1 1

Problem Based Learning

04/11/2322

• The original problem-based curriculum at McMaster University, featuring small learning groups with a faculty tutor, was established thirty years ago.

04/11/2333

• Maastricht University in the Netherlands • Newcastle in Australia, • New Mexico School of Medicine • Subsequently, other medical schools such

as Harvard, Bowman Gray, Rush and Southern Illinois University established alternative, parallel curricula and faced the challenge of faculty and curriculum conversion.

04/11/2344

• Sherbrooke in canada

• University of Kentucky School of Medicine developed a problem-based learning curriculum in surgery and more recently problem-based learning has been incorporated in psychiatry and surgical clerkships at Southern Illinois University.

04/11/2355

Why traditional learning was not beneficial ?

• There is too much emphasis on memorization of facts for their own sake, and students seem to readily forget what they were taught later in their clinical years.

04/11/2366

• Many studies have shown that the students will forget most of what you have asked them to memorize and will not be able to apply what they can recall in practice.

Why traditional learning was not beneficial ?

04/11/2377

• Comparison of USMLE score step1 shows that there is no harm on memorization of students between two methods

• However, this examination does not measure competencies or skills that are important or central to the rationale for employing problem-based learning.

Why traditional learning was not beneficial ?

04/11/2388

Good Practice Points

Problem-based learning has proven to enhance students’ critical thinking and independent learning. This points to a need for students to learn by working on cases in multidisciplinary teams.

Such multidisciplinary groups provide opportunities for collaboration and reflection that have the potential to greatly enhance student learning.

Learning in such an environment can provide students with cases that they can recall and adapt later in their careers.

04/11/2399

The teaching of sustain ability involves discussing the serious environmental issues facing the world today, but also the practical solutions that we could apply by integrating real-world situations into our teaching and learning.

The presence of the real client contributes to a

case study and a problem scenario close to the students’ future professional reality.

Good Practice Points

04/11/231010

The presence of the client provides a source of continuous feedback as well as assessment, and give motivation to the students to reach a satisfactory target with their work.

Combined with the contribution from the experts, students accumulate knowledge from practical work(learning-by-doing).

Good Practice Points

04/11/231111

Working in groups enhances team collaboration, increases the sense of individual responsibility and although not always successful, contributes significantly to knowledge exchange and skills to cover all aspects of the project.

Good Practice Points

04/11/231212

• The assessment methods (oral presentations,assignments,OSCE) enhance students’

presentation and communication skills.

Good Practice Points

04/11/231313

if you expect your students to:

• Become independent. • Reason their way through patient problems • Recall and apply what they have been taught in

medical school to the care of their  patients • Recognize when their skills and knowledge are

not adequate to the clinical task they are confronting .

• Acquire new information and skills as they need it, and, as medical research moves ahead, keeping contemporary in their knowledge and skills.

USE PBL AS A TEACHING METHOD

04/11/231414

PBL includes among its goals:

• developing scientific understanding through real-world cases,

• developing reasoning strategies, and

• developing self-directed learning strategies.

04/11/231515

argues that in problem-based

learning the teacher facilitates the project (rather than supervising it) and although the teacher may set the problem scenario, how and what students learn is defined by

them.

•

PBL includes among its goals:

04/11/231616

• Students feel motivated and enthusiastic to be able to express their ideas.

• This contributed to greater participation by the students in order to achieve better results in their assessment.

•

PBL includes among its goals:

04/11/231717

• Students participate in peer assessment and in the future can even contribute to the formulation of their own assessment criteria.

•

PBL includes among its goals:

04/11/231818

Maastricht “seven jump” sequence for PBL

Clarify and agree working definitions and unclear terms and concepts

•Define the problems; agree which phenomena need explanation

•Analyze the problem(brainstorm)

•Arrange possible explanations and working hypotheses

•Generate and prioritize learning objectives

•Research the learning objectives

•Report back, synthesize explanations, and apply newly acquired information to the problem

04/11/231919

• Identifying key information

• Generating and Ranking hypothesis

• Defining Learning Objectives

• Reporting Back

04/11/232020

The tutorial begins when the tutor provides the group with some introductory clinical information about hypothetical patient students may receive information as a written handout, though a video.

04/11/232121

Identifying key information

•

• students work as a group to extract the key pieces of information. Following this, students identify the problem and summarize in a clear and concise way.

04/11/232222

Generating and Ranking hypothesis

The group then “brain storms” to generate hypotheses about what underlies the present problem - these are recorded on a white board.

• At this stage students consider only a brief explanation for each hypothesis that they propose. Then to rank the hypotheses in order for probability.

04/11/232323

Generating an Enquiry strategy

• Students next generate an enquiry strategy which aims to substantiate or refute their hypotheses or to refine the ranking

04/11/232424

Now they must explain the biomedical science mechanisms that link their hypothesis to the presenting problems. The formulation of the favored hypothesis provides the focal point that serves to establish the collective knowledge of the group. Defines what students knows what they do not know and what they need to know to further their understanding of the under lying biomedical science and their ability to solve the clinical problem.

Defining Learning Objectives

04/11/232525

Continue: • The identification of gaps in knowledge help

students to define their learning objectives and these become the focus of self -directed study in the interval between tutorials. Learning objectives should be clear and specific and of appropriate scope to be addressed in the time available between tutorial.

04/11/232626

Continue: • At each tutorial, the group might identify three to five

major learning objectives and perhaps an equal number of lesser objectives.

• Although the PBL tutorial is student centered and the learning student directed. Major learning objectives are identified by case writer as part of the overall curriculum design.

• Tutors must ensure that major objectives are identified. It is imperative all group members pursue all major learning objectives. Thought the group may choose to divide up responsibility for the lesser objectives

04/11/232727

Reporting Back

A key component of PBL is the follow-up tutorial, when students come back to report on their self-directed study and share and integrate new knowledge. The exchange and debate of ideas promotes the consolidation and elaboration of new knowledge and understanding

04/11/232828

Process of PBLProcess of PBL

Read the problem Brainstorm-

hypothesize

Identify learning issues

Research-Learn

(2-7) days

Return-Reread-Report-Review

Next case •

EVALUATE

04/11/232929

PBL PBL TutorialTutorial ““Tutor Tutor ” ”

““StudentsStudents””

04/11/233030

Variations:

• PBL curricula can differ remarkably in curricular design, the extent of the curriculum that is problem-based (all years, first two years, alternative, parallel track or entire curriculum), the problem formats used by students (printed cases, vignettes, simple to complex simulations),

04/11/233131

Variations:

• The role of the tutor, the size of the student group, the degree to which conventional curricula compete with problem-based learning, the kinds and number of subjects or disciplines that are not included in the problem-based learning curriculum (anatomy and biochemistry, for example, are often taught in a conventional manner in some schools with problem-based learning),

•

04/11/233232

Integration new knowledge • Based on the principle that knowledge is

consolidate more readily in context, student should relate new biomedical knowledge to the patients problem. Students also extend their discussion beyond the biomedical and clinical science and consider the public health socioeconomic.

• Ethical and legal aspects of the case finally, new knowledge is generalized.

04/11/233333

Hallmarks of successful tutorials

Student centeredness In PBL there is typically much lively

discussion and exchange of idea between students . Student - centeredness is a fundamental component of “collaborative learning theory” which is considered to be at the heart of the PBL process.

• In principle, the more students “ own” and “drive” the process the better the out come.

04/11/233434

Hallmarks of successful tutorials

Ground rules

For successful group work, it is essential that students share an under standing of the “ground rules” for the conduct of tutorials.

04/11/233535

Hallmarks of successful tutorialsTeam work

•

• PBL emphasizes cooperative and team work, with students sharing resources, cross-checking each other’s understanding and responding to specific difficulties in individuals.

• At the end of each tutorial, the team should evaluate its performance.

•

04/11/233636

Hallmarks of successful tutorials Dialogue between tutor and case-writers

• It is imperative that case writers who are not necessarily tutors in the case meet tutors before and after each PBL Case. In particular, case writers advise the tutors on key issues that might help the tutor to facilitate the unraveling of the case and how to avoid any pitfalls.

• In the same way tutors provide case writers with feed back on the effectiveness of the case and if necessary, suggest modification.

04/11/233737

Group dynamics

• Since the small group tutorial is the pivot point of PBL, the interpersonal interactions or group dynamics powerfully influence its efficacy.

The dysfunctional group

This may include students who arrive late, are disorganized or unprepared.The concept of student ownership of the conduct of the tutorial provides the essential key to resolving such problems.

•

04/11/233838

Dominant and passive personalities

Difficulties can arise when one or more dominant personality inhibit the participation of others.

• It is important to differentiate between passive student, and the one who is quiet and reflective .

• Regular group evaluation of tutorial helps students reflect on how their behavior affects the tutorial process.

04/11/233939

Role of the tutor as a facilitator of PBL

• • The tutor’s main role is to promote student -

centers self directed learning and not a source of knowledge. If the tutor becomes interventionist and directive, students may withdraw, team processes collapse and the tutorial may be reduced to a small - group didactic lecture. one way for tutors to minimize their intervention is to tutor in case outside own discipline.

04/11/234040

A study was performed to compare the outcome of PBL by either an “expert” or a “non-expert” tutor in a single topic area, the study showed that while the non expert tutor was rated more highly for her group management skill, and also rated her students more highly in the area of oral communication, students who were taught by the expert scored higher in the end-of course test in the topic area.

04/11/234141

Criteria for PBL problem construction

1- Stimulating thinking, analysis, reasoning

2- Assuring self-directed learning

3- Using previous basic knowledge

4- Proposing a realistic context

5- Leading to the discovery of learning objectives

6- Arousing curiosity

7- Choosing topics related to public health

8- Assuring a contextual detail

9- Choosing an appropriate vocabulary

04/11/234242

The Future for PBL

Around the world, it is probable that PBL will be at the fore - front of initiatives for future reform in medical education.

04/11/234343