Nesbitt LM, Cliff WH. How the story unfolds: exploring ways faculty develop open-ended and closed-ended case designs. Adv Physiol Educ 32: 279-285, 2008; doi:10.1152/advan.90158.2008.-Open-ended or closed-ended case study design schemes offer different educational advantages. Anatomy and physiology faculty members who participated in a conference workshop were given an identical case about blood doping and asked to build either an open-ended study or a closed-ended study. The workshop participants created a rich array of case questions. Participant-written learning objectives and case questions were compared, and the questions were examined to determine whether they satisfied criteria for open or closed endedness. Many of the participant-written learning objectives were not well matched with the case questions, and participants had differing success writing suitable case questions. Workshop participants were more successful in creating closed-ended questions than open-ended ones. Eighty-eight percent of the questions produced by participants assigned to write closed-ended questions were considered closed ended, whereas only 43% of the questions produced by participants assigned to write open-ended questions were deemed open ended. Our findings indicate that, despite the fact that instructors of anatomy and physiology recognize the value of open-ended questions, they have greater difficulty in creating them. We conclude that faculty should pay careful attention to learning outcomes as they craft open-ended case questions if they wish to ensure that students are prompted to use and improve their higher-order thinking skills. case-based learning; learning objectives; convergent questions; divergent questions; questioning CASES are stories with an educational message (7) and have garnered widespread interest among instructors in the biomedical sciences (11). How these stories unfold depends on the ingenuity of the case designer. The best case studies are written to invite students to explore a multitude of intellectual pathways with learning objectives serving as trail markers for the educational journey ahead (2). In the same way that a master storyteller often fashions a tale to have alternate endings, the case author is at liberty to develop case studies in differing directions-narrowing or widening, closing or opening the scope of the study-as pedagogical needs arise. Previously, we have described some of the essential features that distinguish open-ended from closed-ended case study design elements (2). We noted that open-ended case designs permit multiple solutions [i.e., are divergent (3, 13)] since the knowledge needed to solve the case study may be in flux, the necessary information may not be known or available, or certainty cannot be obtained. Alternately, closed-ended designs usually have a single solution [i.e., are convergent (3, 13)] since the knowledge required is well defined and the information needed is readily accessible. We concluded that, depending on the goal for student learning, either type of case approach can yield outcomes that are beneficial for student understanding. Underlying these contentions was the assumption that, starting from the same scenario, case studies can be profitably unfolded along either open-or closed-ended avenues. While our suggestions generate a helpful framework for choosing between open-and closed-ended design schemes, we realized that our thesis would gain greater definition if we demonstrated the construction of actual case studies illustrating the salient features of both types of architectures. Even though we could have produced such case studies on our own, we hypothesized that by helping other faculty members understand the features of open-and closed-ended case studies, we could enable them to generate useful exemplars. So, we asked a group of instructors of anatomy and physiology to fashion open-or closed-ended components of a single case study as they participated in a workshop that highlighted the features and benefits of both open and closed case design. By doing so, we saw the potential to obtain a much richer tapestry of case elements than we could have invented ourselves, and we recognized that we might also be able to uncover some of the adequacies and inadequacies of faculty members as they approach the design process. Thus, we saw the value in carefully examining and reporting the efforts of workshop participants to develop open-and closed-ended features of a single case. Here, we describe on our efforts to 1) solicit from workshop participants their thoughts on the advantages of closed-and open-ended designs and 2) determine how participants would build a case study following either an open-ended approach or a closed-ended approach to case design when starting from an identical case scenario. We chose a short story about blood doping by an Olympic athlete that offered multiple avenues of inquiry, presented a dilemma to be addressed, and was replete with the social, behavioral, and ethical implications of physiology that Penny Hansen has described as a component of the discipline's recondite curriculum (6). Given this scenario, participants were asked to begin developing a case study by creating the design elements, i.e., learning objectives and corresponding case questions, which would guide and stimulate student learning. By examining the products of the participant's work, we intended to examine and analyze the design schemes they used as they created open-or closed-ended approaches to case studies. METHODS Two workshops, entitled "Open-Ended and Closed-Ended Approaches to the Design of Case Studies," were offered as part of the program of the 2002 national meeting of the Human Anatomy and Physiology Society. The workshop participants consisted of ϳ50 anatomy and physiology educators who were interested in the use o
