Abstract
BACKGROUND AND OBJECTIVES: Effective management of complex neurologic cases requires strong critical thinking and clinical reasoning skills. However, traditional postgraduate education often lacks the structure to develop these competencies. We developed an integrated case-based learning (I-CBL) curriculum to enhance critical thinking skills of postgraduate internal medicine residents in neurologic patient assessments, evaluate its effectiveness as perceived by faculty, and improve residents' acceptance and satisfaction with its implementation. METHODS AND CURRICULUM DESCRIPTION: A prospective mixed-method (pretest and post-test) study with concurrent triangulation design was conducted among postgraduate internal medicine residents (residents) and faculty in a tertiary-care teaching hospital in India. The I-CBL approach was developed using the Theory of Change framework. I-CBL featured systematically planned seminars, journal presentations, and an in-depth case-based presentation tailored to different postgraduate year levels on the same topic within a month. Assessments included pretests and post-tests, Likert scale surveys, the Holistic Critical Thinking Scoring Rubric, and concept map evaluation. Knowledge acquisition and retention were measured immediately before, after, and again after 6 months of completing the topics. Quantitative data were analyzed using mixed-design analysis of variance while qualitative data underwent thematic analysis. RESULTS AND ASSESSMENT DATA: All 30 residents (13 women, 17 men) and 10 faculty members participated. Residents showed significant knowledge gains from pretest to post-test, with retention maintained at 6 months (p < 0.05). Critical thinking skills improved notably in seminars (75%), case presentations (40%), and concept mapping (40%). Satisfaction was high, with 96% of residents and 92% of faculty reporting positive experiences. Residents appreciated the I-CBL approach for enhancing engagement, critical thinking, and clinical reasoning. Faculty recognized I-CBL's effectiveness in improving problem solving but cited challenges related to time constraints, workload, and participation equity. DISCUSSION AND LESSONS LEARNED: The I-CBL curriculum effectively bridged theoretical knowledge and clinical practice, enhancing critical thinking, diagnostic skills, and teamwork. While satisfaction levels were high, challenges such as time constraints and faculty workload emerged. Proposed solutions include incorporating diverse cases, improving facilitation skills, and developing objective assessment tools. I-CBL can transform postgraduate neurology education by fostering critical thinking and clinical competence. Addressing implementation challenges can enhance its effectiveness, producing reflective, competent practitioners capable of managing complex neurologic cases and making confident, evidence-based decisions while navigating diagnostic dilemmas.