How Specific Instructional Design Elements Influence the Experience of Case-Based Collaborative Learning in a Mexican Medical School: A Mixed-Methods Study.

Background: Case-based collaborative learning (CBCL) is an instructional method designed to promote active learning (AL). In CBCL, students learn the basics independently and apply their knowledge to case scenarios collaboratively. While theoretically the cognitive principles underlying AL in CBCL should be generalizable, implementation is shaped by local and cultural contexts. This study explored the feasibility of implementing CBCL at the University of Guadalajara, Mexico, where lectures dominate higher education and passive learning is the norm. Methods: This study used a quasi-experimental design and an explanatory mixed-method approach. Ninety-nine fourth-year medical students, enrolled in a virtual evidence-based medicine (EBM) course, were assigned into a group taught via CBCL or a comparison group taught using lectures. Both groups covered identical EBM content: framing clinical questions, database searching, critical appraisal of randomized trials and diagnostic studies, evaluating systematic reviews, and applying evidence to patient care. Students' knowledge (cognitive skills) and attitudes (affective dimensions) were assessed using course exams, survey data, and focus groups. Thematic analysis was used to explore the intervention's impact and feasibility. Results: Both groups performed comparably on the knowledge assessments (CBCL 10 vs CL 9.5 out of 10, Conclusion: CBCL proved feasible and valued by students accustomed to lecture-based approaches. Our findings led to a conceptual model linking specific ID elements in CBCL with motivational domains. This model can guide educators seeking to adapt CBCL or similar AL approaches to their local context and inform future research.