There is no universally accepted definition of CBL. In a recent assessment of case-based learning (CBL), Thistlewaite et al. noted that there is no international consensus on its description, which differs from PBL in terms of structure, and found that CBL is a sort of inquiry-based learning that falls between structured and guided learning. ⁹

a) Case-based learning is an active-learning strategy, much like problem-based learning, involving small groups in which the group focuses on solving a presented problem. ¹⁰

b) Active learning strategies can be defined as “instructional activities involving students in doing things and simultaneously thinking about what they are doing. ¹¹

c) The goal of CBL is to prepare students for clinical practice using authentic clinical cases. It links theory to practice through the application of knowledge to the cases, using inquiry-based learning methods. ⁹

d) Discussing a clinical case related to the topic taught, students evaluated their own understanding of the concept using a high order of cognition. This process encourages active learning and produces a more productive outcome. ¹²

e) Case-based learning is a long-established pedagogical method that focuses on case study teaching and inquiry-based learning; thus, CBL is on the continuum between structured and guided learning. ¹³

f) The case-based learning is structured so that trainees explore clinically relevant topics using open-ended questions with well-defined goals. ¹⁴

g) The latest definition of CBL: it is a form of learning that involves a clinical case, a problem or question to be solved, and a stated set of learning objectives with a measured outcome. Included in this definition is that some, but not all, of the information is presented prior to or during the learning intervention, and some of the information is discovered during the problem solving or question answering. The learner acquires some of the learning objectives during the CBL session, whether it is live, web-based, or on paper.  ¹⁵

h) CBL is defined as an inquiry-based learning experience that uses actual or simulated patient cases to solve or investigate a clinical problem under the supervision of a teacher and stated learning objectives.  ¹⁵

Medical schools have recognized the importance of embracing clinical work early on, referring to the combination of basic and clinical sciences as "vertical integration." Human health disciplines have recognized the value of using real or simulated cases to explain educational concepts. Numerous novel teaching methods have been developed in recent times, including small group learning modalities like problem-based learning (PBL), case-based learning (CBL), and team-based learning (TBL). Using clinical cases to aid teaching has been termed case-based learning (CBL). Of these methods, PBL and CBL have attracted the most attention.  16, 17, 18 Case-based learning (CBL) is the utilization of clinical situations to improve educational outcomes.  15, 19 In 1912, Dr. James Lorrain Smith used CBL to teach the case method of teaching pathology at the University of Edinburgh. CBL is widely used worldwide in a variety of medical fields. CBL was used at several educational levels, from undergraduate to graduate. CBL sessions were given utilizing a range of media, including many live formats, paper and pencil, and web-based media.  6, 15 CBL is utilized for imparting knowledge in healthcare and medicine. The use of CBL in several sectors includes medicine, dentistry, pharmacology, occupational and physical therapy, nursing, allied health, and child development.  20 Implementing CBL needs careful planning, teamwork, and a commitment to continuous enhancement. Each phase should be specific to the students' learning environment and requirements.

The basic rules and its implementation procedures are summarized in Table 1, Table 2.

Table 3

Sl. No.	Advantages of CBL: 1, 5, 8, 15, 20, 23, 22, 24, 25
1.	Enhance critical thinking to improve teaching effectiveness.
2.	Provide hands-on learning and experience for professional decision-making.
3.	Enhance practical knowledge through conversation, simulation, and reflection.
4.	Reinforce and consolidate earlier professional preparation.
5.	Offer a diverse instructional medium
6.	Analyze difficult circumstances from many perspectives and levels of abstraction
7.	Easier to elicit feedback from learners compared to traditional teaching methods.
8.	Enhance learners' analytical and problem-solving abilities.
9.	Promote reflection and decision-making for action, and familiarity with the process.
10.	Involve learners in their own learning.
11.	Promotes an organized, deeper learning. Learning that involves critical thinking, behavioral adjustments, and generalizability to different situations, rather than just identifying correct answers and critical approach to clinical problem-solving
12.	higher confidence, enhanced communication skills and improved clinical thinking and decision-making
13.	Small group learning (in groups of six to ten)
14.	Empower students to engage in peer learning and apply new knowledge to real-world clinical situations while guided by a facilitator.
15.	Takes less time since the facilitator directs students' attention to crucial parts of the clinical case.
16.	Sessions frequently follow a similar trajectory to what is encountered in the real world when exploring a clinical case • formulation of differential diagnoses. • proposal and interpretation of relevant investigations. • generation of treatment plans. They can also be tailored to focus discussion on any of these aspects of the case. Thus, the CBL format is adaptable and can be used in a variety of time-restricted scenarios.

Table 4

Sl. No.	Limitations/disadvantages of CBL: 5, 26, 27, 28, 23, 29, 30, 31, 25
1.	A major barrier to successful implementation is the lack of skilled and enthusiastic teaching teams, which raises teacher requirements and increases to the workload of educators.
2.	It is also a resource-intensive process that requires adequate time, space, and funds to coordinate, with class sizes exceeding 100 students, most schools demand a minimum of ten groups, which necessitates the availability of ten or more professionally thought-out small group rooms as well as ten or more properly qualified facilitators.
3.	Unlike in advanced nations CBL has not been a standard pedagogical approach Dentistry is a multidisciplinary dental course including restorative dentistry, preventive dentistry, periodontology, prosthodontics, paediatric dentistry, and oral medicine in many countries including China. which is completely different from the dental education patterns in developed countries, such as the United States.
4.	CBL may not provide an organized perspective of knowledge since it places knowledge in real-world contexts in a piecemeal fashion.
5.	For many students, discussing and analysing a case is an unfamiliar experience. It is rare that all students in a case discussion will be eager to participate and state their views without hesitation, the larger the class size, the higher the probability of additional distractions occurring.
6.	Students' reactions to a strange environment vary.For example, the flow and depth of the discussion may be disrupted by students being unsure of how to respond to prompts from the case leader or other students; class members may fail to assimilate the highly nuanced discussion and debate that case analysis often engenders, resulting in frustration or frequently perplexed.
7.	The biggest issue is minimal or non-existent participation. For a various reasons, student’s may be reluctant to participate, despite the best efforts by the Case instructors, student either contribute very little or never speak at all.
8.	Students may spend a significant amount of time preparing, as well as more time looking for information, resulting in a reduction in extracurricular activities.
9.	The labour-intensive process of preparing cases for instruction is always changing based on the use of the case and the course material it is connected to. It is rare for teachers to be able to use the same case preparation for multiple classes and learning objectives concurrently.
10.	The complexity of each case differs. A lack of information limits the types of scenarios, issues within them, and levels of case complexity.
11.	Case teachers also need to be ready to intervene when a student tries to control the conversation at the expense of other students' participation and the case discussion.
12.	Unexpected, unusual, but intriguing topics could come up and tempt the teacher to alter the direction of the conversation. While in certain cases this could be helpful, it frequently means that the case's original intent and objectives of learning may be lost.
13.	The analytical levels within instances require time to uncover. The length of time required is determined by the complexity of the individual case. It is therefore critical to limit the depth of case analysis in accordance with both teaching objectives and time limits.
14.	The instructor should be exceptionally adept at modelling case discussion and interpersonal communication abilities. Not every instructor has or is willing to learn these crucial characteristics, which can lead to poor case teaching.
15.	Another challenge of using many facilitators is the difficulty of standardizing experiences across groups. Each facilitator adds his or her own style, experience, and knowledge to the CBL session, which gives many great opportunities but also guarantees that no two groups will share the same educational experience.

There are two alternatives to create a scenario:

1. Consider utilizing or adapting open access cases from the journals: The availability of open resources and databases containing cases that instructors can download makes this approach even more accessible in the classroom. 32

2. Consider writing original cases: If an instructor is unable to find open access cases relevant to their course learning objectives, they may choose to write their own. 32 The examples can be the cases from specialty textbooks, or the cases reported to the faculty/universities/college hospital. 33, 34, 35, 36, 37

1. Need teachers with outstanding learning abilities, a strong sense of responsibility, patience, and the confidence to experiment with novel methods and technologies.

2. Orientation and training programs should be conducted for the faculty to sensitize and implement different teaching approaches.

3. It takes time for both teachers and students to get used to the new teaching method and evaluation system.

4. The facilitators play a major role in making the discussion interesting and stop the students if they are distracting from the scenario. The smaller groups of students (10) help him to involve all the students to interact.

5. Students should be provided enough time for preparation (7 days) so active learning doesn’t take up their extracurricular activities time.

6. Each teaching mode has its own advantages and limitations, including lecture-based learning (LBL) or it being CBL, Implementing CBL necessitates meticulous preparation, teamwork, and a commitment to ongoing improvement.

However, assessing competencies can be more subjective than traditional grading; not having adequate staff can increase the workload of educators, and their interest in adapting new teaching skills can still be a challenge.