

A panel of 10 faculty from the two nursing education programs were recruited for Phase 2 of the e-Delphi. To be included, faculty were required to have a minimum of three years of experience in nurse education, be employed as nursing faculty, and self-identify as having experience with MAiD. A convenience sample of 5 fourth-year nursing students were recruited to participate in Phase 3. Students had to be in good standing in the nursing program and be willing to share their experiences of the survey in an online group interview format.

The modified e-Delphi was conducted in 3 phases: Phase 1 entailed item generation through literature and existing survey review. Phase 2 entailed item refinement through a faculty expert panel review with focus on content validity, prioritization, and revision of item wording [ 25 ]. Phase 3 entailed an assessment of face validity through focus group-based cognitive interview with nursing students.

Phase I. Item generation through literature review

The goal of phase 1 was to develop a bank of survey items that would represent the variables of interest and which could be provided to expert faculty in Phase 2. Initial survey items were generated through a literature review of similar surveys designed to assess knowledge and attitudes toward MAiD/euthanasia in healthcare providers; Canadian empirical studies on nurses’ roles and/or experiences with MAiD; and legislative and expert panel documents that outlined proposed changes to the legislative eligibility criteria and safeguards. The literature review was conducted in three online databases: CINAHL, PsycINFO, and Medline. Key words for the search included nurses , nursing students , medical students , NPs, MAiD , euthanasia , assisted death , and end-of-life care . Only articles written in English were reviewed. The legalization and legislation of MAiD is new in many countries; therefore, studies that were greater than twenty years old were excluded, no further exclusion criteria set for country.

Items from surveys designed to measure similar variables in other health care providers and geographic contexts were placed in a table and similar items were collated and revised into a single item. Then key variables were identified from the empirical literature on nurses and MAiD in Canada and checked against the items derived from the surveys to ensure that each of the key variables were represented. For example, conscientious objection has figured prominently in the Canadian literature, but there were few items that assessed knowledge of conscientious objection in other surveys and so items were added [ 15 , 21 , 28 , 29 ]. Finally, four case studies were added to the survey to address the anticipated changes to the Canadian legislation. The case studies were based upon the inclusion of mature minors, advanced consent, and mental disorder as the sole underlying medical condition. The intention was to assess nurses’ beliefs and comfort with these potential legislative changes.

Phase 2. Item refinement through expert panel review

The goal of phase 2 was to refine and prioritize the proposed survey items identified in phase 1 using a modified e-Delphi approach to achieve consensus among an expert panel [ 26 ]. Items from phase 1 were presented to an expert faculty panel using a Qualtrics (Provo, UT) online survey. Panel members were asked to review each item to determine if it should be: included, excluded or adapted for the survey. When adapted was selected faculty experts were asked to provide rationale and suggestions for adaptation through the use of an open text box. Items that reached a level of 75% consensus for either inclusion or adaptation were retained [ 25 , 26 ]. New items were categorized and added, and a revised survey was presented to the panel of experts in round 2. Panel members were again asked to review items, including new items, to determine if it should be: included, excluded, or adapted for the survey. Round 2 of the modified e-Delphi approach also included an item prioritization activity, where participants were then asked to rate the importance of each item, based on a 5-point Likert scale (low to high importance), which De Vaus [ 30 ] states is helpful for increasing the reliability of responses. Items that reached a 75% consensus on inclusion were then considered in relation to the importance it was given by the expert panel. Quantitative data were managed using SPSS (IBM Corp).

Phase 3. Face validity through cognitive interviews with nursing students

The goal of phase 3 was to obtain initial face validity of the proposed survey using a sample of nursing student informants. More specifically, student participants were asked to discuss how items were interpreted, to identify confusing wording or other problematic construction of items, and to provide feedback about the survey as a whole including readability and organization [ 31 , 32 , 33 ]. The focus group was held online and audio recorded. A semi-structured interview guide was developed for this study that focused on clarity, meaning, order and wording of questions; emotions evoked by the questions; and overall survey cohesion and length was used to obtain data (see Supplementary Material 2  for the interview guide). A prompt to “think aloud” was used to limit interviewer-imposed bias and encourage participants to describe their thoughts and response to a given item as they reviewed survey items [ 27 ]. Where needed, verbal probes such as “could you expand on that” were used to encourage participants to expand on their responses [ 27 ]. Student participants’ feedback was collated verbatim and presented to the research team where potential survey modifications were negotiated and finalized among team members. Conventional content analysis [ 34 ] of focus group data was conducted to identify key themes that emerged through discussion with students. Themes were derived from the data by grouping common responses and then using those common responses to modify survey items.

Ten nursing faculty participated in the expert panel. Eight of the 10 faculty self-identified as female. No faculty panel members reported conscientious objector status and ninety percent reported general agreement with MAiD with one respondent who indicated their view as “unsure.” Six of the 10 faculty experts had 16 years of experience or more working as a nurse educator.

Five nursing students participated in the cognitive interview focus group. The duration of the focus group was 2.5 h. All participants identified that they were born in Canada, self-identified as female (one preferred not to say) and reported having received some instruction about MAiD as part of their nursing curriculum. See Tables  1 and 2 for the demographic descriptors of the study sample. Study results will be reported in accordance with the study phases. See Fig.  1 for an overview of the results from each phase.

Fig. 1  Overview of survey development findings

Phase 1: survey item generation

Review of the literature identified that no existing survey was available for use with nursing students in the Canadian context. However, an analysis of themes across qualitative and quantitative studies of physicians, medical students, nurses, and nursing students provided sufficient data to develop a preliminary set of items suitable for adaptation to a population of nursing students.

Four major themes and factors that influence knowledge, attitudes, and beliefs about MAiD were evident from the literature: (i) endogenous or individual factors such as age, gender, personally held values, religion, religiosity, and/or spirituality [ 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 ], (ii) experience with death and dying in personal and/or professional life [ 35 , 40 , 41 , 43 , 44 , 45 ], (iii) training including curricular instruction about clinical role, scope of practice, or the law [ 23 , 36 , 39 ], and (iv) exogenous or social factors such as the influence of key leaders, colleagues, friends and/or family, professional and licensure organizations, support within professional settings, and/or engagement in MAiD in an interdisciplinary team context [ 9 , 35 , 46 ].

Studies of nursing students also suggest overlap across these categories. For example, value for patient autonomy [ 23 ] and the moral complexity of decision-making [ 37 ] are important factors that contribute to attitudes about MAiD and may stem from a blend of personally held values coupled with curricular content, professional training and norms, and clinical exposure. For example, students report that participation in end of life care allows for personal growth, shifts in perception, and opportunities to build therapeutic relationships with their clients [ 44 , 47 , 48 ].

Preliminary items generated from the literature resulted in 56 questions from 11 published sources (See Table  3 ). These items were constructed across four main categories: (i) socio-demographic questions; (ii) end of life care questions; (iii) knowledge about MAiD; or (iv) comfort and willingness to participate in MAiD. Knowledge questions were refined to reflect current MAiD legislation, policies, and regulatory frameworks. Falconer [ 39 ] and Freeman [ 45 ] studies were foundational sources for item selection. Additionally, four case studies were written to reflect the most recent anticipated changes to MAiD legislation and all used the same open-ended core questions to address respondents’ perspectives about the patient’s right to make the decision, comfort in assisting a physician or NP to administer MAiD in that scenario, and hypothesized comfort about serving as a primary provider if qualified as an NP in future. Response options for the survey were also constructed during this stage and included: open text, categorical, yes/no , and Likert scales.

Phase 2: faculty expert panel review

Of the 56 items presented to the faculty panel, 54 questions reached 75% consensus. However, based upon the qualitative responses 9 items were removed largely because they were felt to be repetitive. Items that generated the most controversy were related to measuring religion and spirituality in the Canadian context, defining end of life care when there is no agreed upon time frames (e.g., last days, months, or years), and predicting willingness to be involved in a future events – thus predicting their future selves. Phase 2, round 1 resulted in an initial set of 47 items which were then presented back to the faculty panel in round 2.

Of the 47 initial questions presented to the panel in round 2, 45 reached a level of consensus of 75% or greater, and 34 of these questions reached a level of 100% consensus [ 27 ] of which all participants chose to include without any adaptations) For each question, level of importance was determined based on a 5-point Likert scale (1 = very unimportant, 2 = somewhat unimportant, 3 = neutral, 4 = somewhat important, and 5 = very important). Figure  2 provides an overview of the level of importance assigned to each item.

Ranking level of importance for survey items

After round 2, a careful analysis of participant comments and level of importance was completed by the research team. While the main method of survey item development came from participants’ response to the first round of Delphi consensus ratings, level of importance was used to assist in the decision of whether to keep or modify questions that created controversy, or that rated lower in the include/exclude/adapt portion of the Delphi. Survey items that rated low in level of importance included questions about future roles, sex and gender, and religion/spirituality. After deliberation by the research committee, these questions were retained in the survey based upon the importance of these variables in the scientific literature.

Of the 47 questions remaining from Phase 2, round 2, four were revised. In addition, the two questions that did not meet the 75% cut off level for consensus were reviewed by the research team. The first question reviewed was What is your comfort level with providing a MAiD death in the future if you were a qualified NP ? Based on a review of participant comments, it was decided to retain this question for the cognitive interviews with students in the final phase of testing. The second question asked about impacts on respondents’ views of MAiD and was changed from one item with 4 subcategories into 4 separate items, resulting in a final total of 51 items for phase 3. The revised survey was then brought forward to the cognitive interviews with student participants in Phase 3. (see Supplementary Material 1 for a complete description of item modification during round 2).

Phase 3. Outcomes of cognitive interview focus group

Of the 51 items reviewed by student participants, 29 were identified as clear with little or no discussion. Participant comments for the remaining 22 questions were noted and verified against the audio recording. Following content analysis of the comments, four key themes emerged through the student discussion: unclear or ambiguous wording; difficult to answer questions; need for additional response options; and emotional response evoked by questions. An example of unclear or ambiguous wording was a request for clarity in the use of the word “sufficient” in the context of assessing an item that read “My nursing education has provided sufficient content about the nursing role in MAiD.” “Sufficient” was viewed as subjective and “laden with…complexity that distracted me from the question.” The group recommended rewording the item to read “My nursing education has provided enough content for me to care for a patient considering or requesting MAiD.”

An example of having difficulty answering questions related to limited knowledge related to terms used in the legislation such as such as safeguards , mature minor , eligibility criteria , and conscientious objection. Students were unclear about what these words meant relative to the legislation and indicated that this lack of clarity would hamper appropriate responses to the survey. To ensure that respondents are able to answer relevant questions, student participants recommended that the final survey include explanation of key terms such as mature minor and conscientious objection and an overview of current legislation.

Response options were also a point of discussion. Participants noted a lack of distinction between response options of unsure and unable to say . Additionally, scaling of attitudes was noted as important since perspectives about MAiD are dynamic and not dichotomous “agree or disagree” responses. Although the faculty expert panel recommended the integration of the demographic variables of religious and/or spiritual remain as a single item, the student group stated a preference to have religion and spirituality appear as separate items. The student focus group also took issue with separate items for the variables of sex and gender, specifically that non-binary respondents might feel othered or “outed” particularly when asked to identify their sex. These variables had been created based upon best practices in health research but students did not feel they were appropriate in this context [ 49 ]. Finally, students agreed with the faculty expert panel in terms of the complexity of projecting their future involvement as a Nurse Practitioner. One participant stated: “I certainly had to like, whoa, whoa, whoa. Now let me finish this degree first, please.” Another stated, “I'm still imagining myself, my future career as an RN.”

Finally, student participants acknowledged the array of emotions that some of the items produced for them. For example, one student described positive feelings when interacting with the survey. “Brought me a little bit of feeling of joy. Like it reminded me that this is the last piece of independence that people grab on to.” Another participant, described the freedom that the idea of an advance request gave her. “The advance request gives the most comfort for me, just with early onset Alzheimer’s and knowing what it can do.” But other participants described less positive feelings. For example, the mature minor case study yielded a comment: “This whole scenario just made my heart hurt with the idea of a child requesting that.”

Based on the data gathered from the cognitive interview focus group of nursing students, revisions were made to 11 closed-ended questions (see Table  4 ) and 3 items were excluded. In the four case studies, the open-ended question related to a respondents’ hypothesized actions in a future role as NP were removed. The final survey consists of 45 items including 4 case studies (see Supplementary Material 3 ).

The aim of this study was to develop and validate a survey that can be used to track the growth of knowledge about MAiD among nursing students over time, inform training programs about curricular needs, and evaluate attitudes and willingness to participate in MAiD at time-points during training or across nursing programs over time.

The faculty expert panel and student participants in the cognitive interview focus group identified a need to establish core knowledge of the terminology and legislative rules related to MAiD. For example, within the cognitive interview group of student participants, several acknowledged lack of clear understanding of specific terms such as “conscientious objector” and “safeguards.” Participants acknowledged discomfort with the uncertainty of not knowing and their inclination to look up these terms to assist with answering the questions. This survey can be administered to nursing or pre-nursing students at any phase of their training within a program or across training programs. However, in doing so it is important to acknowledge that their baseline knowledge of MAiD will vary. A response option of “not sure” is important and provides a means for respondents to convey uncertainty. If this survey is used to inform curricular needs, respondents should be given explicit instructions not to conduct online searches to inform their responses, but rather to provide an honest appraisal of their current knowledge and these instructions are included in the survey (see Supplementary Material 3 ).

Some provincial regulatory bodies have established core competencies for entry-level nurses that include MAiD. For example, the BC College of Nurses and Midwives (BCCNM) requires “knowledge about ethical, legal, and regulatory implications of medical assistance in dying (MAiD) when providing nursing care.” (10 p. 6) However, across Canada curricular content and coverage related to end of life care and MAiD is variable [ 23 ]. Given the dynamic nature of the legislation that includes portions of the law that are embargoed until 2024, it is important to ensure that respondents are guided by current and accurate information. As the law changes, nursing curricula, and public attitudes continue to evolve, inclusion of core knowledge and content is essential and relevant for investigators to be able to interpret the portions of the survey focused on attitudes and beliefs about MAiD. Content knowledge portions of the survey may need to be modified over time as legislation and training change and to meet the specific purposes of the investigator.

Given the sensitive nature of the topic, it is strongly recommended that surveys be conducted anonymously and that students be provided with an opportunity to discuss their responses to the survey. A majority of feedback from both the expert panel of faculty and from student participants related to the wording and inclusion of demographic variables, in particular religion, religiosity, gender identity, and sex assigned at birth. These and other demographic variables have the potential to be highly identifying in small samples. In any instance in which the survey could be expected to yield demographic group sizes less than 5, users should eliminate the demographic variables from the survey. For example, the profession of nursing is highly dominated by females with over 90% of nurses who identify as female [ 50 ]. Thus, a survey within a single class of students or even across classes in a single institution is likely to yield a small number of male respondents and/or respondents who report a difference between sex assigned at birth and gender identity. When variables that serve to identify respondents are included, respondents are less likely to complete or submit the survey, to obscure their responses so as not to be identifiable, or to be influenced by social desirability bias in their responses rather than to convey their attitudes accurately [ 51 ]. Further, small samples do not allow for conclusive analyses or interpretation of apparent group differences. Although these variables are often included in surveys, such demographics should be included only when anonymity can be sustained. In small and/or known samples, highly identifying variables should be omitted.

There are several limitations associated with the development of this survey. The expert panel was comprised of faculty who teach nursing students and are knowledgeable about MAiD and curricular content, however none identified as a conscientious objector to MAiD. Ideally, our expert panel would have included one or more conscientious objectors to MAiD to provide a broader perspective. Review by practitioners who participate in MAiD, those who are neutral or undecided, and practitioners who are conscientious objectors would ensure broad applicability of the survey. This study included one student cognitive interview focus group with 5 self-selected participants. All student participants had held discussions about end of life care with at least one patient, 4 of 5 participants had worked with a patient who requested MAiD, and one had been present for a MAiD death. It is not clear that these participants are representative of nursing students demographically or by experience with end of life care. It is possible that the students who elected to participate hold perspectives and reflections on patient care and MAiD that differ from students with little or no exposure to end of life care and/or MAiD. However, previous studies find that most nursing students have been involved with end of life care including meaningful discussions about patients’ preferences and care needs during their education [ 40 , 44 , 47 , 48 , 52 ]. Data collection with additional student focus groups with students early in their training and drawn from other training contexts would contribute to further validation of survey items.

Future studies should incorporate pilot testing with small sample of nursing students followed by a larger cross-program sample to allow evaluation of the psychometric properties of specific items and further refinement of the survey tool. Consistent with literature about the importance of leadership in the context of MAiD [ 12 , 53 , 54 ], a study of faculty knowledge, beliefs, and attitudes toward MAiD would provide context for understanding student perspectives within and across programs. Additional research is also needed to understand the timing and content coverage of MAiD across Canadian nurse training programs’ curricula.

The implementation of MAiD is complex and requires understanding of the perspectives of multiple stakeholders. Within the field of nursing this includes clinical providers, educators, and students who will deliver clinical care. A survey to assess nursing students’ attitudes toward and willingness to participate in MAiD in the Canadian context is timely, due to the legislation enacted in 2016 and subsequent modifications to the law in 2021 with portions of the law to be enacted in 2027. Further development of this survey could be undertaken to allow for use in settings with practicing nurses or to allow longitudinal follow up with students as they enter practice. As the Canadian landscape changes, ongoing assessment of the perspectives and needs of health professionals and students in the health professions is needed to inform policy makers, leaders in practice, curricular needs, and to monitor changes in attitudes and practice patterns over time.

Availability of data and materials

The datasets used and/or analysed during the current study are not publicly available due to small sample sizes, but are available from the corresponding author on reasonable request.

Abbreviations

British Columbia College of Nurses and Midwives

Medical assistance in dying

Nurse practitioner

Registered nurse

University of British Columbia Okanagan

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We would like to acknowledge the faculty and students who generously contributed their time to this work.

JS received a student traineeship through the Principal Research Chairs program at the University of British Columbia Okanagan.

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JS made substantial contributions to the conception of the work; data acquisition, analysis, and interpretation; and drafting and substantively revising the work. JS has approved the submitted version and agreed to be personally accountable for the author's own contributions and to ensure that questions related to the accuracy or integrity of any part of the work, even ones in which the author was not personally involved, are appropriately investigated, resolved, and the resolution documented in the literature. BP made substantial contributions to the conception of the work; data acquisition, analysis, and interpretation; and drafting and substantively revising the work. BP has approved the submitted version and agreed to be personally accountable for the author's own contributions and to ensure that questions related to the accuracy or integrity of any part of the work, even ones in which the author was not personally involved, are appropriately investigated, resolved, and the resolution documented in the literature. LO made substantial contributions to the conception of the work; data acquisition, analysis, and interpretation; and substantively revising the work. LO has approved the submitted version and agreed to be personally accountable for the author's own contributions and to ensure that questions related to the accuracy or integrity of any part of the work, even ones in which the author was not personally involved, are appropriately investigated, resolved, and the resolution documented in the literature. NDO made substantial contributions to the conception of the work; data acquisition, analysis, and interpretation; and substantively revising the work. NDO has approved the submitted version and agreed to be personally accountable for the author's own contributions and to ensure that questions related to the accuracy or integrity of any part of the work, even ones in which the author was not personally involved, are appropriately investigated, resolved, and the resolution documented in the literature. HS made substantial contributions to drafting and substantively revising the work. HS has approved the submitted version and agreed to be personally accountable for the author's own contributions and to ensure that questions related to the accuracy or integrity of any part of the work, even ones in which the author was not personally involved, are appropriately investigated, resolved, and the resolution documented in the literature.

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Schroeder, J., Pesut, B., Olsen, L. et al. Developing a survey to measure nursing students’ knowledge, attitudes and beliefs, influences, and willingness to be involved in Medical Assistance in Dying (MAiD): a mixed method modified e-Delphi study. BMC Nurs 23 , 326 (2024). https://doi.org/10.1186/s12912-024-01984-z

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Evaluation of integrated community case management of the common childhood illness program in Gondar city, northwest Ethiopia: a case study evaluation design

• Mekides Geta 1 ,
• Geta Asrade Alemayehu 2 ,
• Wubshet Debebe Negash 2 ,
• Tadele Biresaw Belachew 2 ,
• Chalie Tadie Tsehay 2 &
• Getachew Teshale 2  

BMC Pediatrics volume  24 , Article number:  310 ( 2024 ) Cite this article

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Integrated Community Case Management (ICCM) of common childhood illness is one of the global initiatives to reduce mortality among under-five children by two-thirds. It is also implemented in Ethiopia to improve community access and coverage of health services. However, as per our best knowledge the implementation status of integrated community case management in the study area is not well evaluated. Therefore, this study aimed to evaluate the implementation status of the integrated community case management program in Gondar City, Northwest Ethiopia.

A single case study design with mixed methods was employed to evaluate the process of integrated community case management for common childhood illness in Gondar town from March 17 to April 17, 2022. The availability, compliance, and acceptability dimensions of the program implementation were evaluated using 49 indicators. In this evaluation, 484 mothers or caregivers participated in exit interviews; 230 records were reviewed, 21 key informants were interviewed; and 42 observations were included. To identify the predictor variables associated with acceptability, we used a multivariable logistic regression analysis. Statistically significant variables were identified based on the adjusted odds ratio (AOR) with a 95% confidence interval (CI) and p-value. The qualitative data was recorded, transcribed, and translated into English, and thematic analysis was carried out.

The overall implementation of integrated community case management was 81.5%, of which availability (84.2%), compliance (83.1%), and acceptability (75.3%) contributed. Some drugs and medical equipment, like Cotrimoxazole, vitamin K, a timer, and a resuscitation bag, were stocked out. Health care providers complained that lack of refreshment training and continuous supportive supervision was the common challenges that led to a skill gap for effective program delivery. Educational status (primary AOR = 0.27, 95% CI:0.11–0.52), secondary AOR = 0.16, 95% CI:0.07–0.39), and college and above AOR = 0.08, 95% CI:0.07–0.39), prescribed drug availability (AOR = 2.17, 95% CI:1.14–4.10), travel time to the to the ICCM site (AOR = 3.8, 95% CI:1.99–7.35), and waiting time (AOR = 2.80, 95% CI:1.16–6.79) were factors associated with the acceptability of the program by caregivers.

Conclusion and recommendation

The overall implementation status of the integrated community case management program was judged as good. However, there were gaps observed in the assessment, classification, and treatment of diseases. Educational status, availability of the prescribed drugs, waiting time and travel time to integrated community case management sites were factors associated with the program acceptability. Continuous supportive supervision for health facilities, refreshment training for HEW’s to maximize compliance, construction clean water sources for HPs, and conducting longitudinal studies for the future are the forwarded recommendation.

Peer Review reports

Integrated Community Case Management (ICCM) is a critical public health strategy for expanding the coverage of quality child care services [ 1 , 2 ]. It mainly concentrated on curative care and also on the diagnosis, treatment, and referral of children who are ill with infectious diseases [ 3 , 4 ].

Based on the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) recommendations, Ethiopia adopted and implemented a national policy supporting community-based treatment of common childhood illnesses like pneumonia, Diarrhea, uncomplicated malnutrition, malaria and other febrile illness and Amhara region was one the piloted regions in late 2010 [ 5 ]. The Ethiopian primary healthcare units, established at district levels include primary hospitals, health centers (HCs), and health posts (HPs). The HPs are run by Health Extension Workers (HEWs), and they have function of monitoring health programs and disease occurrence, providing health education, essential primary care services, and timely referrals to HCs [ 6 , 7 ]. The Health Extension Program (HEP) uses task shifting and community ownership to provide essential health services at the first level using the health development army and a network of woman volunteers. These groups are organized to promote health and prevent diseases through community participation and empowerment by identifying the salient local bottlenecks which hinder vital maternal, neonatal, and child health service utilization [ 8 , 9 ].

One of the key steps to enhance the clinical case of health extension staff is to encourage better growth and development among under-five children by health extension. Healthy family and neighborhood practices are also encouraged [ 10 , 11 ]. The program also combines immunization, community-based feeding, vitamin A and de-worming with multiple preventive measures [ 12 , 13 ]. Now a days rapidly scaling up of ICCM approach to efficiently manage the most common causes of morbidity and mortality of children under the age of five in an integrated manner at the community level is required [ 14 , 15 ].

Over 5.3 million children are died at a global level in 2018 and most causes (75%) are preventable or treatable diseases such as pneumonia, malaria and diarrhea [ 16 ]. About 99% of the global burden of mortality and morbidity of under-five children which exists in developing countries are due to common childhood diseases such as pneumonia, diarrhea, malaria and malnutrition [ 17 ].

In 2013, the mortality rate of under-five children in Sub-Saharan Africa decreased to 86 deaths per 1000 live birth and estimated to be 25 per 1000live births by 2030. However, it is a huge figure and the trends are not sufficient to reach the target [ 18 ]. About half of global under-five deaths occurred in sub-Saharan Africa. And from the top 26 nations burdened with 80% of the world’s under-five deaths, 19 are in sub-Saharan Africa [ 19 ].

To alleviate the burden, the Ethiopian government tries to deliver basic child care services at the community level by trained health extension workers. The program improves the health of the children not only in Ethiopia but also in some African nations. Despite its proven benefits, the program implementation had several challenges, in particular, non-adherence to the national guidelines among health care workers [ 20 ]. Addressing those challenges could further improve the program performance. Present treatment levels in sub-Saharan Africa are unacceptably poor; only 39% of children receive proper diarrhea treatment, 13% of children with suspected pneumonia receive antibiotics, 13% of children with fever receive a finger/heel stick to screen for malaria [ 21 ].

To improve the program performance, program gaps should be identified through scientific evaluations and stakeholder involvement. This evaluation not only identify gaps but also forward recommendations for the observed gaps. Furthermore, the implementation status of ICCM of common childhood illnesses has not been evaluated in the study area yet. Therefore, this work aimed to evaluate the implementation status of integrated community case management program implementation in Gondar town, northwest Ethiopia. The findings may be used by policy makers, healthcare providers, funders and researchers.

Method and material

Evaluation design and settings.

A single-case study design with concurrent mixed-methods evaluation was conducted in Gondar city, northwest Ethiopia, from March 17 to April 17, 2022. The evaluability assessment was done from December 15–30, 2021. Both qualitative and quantitative data were collected concurrently, analyzed separately, and integrated at the result interpretation phase.

The evaluation area, Gondar City, is located in northwest Ethiopia, 740 km from Addis Ababa, the capital city of the country. It has six sub-cities and thirty-six kebeles (25 urban and 11 rural). In 2019, the estimated total population of the town was 338,646, and 58,519 (17.3%) were under-five children. In the town there are eight public health centers and 14 health posts serving the population. All health posts provide ICCM service for more than 70,852 populations.

Evaluation approach and dimensions

Program stakeholders.

The evaluation followed a formative participatory approach by engaging the potential stakeholders in the program. Prior to the development of the proposal, an extensive discussion was held with the Gondar City Health Department to identify other key stakeholders in the program. Service providers at each health facility (HCs and HPs), caretakers of sick children, the Gondar City Health Office (GCHO), the Amhara Regional Health Bureau (ARHB), the Minister of Health (MoH), and NGOs (IFHP and Save the Children) were considered key stakeholders. During the Evaluability Assessment (EA), the stakeholders were involved in the development of evaluation questions, objectives, indicators, and judgment criteria of the evaluation.

Evaluation dimensions

The availability and acceptability dimensions from the access framework [ 22 ] and compliance dimension from the fidelity framework [ 23 ] were used to evaluate the implementation of ICCM.

Population and samplings

All under-five children and their caregivers attended at the HPs; program implementers (health extension workers, healthcare providers, healthcare managers, PHCU focal persons, MCH coordinators, and other stakeholders); and ICCM records and registries in the health posts of Gondar city administration were included in the evaluation. For quantitative data, the required sample size was proportionally allocated for each health post based on the number of cases served in the recent one month. But the qualitative sample size was determined by data saturation, and the samples were selected purposefully.

The data sources and sample size for the compliance dimension were all administrative records/reports and ICCM registration books (230 documents) in all health posts registered from December 1, 2021, to February 30, 2022 (three months retrospectively) included in the evaluation. The registries were assessed starting from the most recent registration number until the required sample size was obtained for each health post.

The sample size to measure the mothers’/caregivers’ acceptability towards ICCM was calculated by taking prevalence of caregivers’ satisfaction on ICCM program p  = 74% from previously similar study [ 24 ] and considering standard error 4% at 95% CI and 10% non- responses, which gave 508. Except those who were seriously ill, all caregivers attending the ICCM sites during data collection were selected and interviewed consecutively.

The availability of required supplies, materials and human resources for the program were assessed in all 14HPs. The data collectors observed the health posts and collected required data by using a resources inventory checklist.

A total of 70 non-participatory patient-provider interactions were also observed. The observations were conducted per each health post and for health posts which have more than one health extension workers one of them were selected randomly. The observation findings were used to triangulate the findings obtained through other data collection techniques. Since people may act accordingly to the standards when they know they are observed for their activities, we discarded the first two observations from analysis. It is one of the strategies to minimize the Hawthorne effect of the study. Finally a total of 42 (3 in each HPs) observations were included in the analysis.

Twenty one key informants (14 HEWs, 3 PHCU focal person, 3 health center heads and one MCH coordinator) were interviewed. These key informants were selected since they are assumed to be best teachers in the program. Besides originally developed key informant interview questions, the data collectors probed them to get more detail and clear information.

Variables and measurement

The availability of resources, including trained healthcare workers, was examined using 17 indicators, with weighted score of 35%. Compliance was used to assess HEWs’ adherence to the ICCM treatment guidelines by observing patient-provider interactions and conducting document reviews. We used 18 indicators and a weighted value of 40%.

Mothers’ /caregivers’/ acceptance of ICCM service was examined using 14 indicators and had a weighted score of 25%. The indicators were developed with a five-point Likert scale (1: strongly disagree, 2: disagree, 3: neutral, 4: agree and 5: strongly agree). The cut off point for this categorization was calculated using the demarcation threshold formula: ( \(\frac{\text{t}\text{o}\text{t}\text{a}\text{l}\, \text{h}\text{i}\text{g}\text{h}\text{e}\text{s}\text{t}\, \text{s}\text{c}\text{o}\text{r}\text{e}-\,\text{t}\text{o}\text{t}\text{a}\text{l}\, \text{l}\text{o}\text{w}\text{e}\text{s}\text{t} \,\text{s}\text{c}\text{o}\text{r}\text{e}}{2}) +total lowest score\) ( 25 – 27 ). Those mothers/caregivers/ who scored above cut point (42) were considered as “satisfied”, otherwise “dissatisfied”. The indicators were adapted from the national ICCM and IMNCI implementation guideline and other related evaluations with the participation of stakeholders. Indicator weight was given by the stakeholders during EA. Indicators score was calculated using the formula \(\left(achieved \,in \%=\frac{indicator \,score \,x \,100}{indicator\, weight} \right)\) [ 26 , 28 ].

The independent variables for the acceptability dimension were socio-demographic and economic variables (age, educational status, marital status, occupation of caregiver, family size, income level, and mode of transport), availability of prescribed drugs, waiting time, travel time to ICCM site, home to home visit, consultation time, appointment, and source of information.

The overall implementation of ICCM was measured by using 49 indicators over the three dimensions: availability (17 indicators), compliance (18 indicators) and acceptability (14 indicators).

Program logic model

Based on the constructed program logic model and trained health care providers, mothers/caregivers received health information and counseling on child feeding; children were assessed, classified, and treated for disease, received follow-up; they were checked for vitamin A; and deworming and immunization status were the expected outputs of the program activities. Improved knowledge of HEWs on ICCM, increased health-seeking behavior, improved quality of health services, increased utilization of services, improved data quality and information use, and improved child health conditions are considered outcomes of the program. Reduction of under-five morbidity and mortality and improving quality of life in the society are the distant outcomes or impacts of the program (Fig.  1 ).

Integrated community case management of childhood illness program logic model in Gondar City in 2022

Data collection tools and procedure

Resource inventory and data extraction checklists were adapted from standard ICCM tool and check lists [ 29 ]. A structured interviewer administered questionnaire was adapted by referring different literatures [ 30 , 31 ] to measure the acceptability of ICCM. The key informant interview (KII) guide was also developed to explore the views of KIs. The interview questionnaire and guide were initially developed in English and translated into the local language (Amharic) and finally back to English to ensure consistency. All the interviews were done in the local language, Amharic.

Five trained clinical nurses and one BSC nurse were recruited from Gondar zuria and Wegera district as data collectors and supervisors, respectively. Two days training on the overall purpose of the evaluation and basic data collection procedures were provided prior to data collection. Then, both quantitative and qualitative data were gathered at the same time. The quantitative data were gathered from program documentation, charts of ICCM program visitors and, exit interview. Interviews with 21 KIIs and non-participatory observations of patient-provider interactions were used to acquire qualitative data. Key informant interviews were conducted to investigate the gaps and best practices in the implementation of the ICCM program.

A pretest was conducted to 26 mothers/caregivers/ at Maksegnit health post and appropriate modifications were made based on the pretest results. The data collectors were supervised and principal evaluator examined the completeness and consistency of the data on a daily basis.

Data management and analysis

For analysis, quantitative data were entered into epi-data version 4.6 and exported to Stata 14 software for analysis. Narration and tabular statistics were used to present descriptive statistics. Based on established judgment criteria, the total program implementation was examined and interpreted as a mix of the availability, compliance, and acceptability dimensions. To investigate the factors associated with ICCM acceptance, a binary logistic regression analysis was performed. During bivariable analysis, variables with p-values less than 0.25 were included in multivariable analysis. Finally, variables having a p-value less than 0.05 and an adjusted odds ratio (AOR) with a 95% confidence interval (CI) were judged statistically significant. Qualitative data were collected recorded, transcribed into Amharic, then translated into English and finally coded and thematically analyzed.

Judgment matrix analysis

The weighted values of availability, compliance, and acceptability dimensions were 35, 40, and 25 based on the stakeholder and investigator agreement on each indicator, respectively. The judgment parameters for each dimension and the overall implementation of the program were categorized as poor (< 60%), fair (60–74.9%), good (75-84.9%), and very good (85–100%).

Availability of resources

A total of 26 HEWs were assigned within the fourteen health posts, and 72.7% of them were trained on ICCM to manage common childhood illnesses in under-five children. However, the training was given before four years, and they didn’t get even refreshment training about ICCM. The KII responses also supported that the shortage of HEWs at the HPs was the problem in implementing the program properly.

I am the only HEW in this health post and I have not been trained on ICCM program. So, this may compromise the quality of service and client satisfaction.(25 years old HEW with two years’ experience)

All observed health posts had ICCM registration books, monthly report and referral formats, functional thermometer, weighting scale and MUAC tape meter. However, timer and resuscitation bag was not available in all HPs. Most of the key informant finding showed that, in all HPs there was no shortage of guideline, registration book and recording tool; however, there was no OTP card in some health posts.

“Guideline, ICCM registration book for 2–59 months of age, and other different recording and reporting formats and booklet charts are available since September/2016. However, OTP card is not available in most HPs.”. (A 30 years male health center director)

Only one-fifth (21%) of HPs had a clean water source for drinking and washing of equipment. Most of Key-informant interview findings showed that the availability of infrastructures like water was not available in most HPs. Poor linkage between HPs, HCs, town health department, and local Kebele administer were the reason for unavailability.

Since there is no water for hand washing, or drinking, we obligated to bring water from our home for daily consumptions. This increases the burden for us in our daily activity. (35 years old HEW)

Most medicines, such as anti-malaria drugs with RDT, Quartem, Albendazole, Amoxicillin, vitamin A capsules, ORS, and gloves, were available in all the health posts. Drugs like zinc, paracetamol, TTC eye ointment, and folic acid were available in some HPs. However, cotrimoxazole and vitamin K capsules were stocked-out in all health posts for the last six months. The key informant also revealed that: “Vitamin K was not available starting from the beginning of this program and Cotrimoxazole was not available for the past one year and they told us they would avail it soon but still not availed. Some essential ICCM drugs like anti malaria drugs, De-worming, Amoxicillin, vitamin A capsules, ORS and medical supplies were also not available in HCs regularly.”(28 years’ Female PHCU focal)

The overall availability of resources for ICCM implementation was 84.2% which was good based on our presetting judgment parameter (Table  1 ).

Health extension worker’s compliance

From the 42 patient-provider interactions, we found that 85.7%, 71.4%, 76.2%, and 95.2% of the children were checked for body temperature, weight, general danger signs, and immunization status respectively. Out of total (42) observation, 33(78.6%) of sick children were classified for their nutritional status. During observation time 29 (69.1%) of caregivers were counseled by HEWs on food, fluid and when to return back and 35 (83.3%) of children were appointed for next follow-up visit. Key informant interviews also affirmed that;

“Most of our health extension workers were trained on ICCM program guidelines but still there are problems on assessment classification and treatment of disease based on guidelines and standards this is mainly due to lack refreshment training on the program and lack of continuous supportive supervision from the respective body.” (27years’ Male health center head)

From 10 clients classified as having severe pneumonia cases, all of them were referred to a health center (with pre-referral treatment), and from those 57 pneumonia cases, 50 (87.7%) were treated at the HP with amoxicillin or cotrimoxazole. All children with severe diarrhea, very severe disease, and severe complicated malnutrition cases were referred to health centers with a pre-referral treatment for severe dehydration, very severe febrile disease, and severe complicated malnutrition, respectively. From those with some dehydration and no dehydration cases, (82.4%) and (86.8%) were treated at the HPs for some dehydration (ORS; plan B) and for no dehydration (ORS; plan A), respectively. Moreover, zinc sulfate was prescribed for 63 (90%) of under-five children with some dehydration or no dehydration. From 26 malaria cases and 32 severe uncomplicated malnutrition and moderate acute malnutrition cases, 20 (76.9%) and 25 (78.1%) were treated at the HPs, respectively. Of the total reviewed documents, 56 (93.3%), 66 (94.3%), 38 (84.4%), and 25 (78.1%) of them were given a follow-up date for pneumonia, diarrhea, malaria, and malnutrition, respectively.

Supportive supervision and performance review meetings were conducted only in 10 (71.4%) HPs, but all (100%) HPs sent timely reports to the next supervisory body.

Most of the key informants’ interview findings showed that supportive supervision was not conducted regularly and for all HPs.

I had mentored and supervised by supportive supervision teams who came to our health post at different times from health center, town health office and zonal health department. I received this integrated supervision from town health office irregularly, but every month from catchment health center and last integrated supportive supervision from HC was on January. The problem is the supervision was conducted for all programs.(32 years’ old and nine years experienced female HEW)

Moreover, the result showed that there was poor compliance of HEWs for the program mainly due to weak supportive supervision system of managerial and technical health workers. It was also supported by key informants as:

We conducted supportive supervision and performance review meeting at different time, but still there was not regular and not addressed all HPs. In addition to this the supervision and review meeting was conducted as integration of ICCM program with other services. The other problem is that most of the time we didn’t used checklist during supportive supervision. (Mid 30 years old male HC director)

Based on our observation and ICCM document review, 83.1% of the HEWs were complied with the ICCM guidelines and judged as fair (Table  2 ).

Acceptability of ICCM program

Sociodemographic and obstetric characteristics of participants.

A total of 484 study participants responded to the interviewer-administered questionnaire with a response rate of 95.3%. The mean age of study participants was 30.7 (SD ± 5.5) years. Of the total caregivers, the majority (38.6%) were categorized under the age group of 26–30 years. Among the total respondents, 89.3% were married, and regarding religion, the majorities (84.5%) were Orthodox Christian followers. Regarding educational status, over half of caregivers (52.1%) were illiterate (unable to read or write). Nearly two-thirds of the caregivers (62.6%) were housewives (Table  3 ).

All the caregivers came to the health post on foot, and most of them 418 (86.4%) arrived within one hour. The majority of 452 (93.4%) caregivers responded that the waiting time to get the service was less than 30 min. Caregivers who got the prescribed drugs at the health post were 409 (84.5%). Most of the respondents, 429 (88.6%) and 438 (90.5%), received counseling services on providing extra fluid and feeding for their sick child and were given a follow-up date.

Most 298 (61.6%) of the caregivers were satisfied with the convenience of the working hours of HPs, and more than three-fourths (80.8%) were satisfied with the counseling services they received. Most of the respondents, 366 (75.6%), were satisfied with the appropriateness of waiting time and 431 (89%) with the appropriateness of consultation time. The majority (448 (92.6%) of caregivers were satisfied with the way of communicating with HEWs, and 269 (55.6%) were satisfied with the knowledge and competence of HEWs. Nearly half of the caregivers (240, or 49.6%) were satisfied with the availability of drugs at health posts.

The overall acceptability of the ICCM program was 75.3%, which was judged as good. A low proportion of acceptability was measured on the cleanliness of the health posts, the appropriateness of the waiting area, and the competence and knowledge of the HEWs. On the other hand, high proportion of acceptability was measured on appropriateness of waiting time, way of communication with HEWs, and the availability of drugs (Table  4 ).

Factors associated with acceptability of ICCM program

In the final multivariable logistic regression analysis, educational status of caregivers, availability of prescribed drugs, time to arrive, and waiting time were factors significantly associated with the satisfaction of caregivers with the ICCM program.

Accordingly, the odds of caregivers with primary education, secondary education, and college and above were 73% (AOR = 0.27, 95% CI: 0.11–0.52), 84% (AOR = 0.16, 95% CI: 0.07–0.39), and 92% (AOR = 0.08, 95% CI: 0.07–0.40) less likely to accept the program as compared to mothers or caregivers who were not able to read and write, respectively. The odds of caregivers or mothers who received prescribed drugs were 2.17 times more likely to accept the program as compared to their counters (AOR = 2.17, 95% CI: 1.14–4.10). The odds of caregivers or mothers who waited for services for less than 30 min were 2.8 times more likely to accept the program as compared to those who waited for more than 30 min (AOR = 2.80, 95% CI: 1.16–6.79). Moreover, the odds of caregivers/mothers who traveled an hour or less for service were 3.8 times more likely to accept the ICCM program as compared to their counters (AOR = 3.82, 95% CI:1.99–7.35) (Table  5 ).

Overall ICCM program implementation and judgment

The implementation of the ICCM program in Gondar city administration was measured in terms of availability (84.2%), compliance (83.1%), and acceptability (75.3%) dimensions. In the availability dimension, amoxicillin, antimalarial drugs, albendazole, Vit. A, and ORS were available in all health posts, but only six HPs had Ready-to-Use Therapeutic Feedings, three HPs had ORT Corners, and none of the HPs had functional timers. In all health posts, the health extension workers asked the chief to complain, correctly assessed for pneumonia, diarrhea, malaria, and malnutrition, and sent reports based on the national schedule. However, only 70% of caretakers counseled about food, fluids, and when to return, 66% and 76% of the sick children were checked for anemia and other danger signs, respectively. The acceptability level of the program by caretakers and caretakers’/mothers’ educational status, waiting time to get the service and travel time ICCM sites were the factors affecting its acceptability. The overall ICCM program in Gondar city administration was 81.5% and judged as good (Fig.  2 ).

Overall ICCM program implementation and the evaluation dimensions in Gondar city administration, 2022

The implementation status of ICCM was judged by using three dimensions including availability, compliance and acceptability of the program. The judgment cut of points was determined during evaluability assessment (EA) along with the stakeholders. As a result, we found that the overall implementation status of ICCM program was good as per the presetting judgment parameter. Availability of resources for the program implementation, compliance of HEWs to the treatment guideline and acceptability of the program services by users were also judged as good as per the judgment parameter.

This evaluation showed that most medications, equipment and recording and reporting materials available. This finding was comparable with the standard ICCM treatment guide line [ 10 ]. On the other hand trained health care providers, some medications like Zink, Paracetamol and TTC eye ointment, folic acid and syringes were not found in some HPs. However the finding was higher than the study conducted in SNNPR on selected health posts [ 33 ] and a study conducted in Soro district, southern Ethiopia [ 24 ]. The possible reason might be due to low interruption of drugs at town health office or regional health department stores, regular supplies of essential drugs and good supply management and distribution of drug from health centers to health post.

The result of this evaluation showed that only one fourth of health posts had functional ORT Corner which was lower compared to the study conducted in SNNPR [ 34 ]. This might be due poor coverage of functional pipe water in the kebeles and the installation was not set at the beginning of health post construction as reported from one of ICCM program coordinator.

Compliance of HEWs to the treatment guidelines in this evaluation was higher than the study done in southern Ethiopia (65.6%) [ 24 ]. This might be due to availability of essential drugs educational level of HEWs and good utilization of ICCM guideline and chart booklet by HEWs. The observations showed most of the sick children were assessed for danger sign, weight, and temperature respectively. This finding is lower than the study conducted in Rwanda [ 35 ]. This difference might be due to lack of refreshment training and regular supportive supervision for HEWs. This also higher compared to the study done in three regions of Ethiopia indicates that 88%, 92% and 93% of children classified as per standard for Pneumonia, diarrhea and malaria respectively [ 36 ]. The reason for this difference may be due to the presence of medical equipment and supplies including RDT kit for malaria, and good educational level of HEWs.

Moreover most HPs received supportive supervision and performance review meeting was conducted and all of them send reports timely to next level. The finding of this evaluation was lower than the study conducted on implementation evaluation of ICCM program southern Ethiopia [ 24 ] and study done in three regions of Ethiopia (Amhara, Tigray and SNNPR) [ 37 ]. This difference might be due sample size variation.

The overall acceptability of the ICCM program was less than the presetting judgment parameter but slightly higher compared to the study in southern Ethiopia [ 24 ]. This might be due to presence of essential drugs for treating children, reasonable waiting and counseling time provided by HEWs, and smooth communication between HEWs and caregivers. In contrast, this was lower than similar studies conducted in Wakiso district, Uganda [ 38 ]. The reason for this might be due to contextual difference between the two countries, inappropriate waiting area to receive the service and poor cleanness of the HPs in our study area. Low acceptability of caregivers to ICCM service was observed in the appropriateness of waiting area, availability of drugs, cleanness of health post, and competence of HEWs while high level of caregiver’s acceptability was consultation time, counseling service they received, communication with HEWs, treatment given for their sick children and interest to return back for ICCM service.

Caregivers who achieved primary, secondary, and college and above were more likely accept the program services than those who were illiterate. This may more educated mothers know about their child health condition and expect quality service from healthcare providers which is more likely reduce the acceptability of the service. The finding is congruent with a study done on implementation evaluation of ICCM program in southern Ethiopia [ 24 ]. However, inconsistent with a study conducted in wakiso district in Uganda [ 38 ]. The possible reason for this might be due to contextual differences between the two countries. The ICCM program acceptability was high in caregivers who received all prescribed drugs than those did not. Caregivers those waited less than 30 min for service were more accepted ICCM services compared to those more than 30 minutes’ waiting time. This finding is similar compared with the study conducted on implementation evaluation of ICCM program in southern Ethiopia [ 24 ]. In contrary, the result was incongruent with a survey result conducted by Ethiopian public health institute in all regions and two administrative cities of Ethiopia [ 39 ]. This variation might be due to smaller sample size in our study the previous one. Moreover, caregivers who traveled to HPs less than 60 min were more likely accepted the program than who traveled more and the finding was similar with the study finding in Jimma zone [ 40 ].

Strengths and limitations

This evaluation used three evaluation dimensions, mixed method and different data sources that would enhance the reliability and credibility of the findings. However, the study might have limitations like social desirability bias, recall bias and Hawthorne effect.

The implementation of the ICCM program in Gondar city administration was measured in terms of availability (84.2%), compliance (83.1%), and acceptability (75.3%) dimensions. In the availability dimension, amoxicillin, antimalarial drugs, albendazole, Vit. A, and ORS were available in all health posts, but only six HPs had Ready-to-Use Therapeutic Feedings, three HPs had ORT Corners, and none of the HPs had functional timers.

This evaluation assessed the implementation status of the ICCM program, focusing mainly on availability, compliance, and acceptability dimensions. The overall implementation status of the program was judged as good. The availability dimension is compromised due to stock-outs of chloroquine syrup, cotrimoxazole, and vitamin K and the inaccessibility of clean water supply in some health posts. Educational statuses of caregivers, availability of prescribed drugs at the HPs, time to arrive to HPs, and waiting time to receive the service were the factors associated with the acceptability of the ICCM program.

Therefore, continuous supportive supervision for health facilities, and refreshment training for HEW’s to maximize compliance are recommended. Materials and supplies shall be delivered directly to the health centers or health posts to solve the transportation problem. HEWs shall document the assessment findings and the services provided using the registration format to identify their gaps, limitations, and better performances. The health facilities and local administrations should construct clean water sources for health facilities. Furthermore, we recommend for future researchers and program evaluators to conduct longitudinal studies to know the causal relationship of the program interventions and the outcomes.

Data availability

Data will be available upon reasonable request from the corresponding author.

Abbreviations

Ethiopian Demographic and Health Survey

Health Center/Health Facility

Health Extension Program

Health Extension Workers

Health Post

Health Sector Development Plan

Integrated Community Case Management of Common Childhood Illnesses

Information Communication and Education

Integrated Family Health Program

Integrated Management of Neonatal and Childhood Illness

Integrated Supportive Supervision

Maternal and Child Health

Mid Upper Arm Circumference

Non-Government Organization

Oral Rehydration Salts

Outpatient Therapeutic program

Primary health care unit

Rapid Diagnostics Test

Ready to Use Therapeutic Foods

Sever Acute Malnutrition

South Nation Nationalities People Region

United Nations International Child Emergency Fund

World Health Organization

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Acknowledgements

We are very grateful to University of Gondar and Gondar town health office for its welcoming approaches. We would also like to thank all of the study participants of this evaluation for their information and commitment. Our appreciation also goes to the data collectors and supervisors for their unreserved contribution.

No funding is secured for this evaluation study.

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Metema District Health office, Gondar, Ethiopia

Mekides Geta

Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, P.O. Box 196, Gondar, Ethiopia

Geta Asrade Alemayehu, Wubshet Debebe Negash, Tadele Biresaw Belachew, Chalie Tadie Tsehay & Getachew Teshale

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Contributions

All authors contributed to the preparation of the manuscript. M.G. conceived and designed the evaluation and performed the analysis then T.B.B., W.D.N., G.A.A., C.T.T. and G.T. revised the analysis. G.T. prepared the manuscript and all the authors revised and approved the final manuscript.

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Correspondence to Getachew Teshale .

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Ethics approval and consent to participate.

Ethical approval was obtained from Institutional Review Board (IRB) of Institute of Public Health, College of Medicine and Health sciences, University of Gondar (Ref No/IPH/1482/2013). Informed consent was obtained from all subjects and/or their legal guardian(s).

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Geta, M., Alemayehu, G.A., Negash, W.D. et al. Evaluation of integrated community case management of the common childhood illness program in Gondar city, northwest Ethiopia: a case study evaluation design. BMC Pediatr 24 , 310 (2024). https://doi.org/10.1186/s12887-024-04785-0

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Received : 20 February 2024

Accepted : 22 April 2024

Published : 09 May 2024

DOI : https://doi.org/10.1186/s12887-024-04785-0

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Getting seniors back on their bicycle; a pretest-posttest case-control study on the improvement of bicycle balance control

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Objective Quantify the effectiveness and generalizability of an intervention that aims at restoring bicycle balance control skills in seniors that have quit cycling. Methods The intervention was designed such that the difficulty of the bicycle balance control task could be increased in a stepwise fashion, gradually approaching the difficulty of bicycle balance control on the public roads. The intervention lasted 11 weeks and involved three components: (1) training on an exercise bicycle, (2) balance control training on a bicycle simulator, and (3) cycling on the public roads with a safe start-and-stop technique that was practiced on the bicycle simulator. The intervention was administered to a group of community-dwelling senior citizens (N=23) that had quit cycling (N=19) or that were on the verge of doing so (N=4). The effectiveness of the intervention was evaluated by comparing balance control skill and confidence between a post- and a pre-intervention measurement. As a check for possible spontaneous recovery, the same comparison was also performed in a matched control group that did not participate in the intervention. Results This intervention produced a very large improvement (Cohen's d = 1.8, t(16)=7.5, p<.001) in balance control skills and confidence on the public roads. Conclusion Bicycle balance control skills and confidence can be restored over a short period of time. However, this does not rule out the importance of the slower process of acquiring a sufficient lower body strength. Impact Statement Increasing balance control skills and confidence is a realistic short-term target for rehabilitation interventions.

Competing Interest Statement

The authors have declared no competing interest.

Funding Statement

This study was funded by the Radboud Center Social Sciences

Author Declarations

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

Ethics Committee of the faculty of Social Sciences (ECSS) of the Radboud University (ECSS-2020-132)

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Title changed. Added a statistical motivation for the pretest-posttest design. Manuscript shortened to meet publisher requirements.

Data Availability

All data produced in the present study are available upon reasonable request to the authors

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