Table 3.

Student and facilitator responses: “Most difficult features of CBLs and suggestions for improvement”

Theme	Example of student comment
Student responses: most difficult features of CBLs and suggestions for improvement
Students felt it would be beneficial to have tutors who were specialists in their fields, as occurs in TBLs.	The tutors were great, however most of them did not come from the field of nephrology, and were hence not able to answer all our questions. What is better about the TBLs, is that we usually have at least one specialist (consultant) and a physiologist present. This means that they are truly experts in their field, and any question related to the field can be answered.
Students would prefer that less information was provided to them on the CBL case.	Would be nice if not all cases were so clear cut from the beginning, adding distractors may make it more realistic. The title of CBL and TBL both sometimes will give away the diagnosis. It would be less helpful / fun if students already go in with an idea in mind.
Students felt there were a lot of repetitive questions that should not have been repeated.	Removing the repetitive questions such as “what are the patient problems” as asking this 3 times we did not add any new information and felt as though we had already discussed everything to be discussed with the tutor.
Students recommended the inclusion of pre-reading, as occurs for each of the TBLs.	Having some pre work or some reading about the case as whilst we had some lectures on the context of the cases, clinically we did not have that much knowledge so it was hard to know the best ways to manage or the specific treatments without having learnt it before.
The online technology was not always working and students felt additional images would be helpful.	Some of the videos didn’t work so we felt as though we were missing key bits of clinical information that would help us progress with the case. We felt that at some times we were not given enough information in order to make diagnostic or management decisions. I think more images (medical imaging, histo etc) and explanation about the pathophys of the underlying condition would be good
Facilitator responses: most difficult features of CBL and suggestions for improvement
Tutors found timing segments of the session difficult and would like timing schedules. They found at times, the tutorials were too fast paced.	Timing - would be nice to get some time-guides throughout the resource to know we are on track. Time frame was very tight. I felt I had to keep the session moving relatively quickly and at times perhaps cut the team off early rather than giving them more time to discuss the issues
Tutors would like the objectives for the session to be emphasised to ensure the session remains focussed.	Clear learning objectives for the session (I may have missed this) - because sometimes discussions can get slightly side tracked if we are not careful. Staying on track, navigating the case. As a tutor it is hard to know how much information I am able to volunteer or whether I should encourage them to research it themselves.
Tutors found the questions within the CBL to be repetitive at time.	I felt some parts were fairly repetitive, constantly asking for lists of problems and so forth, I think it could be clearer what the students were expected to contribute as they moved through. Less repetitive questions - especially questions like what are the issues was asked multiple times
Tutors felt the questions needed refining, and to have more practical clinical applications.	The EBM question was a bit out of place. I think this was a big deviation from the clinical process but I understand its role. Perhaps this question needs to be softened, and more angled about seeking knowledge about management, etc. For example, a dilemma about co-prescribing medications, or nephrotoxicity and needing to check MIMs might have been worthwhile. Similarly, guides on how to manage Warfarin dosing, etc. Just a little more practical.
Tutors four delivery of CBL on Kuracloud to be distracting, and some indicated they would prefer paper cases.	I find the technology can be a bit distracting, students engaged better when we discussed the answers rather than pressing the professor button. There were flaws in the online platform with some incorrect answer on particular sessions (i.e the answer for one section was repeated on 2 other sections instead of their respective answers.
Tutors felt more images would be helpful.	More images, blood and investigations to interpret “good overall minimal improvements need to be made perhaps a brief review (5 min) of anatomy/physiology of relevant system prior to clinical scenario”.
MCQs at the end of the session as a way to solidify knowledge.	Some MCQs after to solidify concepts.