Issues emerging from instructional innovation are inevitable, yet basing any curriculum shift on a theoretical framework is paramount. This paper grounds the case-based pedagogy in three learning theories: behaviorism, cognitivism, and constructivism. The three theories are described and situated in relation to the case study method. An in-depth exploration of the assumptions of each theory helped to identify and analyze several issues that emerged upon the implementation of the case-based pedagogy in a nursing curriculum. In line with the three pedagogical standpoints, and after an extensive literature review, measures are proposed to improve the quality of student learning in a case-based curriculum, and principles are derived to support educators in their teaching with case studies. The application of the three learning theories may be especially useful to educators and instructional leaders when shifting paradigms. By describing the key challenges that educators may face with instructional innovation and the usefulness of the cognitivist, behaviorist, and constructivist perspectives in providing explanations and recommendations, provides a beginning research base for improving pedagogies. Failure to employ theories of learning in similar educational shifts may hinder the progress of any intended curriculum transformation. (Contains 2 tables.)