Dental Students Say a Three-Phase Case Method Bridges the Preclinical-Clinical Divide

Dental education has long been haunted by a stubborn gap: students who can recite pharmacology, pathology, and physiology with precision in lecture halls often freeze when a real patient sits in the chair. A new qualitative study from Mahidol University, published in Heliyon, suggests that a carefully sequenced, multidisciplinary form of case-based learning may help close that divide. The researchers, led by Kawin Sipiyaruk and colleagues at Mahidol International Dental School, developed and evaluated a framework they call preclinical multidisciplinary case-based learning, or PM-CBL, and interviewed fourteen students and recent graduates about how it shaped their knowledge integration and perceived readiness for clinical practice.

The problem the team set out to address is well documented in health professions education. Traditional dental curricula tend to rely on didactic, teacher-centered instruction that produces passive learning environments and fragments knowledge into silos. Educational researchers distinguish between horizontal integration, which connects disciplines such as anatomy and pathology at the same stage of training, and vertical integration, which links foundational science to advanced clinical topics across time. Both are considered essential for clinical problem-solving, yet conventional teaching methods often deliver neither, leaving students to assemble the pieces on their own, usually under the pressure of real patient care.

Case-based learning has emerged as one of the most promising answers. By anchoring instruction in clinically relevant scenarios, CBL builds on students’ existing knowledge, encourages critical thinking, and has repeatedly outperformed lecture-based methods in knowledge retention and integration. But the Mahidol team identified a weakness in the standard format: traditional CBL typically drops students into undifferentiated groups without a dedicated phase for discipline-specific inquiry, which can produce a superficial grasp of specialized knowledge before students are asked to synthesize it with peers. Problem-based learning and team-based learning share similar limitations, prioritizing either open-ended inquiry or group accountability testing rather than a deliberate progression from individual expertise to multidisciplinary synthesis.

PM-CBL was designed to fix that. The framework unfolds in three sequenced phases, each grounded in a distinct learning theory. In Phase 1, grounded in constructivist theory, students work independently within an assigned discipline—microbiology and immunology, pharmacology, anatomy, physiology, or pathology—conducting literature reviews and presenting findings to a discipline instructor for structured feedback. Phase 2, informed by social constructivism, brings the five discipline representatives together to integrate their findings around a shared case and prepare a group presentation. Phase 3, drawing on Kolb’s experiential learning cycle, culminates in formal presentations to all instructors, cross-disciplinary questioning, and an individual written reflection. The activity ran twice during the preclinical curriculum, once in the third year focusing on systemic diseases and once in the fourth year on oral conditions with systemic involvement.

One representative fourth-year case illustrates the approach in action: a 26-year-old pregnant patient presenting with gum swelling, difficulty chewing, and a grey-white ulcerated tongue lesion. The pharmacology group examined drugs contraindicated in pregnancy, the pathology group described histopathological features, the anatomy group considered fetal safety in dental treatment, the physiology group explained the hormonal mechanisms behind gingival enlargement, and the microbiology group identified possible causative organisms. Only when all five perspectives converged did the full clinical picture emerge—a deliberate demonstration that no single discipline can manage a complex patient alone.

To evaluate the framework, the researchers conducted semi-structured interviews with fourteen participants—five fifth-year students, five sixth-year students, and four recent graduates—who had completed PM-CBL in their preclinical years and subsequently entered clinical practice. Interviewers had no teaching or grading role in the activity, and the analysis employed reflexive thematic analysis with a collaborative team that blended former learners, the course developer, and more distanced researchers. Four main themes emerged: learning activities and processes, concerns in learning design, educational outcomes, and clinical application.

The educational payoffs were striking. Ten of the fourteen participants reported that PM-CBL deepened their knowledge acquisition and reinforced preclinical material they had studied years earlier. Ten described genuine multidisciplinary integration, with one noting it was the first time they had linked their preclinical knowledge into a coherent whole rather than viewing each subject in isolation. Ten also reported gains in research and self-directed learning skills, learning to navigate databases, screen academic papers critically, and rely on evidence rather than blogs or simple websites. Most tellingly, all fourteen participants connected the experience to clinical application, describing how early exposure to diverse cases helped them diagnose lesions, assess patients with systemic conditions, and identify risks with greater confidence during their clinical years.

The study is equally candid about the framework’s shortcomings. Eleven participants questioned the realism of the cases, noting that some were overly rare or complex and that real clinical diagnosis requires investigating information rather than receiving it all at once. Nine complained that lengthy, information-dense presentations eroded engagement. Eight wanted the freedom to choose their assigned discipline rather than being randomly allocated, and several noted that rigid assignments meant they barely discussed disciplines outside their own. Participants also called for more frequent instructor interaction beyond the two fixed meetings, and seven argued that the activity should be repositioned later in the curriculum, closer to the start of clinical training, so that reinforced knowledge does not fade before it is needed.

From these findings the team constructed a conceptual model proposing how design concerns shape learning processes, which in turn drive educational outcomes and ultimately clinical readiness. The authors frame the model as hypothesis-generating rather than empirically validated, and they acknowledge the limitations inherent in a single-center qualitative study with a modest sample and potential recall bias among graduates reflecting on experiences from years past. Perceived readiness, they note, is not the same as measured competence; future work should incorporate objective metrics such as standardized assessments and direct clinical observation.

Nevertheless, the study offers a compelling and theoretically grounded template for reform. By sequencing constructivist knowledge-building, socially constructed integration, and experiential application, PM-CBL maps a deliberate cognitive journey from passive reception to interactive engagement—a progression the authors also interpret through the ICAP framework of cognitive engagement. Their recommendations are practical: use common, clinically realistic cases; allow flexible discipline selection; increase interactivity and instructor feedback; consider gamified elements such as roleplay; and place the activity close to the clinical years. For dental schools wrestling with the persistent chasm between preclinical theory and patient care, the message is clear—integration does not happen by accident. It must be engineered, phase by phase, into the very architecture of learning.

Subject of Research: Multidisciplinary case-based learning in preclinical dental education

Article Title: Exploring learning experiences and perceived benefits of multidisciplinary case-based learning for knowledge integration and clinical readiness among preclinical dental students

Article References: Sipiyaruk, K., Asavisanu, M., Chirachanchai, J., Ruangvanish, W., Wachirawuttikai, U., & Supa-amornkul, S. (2026). Exploring learning experiences and perceived benefits of multidisciplinary case-based learning for knowledge integration and clinical readiness among preclinical dental students. Heliyon, 12(15), Article e45526. https://doi.org/10.1016/j.heliyon.2026.e45526

Image Credits: AI Generated

DOI: 10.1016/j.heliyon.2026.e45526

Keywords: dental education, case-based learning, preclinical training, knowledge integration, clinical readiness, qualitative research, constructivism, experiential learning, multidisciplinary curriculum, thematic analysis, Mahidol University, health professions education