ArticleBMC medical education2026
Dynamic CBME in action: rule-based digital case-based learning to evaluate antibiotic-stewardship reasoning in MBBS learners.
Article in BMC medical education, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundAntimicrobial resistance is a major global public health threat, necessitating improved antibiotic stewardship. India's Competency-Based Medical Education (CBME) framework requires robust methods to assess and cultivate clinical reasoning. This study evaluated a rule-based Digital Case-Based Learning (DCBL) module with algorithm-triggered formative feedback for antibiotic-stewardship decision-making among undergraduate medical learners.
methodsA quasi-experimental, single-group pre-post study evaluated three rule-based DCBL micro-cases (upper respiratory tract infection [URTI], urinary tract infection [UTI], and acute watery diarrhoea) in 271 third- and fourth-phase MBBS learners at a tertiary-care teaching hospital in South India. Script Concordance Test (SCT) performance was assessed using parallel pre- and post-test forms. Usability and workload were measured using the System Usability Scale (SUS) and two NASA Task Load Index (NASA-TLX) items.
resultsOverall SCT scores changed from 5.65 +/- 4.73 to 6.05 +/- 4.48 (mean change = 0.40; 95% CI: -0.41 to 1.21; p = 0.33; Cohen's d = 0.059). The UTI case showed a statistically significant domain-specific improvement (mean change = 0.58; p = 0.003; Cohen's d = 0.18), which falls below the conventional small-effect threshold. URTI and diarrhoea cases showed no significant change. The mean SUS score was 62.4 +/- 18.7; 76.0% of learners rated platform usability as average or good, with moderate cognitive workload.
conclusionA single-session rule-based DCBL intervention was feasible and acceptable in routine CBME teaching and showed a domain-specific SCT signal in the UTI case. The overall SCT change was not statistically significant and should not be interpreted as evidence of effectiveness or generalised across antibiotic-stewardship scenarios. Controlled, multisite, longitudinal studies are needed to confirm these preliminary findings.
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