Effectiveness of Structured Case-Based Learning Versus Traditional Didactics in Enhancing Clinical Decision-Making...

Clinical decision-making is central to orthopedic residency training but is challenging to teach using traditional didactic lectures, which emphasize information transmission over active reasoning. Structured case-based learning (CBL) has been proposed as a learner-centered alternative that targets diagnostic reasoning, management planning, and decision-making under uncertainty. To compare the educational effectiveness of structured case-based learning versus traditional didactic lectures (TDL) in enhancing clinical decision-making among orthopedic surgery residents. A retrospective, multicenter cohort study was conducted across four postgraduate medical education programs in China. A total of 120 orthopedic residents were included (CBL and TDL, n = 60). Both groups completed an 8-week curriculum covering eight high-risk orthopedic topics with equivalent instructional time and objectives. The CBL intervention incorporated flipped pre-work, progressive case disclosure, forced decision nodes, and structured debriefing, while the TDL arm used slide-based lectures with question-and-answer periods. The primary outcome was a prespecified composite clinical decision-making score derived from standardized objective structured clinical examination (OSCE) decision stations, a Script Concordance Test, and time-to-correct-decision metrics. Secondary outcomes included knowledge performance, appropriateness of management, communication scores, retention at 8 weeks, learner satisfaction, engagement, and cognitive load. Assessors were blinded to the instructional group. Baseline characteristics and performance were comparable between groups. The CBL group achieved significantly higher composite decision-making scores than the TDL group at post-intervention and at 8-week retention, with moderate effect sizes. Secondary outcomes, including OSCE performance, reasoning under uncertainty, decision speed, knowledge scores, appropriateness of management, and communication ratings, consistently favored CBL. Learner satisfaction was higher in the CBL group, while cognitive load and attendance were similar between groups. Structured case-based learning was associated with superior educational performance compared with traditional lectures among orthopedic residents, with durable gains in decision-making. These findings support the integration of structured, decision-focused case discussions into residency didactic curricula.