Learning is a socio-historical and cultural process that occurs from the interaction between the individual and the social environment in which they are inserted. This way, active teaching–learning methodologies allow the construction of knowledge in a collaborative way, encouraging the exchange of experiences among students and dialogue among them. Finally, we can mention the constructivist approach that highlights the importance of the student's active role in the construction of their own knowledge. Through active teaching–learning methodologies, they are challenged to develop hypotheses, test them, and refute them, thus developing important cognitive abilities such as creativity, reflection, and problem-solving.6

In medical education, learning activities are often based on patient cases—real patients (on the wards, in clinics, and in the community), simulated (people acting as patients with specific problems) cases, virtual (online patients of varying degrees of authenticity and sophistication) cases. It is believed that such cases increase the relevance of the subject by focusing on the real lives and real performance of healthcare professionals. Basic, social, and clinical sciences are studied in relation to the case, are integrated with clinical presentations and conditions (including health and illness), and student learning is therefore linked to real-life situations.7

The use of active teaching–learning methodologies has been widely discussed in recent years by several international authors, who highlight the importance of a student-centered approach, rather than a teacher-centered approach. According to Prince's study, traditional teaching methods, based on lectures, are not effective in training professionals to be capable of dealing with the challenges of today's world. In this study, the authors argue that active methodologies, which encourage students' active participation in the learning process, are essential for the development of skills such as critical thinking, problem-solving, and collaboration. The importance of active and collaborative learning in the development of socio-emotional skills such as empathy, resilience, and the ability to work as a team should also be highlighted. Active methodologies are essential not only for the acquisition of knowledge, but also for the formation of conscious and engaged citizens.9

A study carried out in 2020 investigated students' perception regarding the use of active methodologies. The authors concluded that they positively evaluated the use of these methodologies, indicating that they provided a more meaningful and enriching learning experience. This dimension of student learning related to positive experience is linked to the results of their learning. Students demonstrated a strong interest in active learning sustained due to high levels of discussion, promoting the development of efficient learning gains. In short, the use of active methodologies has been widely discussed by international and current authors, who highlight the benefits of these methodologies in promoting more meaningful and engaging learning.8

Compared to other more traditional approaches, such as lectures, students consider that CBCL favors more autonomous and meaningful learning, which encourages the development of skills such as creativity, curiosity, and the ability to solve problems. Furthermore, they highlight that this method encourages collaboration among students, promoting an exchange of experiences and knowledge relevant to group learning. In summary, CBCL is seen by students as an innovative and effective methodology for teaching Physiology, which favors meaningful learning and students' ability to apply the concepts studied in practical and everyday situations, providing greater enjoyment and integration.10

A study in Boston compared learning in Human Physiology using the CBCL with PBL. The results showed that the CBCL was more efficient in increasing the understanding of concepts by students who had a lower performance in the PBL methodology, in addition to contributing to the development of research and critical-thinking skills. One of the relevant points is that students participate more actively in groups of 4 components as recommended by the CBCL, besides the preparation that must be carried out with the availability of materials for prior study.10

Another study, conducted at the University of Michigan, in the United States, also compared the use of CBCL with PBL and traditional classroom teaching. The results revealed that the CBCL provided greater student engagement with the subject content, in addition to encouraging active participation and critical reflection on the concepts covered.11

Recent studies have demonstrated that CBCL can effectively improve clinical reasoning skills in medical education. The approach allows students to share their perspectives and knowledge, ask clarifying questions, and receive feedback from peers and educators. This collaborative process helps students develop critical-thinking and problem-solving skills, which are essential in making effective clinical decisions. Additionally, CBCL helps develop effective communication and teamwork skills, which are crucial in the healthcare profession. Students can learn to work effectively together with their peers and other healthcare professionals, creating a culture of collaboration and improving patient outcomes. This approach has been shown to improve engagement and active participation, providing a more innovative and flexible learning experience. CBCL and clinical reasoning continue to be important areas of study in medical education. The collaborative approach provides an effective way to improve clinical reasoning and communication skills. As medical education continues to evolve, it is essential to adopt these approaches to train the next generation of healthcare professionals.12

In contrast, in traditional classroom methodology, emphasis is placed primarily on the transmission of information, with few opportunities for debate and discussion about the application and relevance of learned concepts. Furthermore, other teaching–learning methodologies, such as PBL and project-based learning, have also been used in Physiology with positive results. These approaches emphasize the active and collaborative participation of students in solving problems or carrying out practical projects, encouraging the application of theoretical concepts learned in real situations. However, regardless of the methodology used, difficulty concentrating is a common challenge faced by students and this difficulty is due to numerous factors, such as: the inability to master certain topics, fear of failure, and frustration at not being able to achieve the expected objectives. Therefore, it is important that teachers are aware of this problem and adopt appropriate pedagogical strategies to help students maintain focus and motivation during classes and study activities.13

Constructive debate is a technique that aims to promote discussion and critical questioning of topics and ideas. In this process, participants show their points of view in a respectful and constructive way, seeking to identify flaws, and find solutions to complex problems. This type of debate is essential to foster collaborative learning, as it allows each participant to present their perspective and contribute to the collective construction of knowledge.14

Collaborative learning provides constructive debate and has been widely used as effective strategies to facilitate the understanding of complex concepts and promote the development of critical skills in university students. Collaborative learning refers to a process in which students work together to achieve a common goal, using their skills, knowledge, and experiences to solve problems and create solutions. This process involves active discussions and the exchange of ideas and perspectives, leading to the collective construction of knowledge. In general, collaborative learning and constructive debate are highly effective teaching strategies that engage students in the active construction of knowledge and encourage the exchange of ideas and perspectives. When applied to the discussion of scientific articles, these strategies can deepen students' understanding and promote the development of critical skills that are essential for professional training and career success.15

Collaborative learning and teamwork are fundamental concepts for the success of projects in different areas. These practices are increasingly valued in the job market, as they allow individuals to work together more effectively, using their strengths, and making up for their weaknesses. Collaborative learning is a practice that is based on the idea that people learn best when they work together and share knowledge. The author highlights that this form of learning can be applied in different areas, such as education, health, and business, and offers benefits such as motivation for those involved, better retention of the content learned, and greater problem-solving.16

Collaborative learning is a teaching approach in which students work together to achieve a common goal. This involves the exchange of knowledge, skills, and experiences among group members. This approach has been shown to be effective in improving student learning and developing social skills. It has been observed that collaborative learning can lead to greater student learning.10

Furthermore, collaborative learning can improve students' performance in written assignments, where it was observed that those who worked in groups had a better understanding of the subject and produced higher quality work than those who worked alone. Additionally, collaborative learning can help students develop social skills, such as communication and problem-solving as a team. It is also observed that collaborative learning can be a tool to help students develop important skills and help them become more efficient professionals.17

Active methodologies are a teaching approach that places students as the protagonists of their own learning. They are characterized by the use of pedagogical resources such as group discussions, problem-solving, case studies, projects, among others. However, the use of active methodologies can create a study overload for students, especially when there is no adequate planning of activities and the time available to carry them out. A study carried out by Lopes et al. (2016) evaluated students' perception regarding the use of active methodologies and it was observed that the majority considered that the proposed activities required more study time than expected and that the theoretical course workload was insufficient to absorb all the content.18

Another study that analyzed the relationship between the use of active methodologies and study overload observed that the practice of group activities and classroom discussions were those that generated the most work overload for students. To avoid study overload, teachers need to properly plan activities and consider the time needed to carry them out. Furthermore, it is important that students are guided on how to manage their study time and organize their activities efficiently.19

Student engagement refers to students being actively involved in their learning tasks and is divided into behavioral (students' levels of participation in their learning tasks), cognitive (the cognitive and self-regulation strategies used by students in their learning processes), and emotional engagement (students' emotional reactions to teachers, students, learning, and school in general).20 It also showed that there is a moderately strong and positive correlation between student involvement and academic results, which was stronger for behavioral involvement. Most known methodologies advocate that groups be divided and organized randomly, and therefore heterogeneously. This encourages students to develop attitudinal skills, exercising interpersonal and interprofessional relationships, corroborating the students' responses that they find it difficult to interact with the group, which is an important factor for low engagement.

Collaborative learning allows the training of essential skills for clinicians (e.g., exploration, self-learning, application of knowledge), but has the potential to overwhelm students and distort their ability to work on problems, impairing their memory, and knowledge acquisition. The disadvantages can be compounded when limited time is given to work on an unfamiliar specialty.21 Therefore, the teacher's organization of these moments in advance, sending out the material, is fundamental to avoiding these situations, and organizing the time during the meetings is important for carrying out the activities in a way that doesn't lead to frustration or low student engagement.

It is important to highlight that active methodologies are diverse and range from project-based learning, cooperative learning, PBL, and others. What the studies have in common is that they evaluated the impact of these practices on student engagement and motivation. A study evaluated student motivation in a university course that used active learning methodologies and the results showed that students were more motivated than those who took a traditional course. The authors suggested that the opportunity to work on projects relevant to their areas of interest contributes to student motivation.22

The study met expectations based on understanding student performance when conducting a class using the CBCL methodology. The initial difficulties presented were mitigated as the activity was carried out, providing the tutor with verbal and visual feedback of adequate student acceptance. Subjectively, it was possible to observe that the students' performance represented an absolutely dynamic and engaging process in which the vast majority were involved in a very eloquent and engaged way. The constructive interventions promoted brought students greater confidence and enthusiasm in conducting the proposed case, as well as its discussion through small groups that shared their answers, providing a safe and motivating environment for the student. The CBCL methodology has been shown to stimulate the integration of knowledge, bringing students a positive experience, through this active, student-centered methodology with the promotion of clinical reasoning.

The study was not carried out with patients or in a hospital environment. An anonymous questionnaire was used.