Exploring the Case-Based Learning Challenge (CBLC): a digitally mediated, inter-university simulation to enhance clinical reasoning in physiotherapy students - a quasi-experimental study

Teaching clinical reasoning and communication skills is a fundamental component of physiotherapy education. Integrating theoretical knowledge with practical application remains a core challenge, particularly in an evolving educational landscape increasingly shaped by digitalisation and inter-institutional collaboration. This study evaluates the feasibility and student-level educational impact of a national, digitally mediated, case-based simulation—the Case-Based Learning Challenge (CBLC)—designed to support clinical reasoning and decision-making in third-year physiotherapy students across multiple Italian universities. A one-group quasi-experimental design with repeated measures was adopted. The intervention consisted of a national, digitally mediated simulation, structured around the presentation and peer discussion of a complex cardiorespiratory case. Students from two universities acted as active presenters (Challenger Universities), while those from 23 additional institutions participated as guided observers (Observer Universities). University affiliation was collected only at the level of these categories (Challenger vs. Observer). The session included three phases: case presentation, peer review, and collaborative Q&A. All students completed a competence questionnaire before and immediately after the intervention, and a satisfaction survey post-intervention. Descriptive and inferential statistics were applied, including paired-sample t-tests to assess changes in competence and Cronbach’s alpha to evaluate internal consistency. A total of 399 students completed the baseline assessment, and 256 completed the post-intervention survey. Statistically significant improvements were observed in general clinical knowledge (mean score increase from 3.59 to 4.02; p < 0.001), and in the total competence score (from 7.05 to 7.47; p < 0.001). No significant change was detected in case-specific knowledge. Student satisfaction ratings were generally favourable across domains, with higher scores related to content relevance and inter-university exchange, and lower ratings associated with organisational and technical aspects. The satisfaction survey demonstrated excellent internal consistency (Cronbach’s alpha = 0.913), while the competence questionnaire showed suboptimal reliability. The CBLC represents a feasible national digital format for delivering case-based, peer-discussion learning across multiple physiotherapy programmes and was associated with small improvements in general knowledge alongside favourable student perceptions. As outcomes were assessed at the student level and institution-specific identifiers were not collected for observer participants, these findings should be interpreted as evidence of feasibility and short-term educational impact rather than demonstrated standardisation across programmes. Future evaluations should incorporate predefined institution-level benchmarking metrics, process measures of inter-university collaboration, and delayed or performance-based assessments.