Promoting Evidence-Based Thinking Through the STIRS Case Studies

The main goal of the AAC&U Scientific Thinking and Integrative Reasoning Skills (STIRS) project is to promote and support evidence-based thinking among college and university students (Riegelman and Hovland 2012). To help fulfill that need, a group of thirteen faculty members from across the country were selected to develop high-quality curricular materials to help instructors incorporate the STIRS framework into their courses. More specifically, these STIRS Scholars created peer-reviewed teaching case studies using a variety of topics that exemplify how the STIRS framework can be used to create engaging and effective student learning experiences.

The Need for Curriculum Development to Support Evidence-Based Thinking

It has been shown that many faculty do not use evidence-based pedagogical approaches in their classrooms (Bok 2006). Many significant barriers impede faculty from changing their teaching, including that they (1) are not rewarded as much for their teaching outcomes as for their research productivity, (2) are not always aware of the literature on effective pedagogical approaches, (3) have limited time to develop and implement new teaching activities, and (4) are uncomfortable with incorporating unfamiliar approaches in the classroom (Bok 2006; Wieman, Perkins, and Gilbert 2010; Brownell and Tanner 2012; President’s Council of Advisors on Science and Technology 2012; Byrne 2016).

In addition, well-developed teaching resources can be difficult to find, especially for the college level; those that do exist vary in quality and may not be suitable for many teaching contexts (Byrne 2016). Given these barriers, efforts to develop course materials that support faculty’s use of effective teaching approaches can help catalyze curricular change. Therefore, to encourage faculty use of materials that promote evidence-based thinking among students, it was critical to create a collection of materials that could be used in diverse contexts. The focus of the STIRS Scholars’ work was to create case studies reflecting the focal themes of the STIRS framework, especially ones that would help students improve their competencies for data analysis and evidence-based reasoning.

Case Studies as a Curricular Context to Promote Evidence-Based Thinking

Case studies are a well-known active learning approach (Barnes, Christensen, and Hansen 1994; Miller and Tanner 2015). As revealed by many studies, active learning approaches promote greater student learning gains, more engagement with course content, and higher retention than lecture-based teaching approaches (Freeman et al. 2014). In addition, case-based learning allows students to think about content in the context of real-world problems or scenarios, which can increase student motivation for learning and help them improve intellectual skills (Hung, Jonassen, and Liu 2008; Miller and Tanner 2015).

Case-based learning is also a learner-centered approach. Learner-centered approaches can promote the retention of information by allowing instructors to understand student misconceptions, biases, and current grasp of concepts, and to address these issues (Gazzaniga, Ivry, and Mangun 2002; Johnstone 1997). Because there is more of a dialogue between students and instructors in student-centered teaching approaches, instructors gain better understanding of the barriers that may prevent students from absorbing certain information, and they are able to break down those barriers so that information reaches students’ working memory (Gazzaniga, Ivry, and Mangun 2002; Johnstone 1997). Further, learner-centered teaching methods can engender more energy and engagement in classrooms, making them more lively and the learning more enjoyable for students and instructors alike (Byrne 2016).

Selecting the STIRS Scholars

The STIRS Scholars were selected on the basis of an application that required submission of a case concept proposal, a statement of interest, a curriculum vita, and a letter of support. Initial case ideas were based on STIRS Scholars’ research or teaching interests, or on a topic that a STIRS Scholar wanted to learn more about. Concept proposals included the case study topic, potential learning objectives, potential audiences, personal background with the case topic, examples of the types of evidence students would be asked to examine as part of the case, approaches the case would use to examine evidence, potential case format, and STIRS keywords and competencies addressed by the case. Thirteen STIRS Scholars were selected from a variety of disciplines, diverse institutions (e.g., small to large sizes, liberal arts to community colleges), and geographic locations. For a complete list of STIR cases and authors, see table 1. The scholars who were selected included faculty from across the spectrum of academic ranks and leadership roles (e.g., assistant through full professors, a program director, and department chairs).

Table 1. STIRS Cases and Authors

Case Title

Case Author

Author Affiliation

Different Times of the Month: A Cross-Cultural Analysis of Menstruation Taboos#

Justin Armstrong

The Writing Program and Department of Anthropology, Wellesley College

The Two-Sex System: Fact or Fallacy?

Angela Bauer

Department of Biology, High Point University

Should English be the Official Language of the United States?

Lynn Burley

Department of Writing, The University of Central Arkansas

Exploring Lawns and Gardens as Complex Socio-Ecological Systems

Loren B. Byrne

Department of Biology, Marine Biology and Environmental Science, Roger Williams University

People, Places, and Pipelines: Debating Tar Sands Oil Transmission

Tami S. Carmichael

Humanities and Integrated Studies Program, University of North Dakota

Organic Foods: Examining the Health Implications

Katherine Hunting*

Department of Environmental and Occupational Health, The George Washington University

The (Ferret) Sneeze Heard Around the World: The Case of the Bioengineered Bird Flu

Jill M. Manske

Department of Biology, University of St. Thomas (Minnesota)

Rising to the Challenge: Examining the Effects of a Growth Mindset

Sal Meyers

Department of Psychology, Simpson College

Preventing Spina Bifida and Other Neural Tube Defects

Richard Riegelman*

Department of Epidemiology and Biostatistics, The George Washington University

MMR Vaccine and Autism: Scientific Inquiry, Ethics, and Evidence-Based Problem Solving

Karen Singer-Freeman

Department of Psychology, Purchase College, State University of New York

To Drill or Not to Drill? A Dilemma in the Context of Climate Change in the Arctic

Vandana Singh

Department of Physics and Earth Sciences, Framingham State University

Cell Phones and Cancer: Evaluating the Evidence to Assess Potential Association

Jennifer S. Stanford

Department of Biology, Drexel University

The Role of Evidence in Emergency Health Care Policy and Law: Rory Staunton and NYU Langone Medical Center

Joel Teitelbaum*

Department of Health Policy and Management, The George Washington University

Trends in Immigrant Adolescent Health in New York City: “Becoming an American Can Be Bad for Your Health”

Katie B. Wilson

Department of Interdisciplinary Studies, Stella and Charles Guttman Community College, The City University of New York

Blood Doping: Cheating or Leveling the Playing Field?#

Adele J. Wolfson

Department of Chemistry, Wellesley College

Congressional Apportionment: Constitutional Questions, Data, and the First Presidential Veto

Ryan J. Zerr

Department of Mathematics, University of North Dakota

*These authors were not STIRS Scholars, but developed example cases for the STIRS Scholars to follow.
# Two STIRS Scholars used their cases in a single team-taught, cross-disciplinary course.

Developing the STIRS Cases
STIRS Scholars were charged with developing case studies to meet the following project goals:

  • ƒ Engage learners in examining complex, multi-dimensional problems relevant to a wide variety of general education courses.
  • ƒ Apply study design and statistical reasoning principles, or other relevant frameworks, to the evaluation of evidence.
  • ƒ Ask learners to communicate effectively about issues raised by the case.
  • ƒ Provide faculty with support in incorporating these cases into a variety of classroom environments.

STIRS Scholars attended a case writing training workshop that was held at an AAC&U General Education and Assessment Meeting in early 2014. In this workshop, STIRS Scholars were paired for peer support in the development of their cases. STIRS Scholars drafted a student case and facilitator guide, all of which were reviewed multiple times by both a mentor (Katherine Hunting) and a peer. Completed student cases and facilitator guides were subject to a blind review process with two peer reviewers, and each STIRS Scholar made final revisions based on reviewer feedback. The final versions of the peer-reviewed cases were published on the AAC&U website in January 2015 (

Published cases include both a student case and a facilitator guide. Student cases include the materials that are provided to the students to support their learning and interaction with the case. This includes preparatory materials, learning objectives, a narrative that explains the case, background information, questions, suggested activities, and references. Facilitator guides were designed to support faculty in teaching the student case. Facilitator guides allow for the possibility that the instructor teaching the case is a novice in both the subject area and in case-based teaching. Facilitator guides include an abstract, teaching suggestions, answers to questions posed in the student case, additional background information as needed, ideas for assessing student learning, support for proposed student activities, an explanation of how the case links to the STIRS framework, suggestions of AAC&U VALUE rubrics that can be used to assess the case, references, and additional optional resources as needed.

The STIRS Teaching Cases

All STIRS cases focus on real-world problems and, due to the varied interests of the STIRS Scholars, the STIRS cases are topically diverse (table 1). Of note, three additional cases were developed prior to the selection of the STIRS Scholars by faculty who were instrumental in developing the STIRS cases. These authors are denoted by an asterisk in table 1. Additionally, two STIRS Scholars used their cases in a single, team-taught, cross-disciplinary course. These cases are denoted by a pound sign in table 1. Though the cases are topically distinct, they were all developed to follow the same basic principles, and thus cases emphasize skills such as evidence-based decision making, writing, research, presentation skills, group work, justifying a position, quantitation, ethical reasoning, scientific thinking, interpreting data, research study design, and interdisciplinary thinking. The student cases and facilitator guides can be downloaded from the AAC&U website ( All STIRS case materials are available at no cost, but to receive the facilitator guide, instructors must register and log on to the AAC&U website. Brief case descriptions are provided below in table 2, which will allow readers to identify the cases they might like to access and use in their own courses.

Table 2. Brief Descriptions of STIRS Case Studies

Different Times of the Month: A Cross-Cultural Analysis of Menstruation Taboos
This case focuses on analyzing attitudes about menstruation and culturally universal menstruation taboos in the context of different cultures and time periods and using cultural anthropology theory and methods.

The Two-Sex System: Fact or Fallacy?
Through this case, students explore whether society’s current two-sex paradigm (male/female) is an accurate reflection of existing sexual phenotypes and how this view affects those individuals who do not fit into the two categories.

Should English be the Official Language of the United States?
By examining data and readings, students investigate the implications of declaring English as the official language of the United States. Students explore key questions and their repercussions using evidence from the US Census, as they advocate and justify policy decisions.

Exploring Lawns and Gardens as Complex Socio-Ecological Systems
In this case, students are asked to examine the ecological and sociocultural context and implications of common lawn and garden management activities. Learning activities promote discussion of environmental science and sustainability studies topics.

People, Places, and Pipelines: Debating Tar Sands Oil Transmission
Students evaluate existing data and other information in this case to debate current environmental, economic, cultural, and ethical issues surrounding tar sands and tar shale oil transmission.  

Organic Foods: Examining the Health Implications
Students consider evidence regarding how organic and conventionally produced foods vary in their environmental and occupational health impacts to explore issues relating to food, health, environment, and sustainability.

The (Ferret) Sneeze Heard Around the World: The Case of the Bioengineered Bird Flu
This case allows students to consider the controversy and debate policies surrounding whether or not to publish data describing how to successfully engineer the avian influenza virus to be transmissible between mammals.

Rising to the Challenge: Examining the Effects of a Growth Mindset
Concepts of a fixed versus growth mindset are considered in this case to understand differences in student academic achievement and how these differences can be addressed to promote academic achievement.

Preventing Spina Bifida and Other Neural Tube Defects
Through this case, students learn about neural tube defects, their causes, and the challenges in addressing the causes of these developmental anomalies. Students are challenged to make recommendations to address the problems arising from these conditions.

MMR Vaccine and Autism: Scientific Inquiry, Ethics, and Evidence-Based Problem Solving
This case centers on vaccines and vaccine safety, with a special focus on the MMR vaccine. The importance of vaccines and visualization of the societal impact of falling vaccination rates are emphasized.

To Drill or Not to Drill? A Dilemma in the Context of Climate Change in the Arctic
Students consider consequences of climate change and barriers to addressing climate change. Emphasis is placed on how students can contribute to addressing the problems raised in the case.

Cell Phones and Cancer: Evaluating the Evidence to Assess Potential Association
The relationship between cell phones and cancer is explored in this case. Students are encouraged to decide whether cell phones cause cancer and learn to make decisions about whether other environmental factors cause cancer.

The Role of Evidence in Emergency Health Care Policy and Law: Rory Staunton and NYU Langone Medical Center
This case centers on emergency medical care and the consequences of health law and policies as applied in the context of one patient’s complex and ultimately tragic case. Students discuss problems in emergency medical care from multiple perspectives, including law and policy.

Trends in Immigrant Adolescent Health in New York City
“Becoming an American Can Be Bad for Your Health.” Information from the fields of public health, anthropology, and history are brought together in this case, as students consider the implications of health issues faced by immigrant adolescents in urban America.

Blood Doping: Cheating or Leveling the Playing Field?
Students discuss the ethics of the use of performance-enhancing drugs in sports and compare and contrast this to other approaches used to improve performance. The science behind performance-enhancing drugs is emphasized.

Congressional Apportionment: Constitutional Questions, Data, and the First Presidential Veto
This case uses the topic of congressional apportionment to allow students to consider important historical, political science and mathematical concepts. Case activities support the development of conclusions centered on the 2000 US presidential elections.

Using the STIRS Cases
The STIRS cases were designed to be used in a variety of contexts and in different types of classrooms. Many cases have suggestions within the facilitator guides about how to adapt them to be taught in general education versus discipline-specific courses, and about teaching in large or small classroom environments. Cases have flexible options for teaching, which are explained in the facilitator guides through suggestions for using selected parts or expanding via extended activities and follow-up assignments. Facilitator guides provide ample material to support the instructor in teaching these cases. They provide additional background information to support the instructor in understanding the concept the case is based on, detailed suggestions regarding case implementation strategies, and the author’s answers to questions posed in the student case.

STIRS Case Studies Outcomes
Since publication on the AAC&U website in January 2015, the STIRS cases have received positive feedback. From January 2015 through January 2016, instructors representing more than 80 institutions from across the country have downloaded more than 230 facilitator guides. Because access to facilitator guides requires instructors to register and log-in to the AAC&U website, the number of downloads of facilitator guides is a good indicator of how many instructors have interest in implementing STIRS cases.

In addition to publication on the AAC&U website, STIRS cases are linked to the Degree Qualifications Profile (DQP) assignment library ( through the National Institute for Learning Outcomes Assessment (NILOA). NILOA, along with the Institute for Evidence-Based Change and the Lumina Foundation, developed the DQP to identify the common learning outcomes that students should have upon graduation from undergraduate- or master’s-level programs ( The DQP assignment library is a repository of peer-reviewed assignments that are intended to support instructors in teaching and assessing the defined DQP learning outcomes to determine whether students are gaining competence in these areas. According to the infographic on the DQP website (, more than 400 institutions are using the DQP. As a result, inclusion of the STIRS cases as part of the DQP assignment library should drive both interest in and use of these cases.


The work of the STIRS Scholars is an important first step in promoting the goals of the STIRS project. The sixteen cases (table 1) represent peer-reviewed, pedagogically sound approaches to enable instructors to more easily incorporate evidence-based thinking into their courses. Already, the cases have allowed the STIRS Scholars to begin to transform their own teaching (Stanford et al. 2016) and have begun to inspire and enable other instructors from across the country to do the same. More work is still needed to develop curricular materials to broadly support the incorporation of this method of teaching and thinking into the classroom, which will allow for sustained inclusion of evidence-based reasoning skills in higher education teaching. Hopefully, the STIRS cases described above provide exemplary models for how case-based teaching can be used to help students develop essential scientific- thinking and evidence-based reasoning skills. 



The STIRS Scholars would like to acknowledge Kevin Hovland, who helped to create the STIRS initiative at AAC&U and managed its initial implementation; Richard K. Riegelman, who developed the STIRS framework and supported this idea through AAC&U; Bethany Sutton, Kathy Wolfe, Lisa Russell O’Shea, and David Paris for their efforts to support the STIRS Scholars and the case studies project; Elizabeth Dickens, who collected data to support our understanding of the impact of this project; Pat Hutchings, who helped to link the STIRS cases with the DQP assignment library; and AAC&U for financial support for this project through an anonymous donor.



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Miller, Sarah, and Kimberly D. Tanner. 2015. “A Portal into Biology Education: An Annotated List of Commonly Encountered Terms.” CBE-Life Sciences Education 14 (2): fe2.

President’s Council of Advisors on Science and Technology. 2012. Engage to Excel: Producing One Million Additional College Graduates with Degrees in Science, Technology, Engineering, and Mathematics.

Riegelman, Richard K., and Kevin Hovland. 2012. “Scientific Thinking and Integrative Reasoning Skills (STIRS): Essential Outcomes for Medical Education and for Liberal Education.” Peer Review 14 (4): 10.

Stanford, Jennifer S., Tami Carmichael, Ryan J. Zerr, Loren Byrne, and Richard K. Riegelman. 2016. “Actual and Potential Uses of STIRS Case Studies in Courses and Curricula.” Peer Review 18 (4): 23–27.

Wieman, Carl, Katherine Perkins, and Sarah Gilbert. 2010. “Transforming Science Education at Large Research Universities: A Case Study in Progress.” Change: The Magazine of Higher Learning 42 (2): 7-14.

Jennifer S. Stanford, assistant professor, department of biology, codirector of the Center for the Advancement of STEM Teaching and Learning Excellence (CASTLE), Drexel University; Loren Byrne, associate professor, department of biology, marine biology, and environmental science, Roger Williams University; and Katherine Hunting, emeritus professor, department of environmental and occupational health, The Milken Institute School of Public Health, The George Washington University

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