Problem based learning

90
PROBLEM BASED LEARNING Professor S. A. Tabish FRCP (London), FRCP (Edin), FAMS, MD

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Transcript of Problem based learning

Page 1: Problem based learning

PROBLEM BASED

LEARNINGProfessor S A TabishFRCP (London) FRCP (Edin) FAMS MD

New Horizons in Medical Education

What were the challengesbull Changes in patientrsquos expectationsbull Changes in HC delivery (style of practice of

doctors)bull Changes in medical knowledge

- traditionally the course was structured as a progression from basic sciences to the clinical sciences with little integration

bull Failing to prepare students adequately for the diversity of problems which they will encounter as professionals Studentrsquos expectations of quality of teaching are higher

bull The exponential growth of med knowledge amp the greatly increased content of the scientific aspect of the curriculum has made the selection of appropriate core content and the integration of basic and clinical sciences important aspects of curricular design

Domains of essential Global Requirements of ME

What was the response to these challenges

bull The development of new curricula incorporating new curriculum themes amp different educational strategies

bull The introduction of new learning situations amp the use of new tools amp aids to learning

bull New methods of assessment [OSCE objective structured clinical exam Which can test performance amp competence in a wide diversity of settings Formative Assessment Portfolio assessment Work-based assess]

New Educational Strategies

bull New strategies appropriate for adult learning (instead of spoon-feeding)

bull Self-directed learningbull Problem Based Learningbull Integrated system based approachbull Task Based learningbull Core amp Student-selected

Componentsbull A spiral curriculum

New Tools amp Aids

bull Use of Study Guides

bull Use of Computer Assisted Programs amp Internet

bull Use of Videos to teach Clinical Skillsconsultation techniques

bull Role of Simulators amp Simulations in aspects of physical exam amp practical procedures

PBLbull Problem-based learning (PBL) is a method of

learning in which learners first encounter a problem followed by a systematic learner-centered inquiry and reflection process

bull PBL is a method designed to help students learn the sciences basic to medicine at the same time they develop the reasoning process used by physicians and other health professionals in their clinical practice

bull 1048708 The problem comes first without advance readings lectures or preparation

bull 1048708 The problem serves as a stimulus for the need to know

PBLbullHelps learners build a bridge

between what they already know and what they need to know to reachthe next level

bull Emphasizing active learning which has been shown to be more satisfying than

passive teacher-to-student learning and to enhance retention and recall

bull Emphasizing student-centered learning in which students are actively involved in setting their own learning goals

Advantages

Encourages bull effective amp self-directed learningbull Critical thinkingbull Team workbull understanding rather than

memorizationbull Facility with professional languagebull Both students amp staff enjoy the

process

Advantages

In preparing students for professional practice PBL

bull Encourages independence as students identify amp meet individual learning needs

bull Stimulates reflection amp self-direction for life-long learning

bull Supports ongoing self-assessmentbull Introduces clinical reasoningbull Enhances critical thinking amp evidence-based

decision makingbull Ensures that knowledge is transferred applied

amp retained by providing a relevant integrated context

bull A problem initiates the activitybull The Group is stimulated to explore

basic scientific amp clinical mechanisms together with social psychological ethical or professional issues

bull Problem stimulates students to reason think critically amp weigh evidence they seek out amp share relevant info

PBL

bull Groups do not need prior knowledge to generate lively ideas as they identify areas for further collective amp personal learning

bull Each student brings individual experience amp makes a distinctive contribution

bull the Tutorrsquos role is to manage interactions rather than supply info

bull An effective Group provides a safe environment for sharing amp testing new knowledge

bull Students practice the language of science amp medicine evaluate ideas and receive feedback from peers amp teacher

bull When clinical exposure is introduced concurrently intellectual amp practical skills develop in parallel

Framework for PBL

bull A trigger initiates the problem (papercomputervideo)

bull Groups brainstorm to identify key issues for discussion

bull Broad thinking produces a rich array of mechanisms amp ideas

bull Hypothesis are critically explored through reasoning

bull The need for additional info is identifiedbull A Conclusion is reachedbull Group reviews the process

Framework for PBL - II

bull In Breaks between Tutorials students identfy Learning Issues to be pursued

bull They are encouraged to adot an evidence-based approach

bull When they reconvene they share and review the learning

Characteristics of an effective PBL Group

An Effective Group is Cohesive motivated mutually supportive amp actively engaged in learning

bull The Group understands the process amp energetically pursues its task

bull Members respect each otherrsquos contribution but examine them critically

bull Discussions flow as students cooperate rather than compete

bull The atmosphere is friendly amp good humouredbull Roles are shared all take turns in scribing

leading discussion taking responsibility for acquiring information

Staff Development

bull Basic training is mandatorybull Further development may be a requirementbull Initial training may involve observation amp

practice with a group from the programbull Effective training ensures that necessary

background goals amp local strategies are considered together with info on assessment amp evaluation

bull In addition to materials supplied to students tutors are usually issued with handbooks highlighting issues for each problem

Tutorrsquos Role in Assessment

bull Individual StudentsGroups may be assessed Summatively (determining progression) or formatively (for feedback)

The GROUP

bull At the end of each problem groups review their processes to encourage self-reflection ampenhance their collective performance

Tutorrsquos Role in Assessment

Individual students

bull Tutors should provide formative feedback to each member

bull Ask students to complete a simple self-assessment questionnaire reviewing appropriate behaviors the tutor returns them with comments

bull Students will be a writtenoralclinical tests that will determine their progression amp ultimate graduation

Evaluating PBL Tutorials-II

bull At the end of each problem time is allocated for evaluation

bull Both the process amp learning in PBL can be evaluated against explicit goals

bull The tutorrsquos review of effectiveness of group processes offers insight for the members

bull Students normally evaluate their tutor helpfulness support for clinical reasoning encouragement for independent learning appropriate intervention provision for effective feedback

PBLbull 1048708 Enabling students to learn in the context in which the

information will be used which increases the ability to retrieve and apply information

bull 1048708 Focusing on important concepts which helps learners organize and store new information in a way that facilitates retrieval and application

bull 1048708 Exploring prior knowledge formulating inquiries derived from and defined by the learnersrsquo need to know and actively constructing meaning through dialogue and reflection

bull 1048708 Utilizing problems designed to simulate studentsrsquo perception of their future profession which serves as a powerful stimulus for studentsrsquo intrinsic motivation to learn

bull 1048708 Actively involving students in monitoring their own progress and reflecting on what works and what needs improvement frequently assessing student performance and providing feedback

PBL Starting the casebull After the introductions and discussion

are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it

bull Reading the case aloud keeps the group focused

bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here

PBL Case (contd)

bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session

PBL Case contdbull SECOND deciding which issues everyone will

tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)

bull THIRD deciding what SPECIFIC questions individuals will try to answer

bull FOURTH deciding how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet or consulting an expert)

The Process of PBL

bullWhat are the issues Identify the important issues in the problem

bull How well do you understand the issues

bull Are there any words or terms about which you are unclear

The Process of PBL contd

bull Consider the basic mechanisms that might explain each important aspect of each problem

bull Assess your current understanding of the basic structural andor functional mechanisms that may contribute to the presentation of the problem

bull Use the collective skills and experiences of group members to explore or explain these phenomena Identify current gaps in knowledge or understanding

Learn from each other

bullShare your own knowledge expertise or ability to reason and synthesize information Be receptive and appreciative of the contribution of your small group members

Determine priorities for learning

bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue

bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan

bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge

bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career

PBL

bull The problem comes first without advance readings lectures or preparation

bull The problem serves as a stimulus for the need to know

Learning Issues

bull Learning issues are questions that cannot be answered with studentsrsquo current knowledge and that can be explored and answered through systematic self-directed inquiry

bull The use of learning issues in tutorials prepares students to handle similar challenges in clinical practice and life-long learning

Learning Issues in PBL First Session1 Getting Started (Introductions Ground

Rules Expectations)2 Identifying Problem3 Exploring Pre-Existing Knowledge4 Generating Hypotheses and Explaining

Mechanisms5 Unfolding the Case Incrementally6 Re-EvaluatingReprioritizing Hypotheses

Based on New Information7 AssessmentReflection

PBL Second Session

8 Independent Self-Directed Study of Learning Issues

PBL Third Session

bull 9 Discussion of Learning Issues and Application of New Knowledge to the Case

bull 10 Continued Unfolding of the Case Incrementally

bull 11 AssessmentReflection

During Tutorial Session students will

1048708 Come prepared to discuss the case and learning issues researched since the last tutorial

1048708 Actively participate in group discussions and contribute to the learning process in a manner that allows for the balanced participation of everyone in the group

1048708 Develop learning issues at each session phrase them as full-sentence questions write them on the board and post them on the course web page

1048708 Consider biological population behaviormental health issuesexplanations and questions of professional attitudes values and ethics related to the patientrsquos problem(s) described in the case

Tutorial Session contd1048708 Go to the board to diagram outline draw etc in

explanation of mechanisms relatedto hypotheses1048708 Debate evidence related to the case and avoid

personal attacks on others1048708 Comply with ground rules with regard to how

the group will function and how itsmembers treat one another1048708 Participate in end-of-session reflection and

assessment by giving and receivingconstructive criticism regarding self tutor

student and group performance

Between Tutorial Session

1048708 Research key learning issues using a variety of resources

1048708 Critically evaluate the credibility of sources and the validity of the information they have obtained in their research

1048708 Integrate what they have learned through research lectures labs clinical skills Perspectives in Medicine (PIM) etc into what is discussed in tutorials

1048708 Synthesize what they have learned and be prepared to discuss it without reading directly from their materials as much as possible and apply it to the case at the next tutorial session

Determine priorities for learning

bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue

bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan

bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge

bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career

PBL Starting the casebull After the introductions and discussion

are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it

bull Reading the case aloud keeps the group focused

bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here

Problem-based learning is designed to develop

1048708 Integrated context-specific knowledge base

1048708 Decision-makingcritical thinking process and skills

1048708 Self-directed life-long learning skills 1048708 Interpersonal collaboration and

communication skills 1048708 Constructive self and peer

assessment skills 1048708 Professional ethics and behavior

PBL Case (contd)

bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session

What is problem based learning

bull In PBL students use triggers from the problem case or scenario to define their own learning objectives

bull Subsequently they do independent self directed study before returning to the group to discuss and refine their acquired knowledge

bull Thus PBL is not about problem solving per se but rather it uses appropriate problems to increase knowledge and understanding

bull The process is clearly defined

PBL

bull PBL uses clinical cases as the context for students to study basic and clinical sciences

bull Its possible advantages over traditional approaches include its greater relevance to the practice of medicine its ability to promote retention and application of knowledge and its encouragement of self-directed life-long learning

bull Possible disadvantages include higher costs both in resources and staff time

PBL

bull An educational method characterized by the use of patient problems as a context for students to learn problem-solving skills and acquire knowledge about the basic and clinical sciences

bull Students usually meet in small groups two or three times a week for PBL tutorials

bull They are presented with a clinical problem (eg a patient with chest pain) and in a series of steps they discuss possible mechanisms and causes develop hypotheses and strategies to test the hypotheses are presented with further information and use this new information to refine their hypotheses finally reaching a conclusion

bull A tutor usually acts as a facilitator guiding students in this group-learning process

bull In the course of this exercise students identify both their existing levels and gaps in their knowledge These gaps form the basis for independent learning outside the PBL tutorials The identification and pursuit of these so-called learning goals is a key element of the PBL process

Rationale for using PBL bull The PBL approach is based on principles of adult

education20 and cognitive psychology21 It differs fundamentally from traditional curricula in which students acquire background knowledge of the basic sciences in the early years of the course and in the later years apply this knowledge to the diagnosis and management of clinical problems This traditional approach has been criticised for a number of reasons42223

bull It creates an artificial divide between the basic and clinical sciences

bull Time is wasted in acquiring knowledge that is subsequently forgotten or found to be irrelevant

bull Application of the acquired knowledge can be difficult bull The acquisition and retention of information that has no

apparent relevance can be boring and even demoralising for students

The group learning process acquiring

desirable learning skills

Generic Skills amp attitudes

bull Teamwork bull Critical evaluation of literature bull Chairing a group bull Self directed learning and use of

resources bull Listening Presentation skills

Recording bull Cooperation bull Respect for colleagues views

bull Group learning facilitates not only the acquisition of knowledge but also several other desirable attributes such as communication skills teamwork problem solving independent responsibility for learning sharing information and respect for others PBL can therefore be thought of as a small group teaching method that combines the acquisition of knowledge with the development of generic skills and attitudes Presentation of clinical material as the stimulus for learning enables students to understand the relevance of underlying scientific knowledge and principles in clinical practice

bull when PBL is introduced into a curriculum several other issues for curriculum design and implementation need to be tackled PBL is generally introduced in the context of a defined core curriculum and integration of basic and clinical sciences It has implications for staffing and learning resources and demands a different approach to timetabling workload and assessment PBL is often used to deliver core material in non-clinical parts of the curriculum Paper based PBL scenarios form the basis of the core curriculum and ensure that all students are exposed to the same problems Recently modified PBL techniques have been introduced into clinical education with real patients being used as the stimulus for learning Despite the essential ad hoc nature of learning clinical medicine a key cases approach can enable PBL to be used to deliver the core clinical curriculum

Copyright copy2003 BMJ Publishing Group Ltd

Wood D F BMJ 2003326328-330

No CRoles of participants in a PBL tutorial aption Found

What happens in a PBL tutorial bull PBL tutorials are conducted in several ways In

this article the examples are modelled on the Maastricht seven jump process but its format of seven steps may be shortened

bull A typical PBL tutorial consists of a group of students (usually eight to 10) and a tutor who facilitates the session The length of time (number of sessions) that a group stays together with each other and with individual tutors varies between institutions A group needs to be together long enough to allow good group dynamics to develop but may need to be changed occasionally if personality clashes or other dysfunctional behaviour emerges

bull Students elect a chair for each PBL scenario and a scribe to record the discussion The roles are rotated for each scenario Suitable flip charts or a whiteboard should be used for recording the proceedings At the start of the session depending on the trigger material either the student chair reads out the scenario or all students study the material If the trigger is a real patient in a ward clinic or surgery then a student may be asked to take a clinical history or identify an abnormal physical sign before the group moves to a tutorial room For each module students may be given a handbook containing the problem scenarios and suggested learning resources or learning materials may be handed out at appropriate times as the tutorials progress

Examples of trigger material for PBL scenarios bull Paper based clinical scenarios bull Experimental or clinical laboratory data bull Photographs bull Video clips bull Newspaper articles bull All or part of an article from a scientific

journal bull A real or simulated patient bull A family tree showing an inherited

disorder

PBL tutorial process ndash Step 1 Identify and clarify unfamiliar terms presented in the scenario

scribe lists those that remain unexplained after discussion ndash Step 2 Define the problem or problems to be discussed students may

have different views on the issues but all should be considered scribe records a list of agreed problems

ndash Step 3 Brainstorming session to discuss the problem(s) suggestingpossible explanations on basis of prior knowledge students draw on each others knowledge and identify areas of incomplete knowledge scribe records all discussion

ndash Step 4 Review steps 2 and 3 and arrange explanations into tentativesolutions scribe organises the explanations and restructures if necessary

ndash Step 5 Formulate learning objectives group reaches consensus onthe learning objectives tutor ensures learning objectives are focused achievable comprehensive and appropriate

ndash Step 6 Private study (all students gather information related to eachlearning objective)

ndash Step 7 Group shares results of private study (students identify theirlearning resources and share their results) tutor checks learning and may assess the group

bull The role of the tutor is to facilitate the proceedings (helping the chair to maintain group dynamics and moving the group through the task) and to ensure that the group achieves appropriate learning objectives in line with those set by the curriculum design team The tutor may need to take a more active role in step 7 of the process to ensure that all the students have done the appropriate work and to help the chair to suggest a suitable format for group members to use to present the results of their private study The tutor should encourage students to check their understanding of the material He or she can do this by encouraging the students to ask open questions and ask each other to explain topics in their own words or by the use of drawings and diagrams

PBL in curriculum design bull PBL may be used either as the mainstay of an entire

curriculum or for the delivery of individual courses In practice PBL is usually part of an integrated curriculum using a systems based approach with non-clinical material delivered in the context of clinical practice A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge skills and attitudes A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios Sufficient time should be allowed each week for students to do the self directed learning required for PBL

bull

Copyright copy2003 BMJ Publishing Group Ltd

Wood D F BMJ 2003326328-330

No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found

Writing PBL scenarios

bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives

bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after

studying the scenario should be consistent with the faculty learning objectives

bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding

bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice

bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge

bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented

bull The problem should be sufficiently open so that discussion is not curtailed too early in the process

bull Scenarios should promote participation by the students in seeking information from various learning resources

bull Adapted from Dolmans et al Med Teacher 199719185-9

Staff development

bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)

A dysfunctional group a dominant character may

make it difficult for other students to be heard

A dysfunctional group a dominant character may make it difficult for other students to be heard

bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties

Advantages of PBL bull Student centred PBLIt fostersactive learning improved

understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks

Disadvantagesbull Tutors who cant teachTutorsenjoy passing on

their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful

Assessment of PBL

bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods

bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL

Conclusion

bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning

bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL

PBL 5 Easy Steps

bull Read the problem

Mrs Paula Embledon

Mrs Paula Embledon is a 78 year old woman who has come to the emergency room complaining of shortness of breath and pain in her chest She had been in relatively good health until three weeks previously when she sprained

2 Brain storm

bull Brainstorm

bull ndash hypotheses

bull - what do we know in support of the hypothesis

bull - what do we need to know to test the hypothesis

ndash learning issues

Brainstorm

bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)

ndash specific issues (for individuals to look up)

ndash overlapping issues

bull 4 Individual Reading - Research - Preparation

bull 5 Return

bull ndash review case so far ndash report and discuss

ndash assess progress - continue pagenext pagecomplete

ndash self-evaluation - How did things go Any suggestions for next time

ndash next problem

bull 5 Return

THE FIRST GROUP SESSION

bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day

bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session

bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr

bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine

bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise

bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator

bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues

bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know

bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)

bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)

bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)

  • PROBLEM BASED LEARNING
  • New Horizons in Medical Education
  • Slide 3
  • Domains of essential Global Requirements of ME
  • What was the response to these challenges
  • New Educational Strategies
  • New Tools amp Aids
  • PBL
  • PBL
  • Advantages
  • Slide 11
  • Slide 12
  • Slide 13
  • Slide 14
  • Framework for PBL
  • Framework for PBL - II
  • Characteristics of an effective PBL Group
  • Staff Development
  • Tutorrsquos Role in Assessment
  • Slide 20
  • Evaluating PBL Tutorials-II
  • PBL
  • Slide 23
  • PBL Starting the case
  • PBL Case (contd)
  • PBL Case contd
  • The Process of PBL
  • The Process of PBL contd
  • Learn from each other
  • Determine priorities for learning
  • Slide 31
  • Slide 32
  • Learning Issues
  • Learning Issues in PBL First Session
  • PBL Second Session
  • PBL Third Session
  • Slide 37
  • Slide 38
  • During Tutorial Session students will
  • Tutorial Session contd
  • Between Tutorial Session
  • Slide 42
  • Slide 43
  • Problem-based learning is designed to develop
  • Slide 45
  • What is problem based learning
  • Slide 47
  • Slide 48
  • Slide 49
  • Rationale for using PBL
  • Slide 51
  • Slide 52
  • The group learning process acquiring desirable learning skills
  • Generic Skills amp attitudes
  • Slide 55
  • Slide 56
  • Slide 57
  • What happens in a PBL tutorial
  • Slide 59
  • Examples of trigger material for PBL scenarios
  • PBL tutorial process
  • Slide 62
  • PBL in curriculum design
  • Slide 64
  • Writing PBL scenarios
  • Slide 66
  • Staff development
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • Slide 70
  • Advantages of PBL
  • Slide 72
  • Slide 73
  • Disadvantages
  • Assessment of PBL
  • Slide 76
  • Conclusion
  • Slide 78
  • PBL 5 Easy Steps
  • 2 Brain storm
  • Brainstorm
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • THE FIRST GROUP SESSION
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
Page 2: Problem based learning

New Horizons in Medical Education

What were the challengesbull Changes in patientrsquos expectationsbull Changes in HC delivery (style of practice of

doctors)bull Changes in medical knowledge

- traditionally the course was structured as a progression from basic sciences to the clinical sciences with little integration

bull Failing to prepare students adequately for the diversity of problems which they will encounter as professionals Studentrsquos expectations of quality of teaching are higher

bull The exponential growth of med knowledge amp the greatly increased content of the scientific aspect of the curriculum has made the selection of appropriate core content and the integration of basic and clinical sciences important aspects of curricular design

Domains of essential Global Requirements of ME

What was the response to these challenges

bull The development of new curricula incorporating new curriculum themes amp different educational strategies

bull The introduction of new learning situations amp the use of new tools amp aids to learning

bull New methods of assessment [OSCE objective structured clinical exam Which can test performance amp competence in a wide diversity of settings Formative Assessment Portfolio assessment Work-based assess]

New Educational Strategies

bull New strategies appropriate for adult learning (instead of spoon-feeding)

bull Self-directed learningbull Problem Based Learningbull Integrated system based approachbull Task Based learningbull Core amp Student-selected

Componentsbull A spiral curriculum

New Tools amp Aids

bull Use of Study Guides

bull Use of Computer Assisted Programs amp Internet

bull Use of Videos to teach Clinical Skillsconsultation techniques

bull Role of Simulators amp Simulations in aspects of physical exam amp practical procedures

PBLbull Problem-based learning (PBL) is a method of

learning in which learners first encounter a problem followed by a systematic learner-centered inquiry and reflection process

bull PBL is a method designed to help students learn the sciences basic to medicine at the same time they develop the reasoning process used by physicians and other health professionals in their clinical practice

bull 1048708 The problem comes first without advance readings lectures or preparation

bull 1048708 The problem serves as a stimulus for the need to know

PBLbullHelps learners build a bridge

between what they already know and what they need to know to reachthe next level

bull Emphasizing active learning which has been shown to be more satisfying than

passive teacher-to-student learning and to enhance retention and recall

bull Emphasizing student-centered learning in which students are actively involved in setting their own learning goals

Advantages

Encourages bull effective amp self-directed learningbull Critical thinkingbull Team workbull understanding rather than

memorizationbull Facility with professional languagebull Both students amp staff enjoy the

process

Advantages

In preparing students for professional practice PBL

bull Encourages independence as students identify amp meet individual learning needs

bull Stimulates reflection amp self-direction for life-long learning

bull Supports ongoing self-assessmentbull Introduces clinical reasoningbull Enhances critical thinking amp evidence-based

decision makingbull Ensures that knowledge is transferred applied

amp retained by providing a relevant integrated context

bull A problem initiates the activitybull The Group is stimulated to explore

basic scientific amp clinical mechanisms together with social psychological ethical or professional issues

bull Problem stimulates students to reason think critically amp weigh evidence they seek out amp share relevant info

PBL

bull Groups do not need prior knowledge to generate lively ideas as they identify areas for further collective amp personal learning

bull Each student brings individual experience amp makes a distinctive contribution

bull the Tutorrsquos role is to manage interactions rather than supply info

bull An effective Group provides a safe environment for sharing amp testing new knowledge

bull Students practice the language of science amp medicine evaluate ideas and receive feedback from peers amp teacher

bull When clinical exposure is introduced concurrently intellectual amp practical skills develop in parallel

Framework for PBL

bull A trigger initiates the problem (papercomputervideo)

bull Groups brainstorm to identify key issues for discussion

bull Broad thinking produces a rich array of mechanisms amp ideas

bull Hypothesis are critically explored through reasoning

bull The need for additional info is identifiedbull A Conclusion is reachedbull Group reviews the process

Framework for PBL - II

bull In Breaks between Tutorials students identfy Learning Issues to be pursued

bull They are encouraged to adot an evidence-based approach

bull When they reconvene they share and review the learning

Characteristics of an effective PBL Group

An Effective Group is Cohesive motivated mutually supportive amp actively engaged in learning

bull The Group understands the process amp energetically pursues its task

bull Members respect each otherrsquos contribution but examine them critically

bull Discussions flow as students cooperate rather than compete

bull The atmosphere is friendly amp good humouredbull Roles are shared all take turns in scribing

leading discussion taking responsibility for acquiring information

Staff Development

bull Basic training is mandatorybull Further development may be a requirementbull Initial training may involve observation amp

practice with a group from the programbull Effective training ensures that necessary

background goals amp local strategies are considered together with info on assessment amp evaluation

bull In addition to materials supplied to students tutors are usually issued with handbooks highlighting issues for each problem

Tutorrsquos Role in Assessment

bull Individual StudentsGroups may be assessed Summatively (determining progression) or formatively (for feedback)

The GROUP

bull At the end of each problem groups review their processes to encourage self-reflection ampenhance their collective performance

Tutorrsquos Role in Assessment

Individual students

bull Tutors should provide formative feedback to each member

bull Ask students to complete a simple self-assessment questionnaire reviewing appropriate behaviors the tutor returns them with comments

bull Students will be a writtenoralclinical tests that will determine their progression amp ultimate graduation

Evaluating PBL Tutorials-II

bull At the end of each problem time is allocated for evaluation

bull Both the process amp learning in PBL can be evaluated against explicit goals

bull The tutorrsquos review of effectiveness of group processes offers insight for the members

bull Students normally evaluate their tutor helpfulness support for clinical reasoning encouragement for independent learning appropriate intervention provision for effective feedback

PBLbull 1048708 Enabling students to learn in the context in which the

information will be used which increases the ability to retrieve and apply information

bull 1048708 Focusing on important concepts which helps learners organize and store new information in a way that facilitates retrieval and application

bull 1048708 Exploring prior knowledge formulating inquiries derived from and defined by the learnersrsquo need to know and actively constructing meaning through dialogue and reflection

bull 1048708 Utilizing problems designed to simulate studentsrsquo perception of their future profession which serves as a powerful stimulus for studentsrsquo intrinsic motivation to learn

bull 1048708 Actively involving students in monitoring their own progress and reflecting on what works and what needs improvement frequently assessing student performance and providing feedback

PBL Starting the casebull After the introductions and discussion

are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it

bull Reading the case aloud keeps the group focused

bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here

PBL Case (contd)

bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session

PBL Case contdbull SECOND deciding which issues everyone will

tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)

bull THIRD deciding what SPECIFIC questions individuals will try to answer

bull FOURTH deciding how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet or consulting an expert)

The Process of PBL

bullWhat are the issues Identify the important issues in the problem

bull How well do you understand the issues

bull Are there any words or terms about which you are unclear

The Process of PBL contd

bull Consider the basic mechanisms that might explain each important aspect of each problem

bull Assess your current understanding of the basic structural andor functional mechanisms that may contribute to the presentation of the problem

bull Use the collective skills and experiences of group members to explore or explain these phenomena Identify current gaps in knowledge or understanding

Learn from each other

bullShare your own knowledge expertise or ability to reason and synthesize information Be receptive and appreciative of the contribution of your small group members

Determine priorities for learning

bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue

bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan

bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge

bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career

PBL

bull The problem comes first without advance readings lectures or preparation

bull The problem serves as a stimulus for the need to know

Learning Issues

bull Learning issues are questions that cannot be answered with studentsrsquo current knowledge and that can be explored and answered through systematic self-directed inquiry

bull The use of learning issues in tutorials prepares students to handle similar challenges in clinical practice and life-long learning

Learning Issues in PBL First Session1 Getting Started (Introductions Ground

Rules Expectations)2 Identifying Problem3 Exploring Pre-Existing Knowledge4 Generating Hypotheses and Explaining

Mechanisms5 Unfolding the Case Incrementally6 Re-EvaluatingReprioritizing Hypotheses

Based on New Information7 AssessmentReflection

PBL Second Session

8 Independent Self-Directed Study of Learning Issues

PBL Third Session

bull 9 Discussion of Learning Issues and Application of New Knowledge to the Case

bull 10 Continued Unfolding of the Case Incrementally

bull 11 AssessmentReflection

During Tutorial Session students will

1048708 Come prepared to discuss the case and learning issues researched since the last tutorial

1048708 Actively participate in group discussions and contribute to the learning process in a manner that allows for the balanced participation of everyone in the group

1048708 Develop learning issues at each session phrase them as full-sentence questions write them on the board and post them on the course web page

1048708 Consider biological population behaviormental health issuesexplanations and questions of professional attitudes values and ethics related to the patientrsquos problem(s) described in the case

Tutorial Session contd1048708 Go to the board to diagram outline draw etc in

explanation of mechanisms relatedto hypotheses1048708 Debate evidence related to the case and avoid

personal attacks on others1048708 Comply with ground rules with regard to how

the group will function and how itsmembers treat one another1048708 Participate in end-of-session reflection and

assessment by giving and receivingconstructive criticism regarding self tutor

student and group performance

Between Tutorial Session

1048708 Research key learning issues using a variety of resources

1048708 Critically evaluate the credibility of sources and the validity of the information they have obtained in their research

1048708 Integrate what they have learned through research lectures labs clinical skills Perspectives in Medicine (PIM) etc into what is discussed in tutorials

1048708 Synthesize what they have learned and be prepared to discuss it without reading directly from their materials as much as possible and apply it to the case at the next tutorial session

Determine priorities for learning

bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue

bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan

bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge

bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career

PBL Starting the casebull After the introductions and discussion

are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it

bull Reading the case aloud keeps the group focused

bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here

Problem-based learning is designed to develop

1048708 Integrated context-specific knowledge base

1048708 Decision-makingcritical thinking process and skills

1048708 Self-directed life-long learning skills 1048708 Interpersonal collaboration and

communication skills 1048708 Constructive self and peer

assessment skills 1048708 Professional ethics and behavior

PBL Case (contd)

bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session

What is problem based learning

bull In PBL students use triggers from the problem case or scenario to define their own learning objectives

bull Subsequently they do independent self directed study before returning to the group to discuss and refine their acquired knowledge

bull Thus PBL is not about problem solving per se but rather it uses appropriate problems to increase knowledge and understanding

bull The process is clearly defined

PBL

bull PBL uses clinical cases as the context for students to study basic and clinical sciences

bull Its possible advantages over traditional approaches include its greater relevance to the practice of medicine its ability to promote retention and application of knowledge and its encouragement of self-directed life-long learning

bull Possible disadvantages include higher costs both in resources and staff time

PBL

bull An educational method characterized by the use of patient problems as a context for students to learn problem-solving skills and acquire knowledge about the basic and clinical sciences

bull Students usually meet in small groups two or three times a week for PBL tutorials

bull They are presented with a clinical problem (eg a patient with chest pain) and in a series of steps they discuss possible mechanisms and causes develop hypotheses and strategies to test the hypotheses are presented with further information and use this new information to refine their hypotheses finally reaching a conclusion

bull A tutor usually acts as a facilitator guiding students in this group-learning process

bull In the course of this exercise students identify both their existing levels and gaps in their knowledge These gaps form the basis for independent learning outside the PBL tutorials The identification and pursuit of these so-called learning goals is a key element of the PBL process

Rationale for using PBL bull The PBL approach is based on principles of adult

education20 and cognitive psychology21 It differs fundamentally from traditional curricula in which students acquire background knowledge of the basic sciences in the early years of the course and in the later years apply this knowledge to the diagnosis and management of clinical problems This traditional approach has been criticised for a number of reasons42223

bull It creates an artificial divide between the basic and clinical sciences

bull Time is wasted in acquiring knowledge that is subsequently forgotten or found to be irrelevant

bull Application of the acquired knowledge can be difficult bull The acquisition and retention of information that has no

apparent relevance can be boring and even demoralising for students

The group learning process acquiring

desirable learning skills

Generic Skills amp attitudes

bull Teamwork bull Critical evaluation of literature bull Chairing a group bull Self directed learning and use of

resources bull Listening Presentation skills

Recording bull Cooperation bull Respect for colleagues views

bull Group learning facilitates not only the acquisition of knowledge but also several other desirable attributes such as communication skills teamwork problem solving independent responsibility for learning sharing information and respect for others PBL can therefore be thought of as a small group teaching method that combines the acquisition of knowledge with the development of generic skills and attitudes Presentation of clinical material as the stimulus for learning enables students to understand the relevance of underlying scientific knowledge and principles in clinical practice

bull when PBL is introduced into a curriculum several other issues for curriculum design and implementation need to be tackled PBL is generally introduced in the context of a defined core curriculum and integration of basic and clinical sciences It has implications for staffing and learning resources and demands a different approach to timetabling workload and assessment PBL is often used to deliver core material in non-clinical parts of the curriculum Paper based PBL scenarios form the basis of the core curriculum and ensure that all students are exposed to the same problems Recently modified PBL techniques have been introduced into clinical education with real patients being used as the stimulus for learning Despite the essential ad hoc nature of learning clinical medicine a key cases approach can enable PBL to be used to deliver the core clinical curriculum

Copyright copy2003 BMJ Publishing Group Ltd

Wood D F BMJ 2003326328-330

No CRoles of participants in a PBL tutorial aption Found

What happens in a PBL tutorial bull PBL tutorials are conducted in several ways In

this article the examples are modelled on the Maastricht seven jump process but its format of seven steps may be shortened

bull A typical PBL tutorial consists of a group of students (usually eight to 10) and a tutor who facilitates the session The length of time (number of sessions) that a group stays together with each other and with individual tutors varies between institutions A group needs to be together long enough to allow good group dynamics to develop but may need to be changed occasionally if personality clashes or other dysfunctional behaviour emerges

bull Students elect a chair for each PBL scenario and a scribe to record the discussion The roles are rotated for each scenario Suitable flip charts or a whiteboard should be used for recording the proceedings At the start of the session depending on the trigger material either the student chair reads out the scenario or all students study the material If the trigger is a real patient in a ward clinic or surgery then a student may be asked to take a clinical history or identify an abnormal physical sign before the group moves to a tutorial room For each module students may be given a handbook containing the problem scenarios and suggested learning resources or learning materials may be handed out at appropriate times as the tutorials progress

Examples of trigger material for PBL scenarios bull Paper based clinical scenarios bull Experimental or clinical laboratory data bull Photographs bull Video clips bull Newspaper articles bull All or part of an article from a scientific

journal bull A real or simulated patient bull A family tree showing an inherited

disorder

PBL tutorial process ndash Step 1 Identify and clarify unfamiliar terms presented in the scenario

scribe lists those that remain unexplained after discussion ndash Step 2 Define the problem or problems to be discussed students may

have different views on the issues but all should be considered scribe records a list of agreed problems

ndash Step 3 Brainstorming session to discuss the problem(s) suggestingpossible explanations on basis of prior knowledge students draw on each others knowledge and identify areas of incomplete knowledge scribe records all discussion

ndash Step 4 Review steps 2 and 3 and arrange explanations into tentativesolutions scribe organises the explanations and restructures if necessary

ndash Step 5 Formulate learning objectives group reaches consensus onthe learning objectives tutor ensures learning objectives are focused achievable comprehensive and appropriate

ndash Step 6 Private study (all students gather information related to eachlearning objective)

ndash Step 7 Group shares results of private study (students identify theirlearning resources and share their results) tutor checks learning and may assess the group

bull The role of the tutor is to facilitate the proceedings (helping the chair to maintain group dynamics and moving the group through the task) and to ensure that the group achieves appropriate learning objectives in line with those set by the curriculum design team The tutor may need to take a more active role in step 7 of the process to ensure that all the students have done the appropriate work and to help the chair to suggest a suitable format for group members to use to present the results of their private study The tutor should encourage students to check their understanding of the material He or she can do this by encouraging the students to ask open questions and ask each other to explain topics in their own words or by the use of drawings and diagrams

PBL in curriculum design bull PBL may be used either as the mainstay of an entire

curriculum or for the delivery of individual courses In practice PBL is usually part of an integrated curriculum using a systems based approach with non-clinical material delivered in the context of clinical practice A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge skills and attitudes A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios Sufficient time should be allowed each week for students to do the self directed learning required for PBL

bull

Copyright copy2003 BMJ Publishing Group Ltd

Wood D F BMJ 2003326328-330

No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found

Writing PBL scenarios

bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives

bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after

studying the scenario should be consistent with the faculty learning objectives

bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding

bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice

bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge

bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented

bull The problem should be sufficiently open so that discussion is not curtailed too early in the process

bull Scenarios should promote participation by the students in seeking information from various learning resources

bull Adapted from Dolmans et al Med Teacher 199719185-9

Staff development

bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)

A dysfunctional group a dominant character may

make it difficult for other students to be heard

A dysfunctional group a dominant character may make it difficult for other students to be heard

bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties

Advantages of PBL bull Student centred PBLIt fostersactive learning improved

understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks

Disadvantagesbull Tutors who cant teachTutorsenjoy passing on

their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful

Assessment of PBL

bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods

bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL

Conclusion

bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning

bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL

PBL 5 Easy Steps

bull Read the problem

Mrs Paula Embledon

Mrs Paula Embledon is a 78 year old woman who has come to the emergency room complaining of shortness of breath and pain in her chest She had been in relatively good health until three weeks previously when she sprained

2 Brain storm

bull Brainstorm

bull ndash hypotheses

bull - what do we know in support of the hypothesis

bull - what do we need to know to test the hypothesis

ndash learning issues

Brainstorm

bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)

ndash specific issues (for individuals to look up)

ndash overlapping issues

bull 4 Individual Reading - Research - Preparation

bull 5 Return

bull ndash review case so far ndash report and discuss

ndash assess progress - continue pagenext pagecomplete

ndash self-evaluation - How did things go Any suggestions for next time

ndash next problem

bull 5 Return

THE FIRST GROUP SESSION

bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day

bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session

bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr

bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine

bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise

bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator

bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues

bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know

bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)

bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)

bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)

  • PROBLEM BASED LEARNING
  • New Horizons in Medical Education
  • Slide 3
  • Domains of essential Global Requirements of ME
  • What was the response to these challenges
  • New Educational Strategies
  • New Tools amp Aids
  • PBL
  • PBL
  • Advantages
  • Slide 11
  • Slide 12
  • Slide 13
  • Slide 14
  • Framework for PBL
  • Framework for PBL - II
  • Characteristics of an effective PBL Group
  • Staff Development
  • Tutorrsquos Role in Assessment
  • Slide 20
  • Evaluating PBL Tutorials-II
  • PBL
  • Slide 23
  • PBL Starting the case
  • PBL Case (contd)
  • PBL Case contd
  • The Process of PBL
  • The Process of PBL contd
  • Learn from each other
  • Determine priorities for learning
  • Slide 31
  • Slide 32
  • Learning Issues
  • Learning Issues in PBL First Session
  • PBL Second Session
  • PBL Third Session
  • Slide 37
  • Slide 38
  • During Tutorial Session students will
  • Tutorial Session contd
  • Between Tutorial Session
  • Slide 42
  • Slide 43
  • Problem-based learning is designed to develop
  • Slide 45
  • What is problem based learning
  • Slide 47
  • Slide 48
  • Slide 49
  • Rationale for using PBL
  • Slide 51
  • Slide 52
  • The group learning process acquiring desirable learning skills
  • Generic Skills amp attitudes
  • Slide 55
  • Slide 56
  • Slide 57
  • What happens in a PBL tutorial
  • Slide 59
  • Examples of trigger material for PBL scenarios
  • PBL tutorial process
  • Slide 62
  • PBL in curriculum design
  • Slide 64
  • Writing PBL scenarios
  • Slide 66
  • Staff development
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • Slide 70
  • Advantages of PBL
  • Slide 72
  • Slide 73
  • Disadvantages
  • Assessment of PBL
  • Slide 76
  • Conclusion
  • Slide 78
  • PBL 5 Easy Steps
  • 2 Brain storm
  • Brainstorm
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • THE FIRST GROUP SESSION
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
Page 3: Problem based learning

bull The exponential growth of med knowledge amp the greatly increased content of the scientific aspect of the curriculum has made the selection of appropriate core content and the integration of basic and clinical sciences important aspects of curricular design

Domains of essential Global Requirements of ME

What was the response to these challenges

bull The development of new curricula incorporating new curriculum themes amp different educational strategies

bull The introduction of new learning situations amp the use of new tools amp aids to learning

bull New methods of assessment [OSCE objective structured clinical exam Which can test performance amp competence in a wide diversity of settings Formative Assessment Portfolio assessment Work-based assess]

New Educational Strategies

bull New strategies appropriate for adult learning (instead of spoon-feeding)

bull Self-directed learningbull Problem Based Learningbull Integrated system based approachbull Task Based learningbull Core amp Student-selected

Componentsbull A spiral curriculum

New Tools amp Aids

bull Use of Study Guides

bull Use of Computer Assisted Programs amp Internet

bull Use of Videos to teach Clinical Skillsconsultation techniques

bull Role of Simulators amp Simulations in aspects of physical exam amp practical procedures

PBLbull Problem-based learning (PBL) is a method of

learning in which learners first encounter a problem followed by a systematic learner-centered inquiry and reflection process

bull PBL is a method designed to help students learn the sciences basic to medicine at the same time they develop the reasoning process used by physicians and other health professionals in their clinical practice

bull 1048708 The problem comes first without advance readings lectures or preparation

bull 1048708 The problem serves as a stimulus for the need to know

PBLbullHelps learners build a bridge

between what they already know and what they need to know to reachthe next level

bull Emphasizing active learning which has been shown to be more satisfying than

passive teacher-to-student learning and to enhance retention and recall

bull Emphasizing student-centered learning in which students are actively involved in setting their own learning goals

Advantages

Encourages bull effective amp self-directed learningbull Critical thinkingbull Team workbull understanding rather than

memorizationbull Facility with professional languagebull Both students amp staff enjoy the

process

Advantages

In preparing students for professional practice PBL

bull Encourages independence as students identify amp meet individual learning needs

bull Stimulates reflection amp self-direction for life-long learning

bull Supports ongoing self-assessmentbull Introduces clinical reasoningbull Enhances critical thinking amp evidence-based

decision makingbull Ensures that knowledge is transferred applied

amp retained by providing a relevant integrated context

bull A problem initiates the activitybull The Group is stimulated to explore

basic scientific amp clinical mechanisms together with social psychological ethical or professional issues

bull Problem stimulates students to reason think critically amp weigh evidence they seek out amp share relevant info

PBL

bull Groups do not need prior knowledge to generate lively ideas as they identify areas for further collective amp personal learning

bull Each student brings individual experience amp makes a distinctive contribution

bull the Tutorrsquos role is to manage interactions rather than supply info

bull An effective Group provides a safe environment for sharing amp testing new knowledge

bull Students practice the language of science amp medicine evaluate ideas and receive feedback from peers amp teacher

bull When clinical exposure is introduced concurrently intellectual amp practical skills develop in parallel

Framework for PBL

bull A trigger initiates the problem (papercomputervideo)

bull Groups brainstorm to identify key issues for discussion

bull Broad thinking produces a rich array of mechanisms amp ideas

bull Hypothesis are critically explored through reasoning

bull The need for additional info is identifiedbull A Conclusion is reachedbull Group reviews the process

Framework for PBL - II

bull In Breaks between Tutorials students identfy Learning Issues to be pursued

bull They are encouraged to adot an evidence-based approach

bull When they reconvene they share and review the learning

Characteristics of an effective PBL Group

An Effective Group is Cohesive motivated mutually supportive amp actively engaged in learning

bull The Group understands the process amp energetically pursues its task

bull Members respect each otherrsquos contribution but examine them critically

bull Discussions flow as students cooperate rather than compete

bull The atmosphere is friendly amp good humouredbull Roles are shared all take turns in scribing

leading discussion taking responsibility for acquiring information

Staff Development

bull Basic training is mandatorybull Further development may be a requirementbull Initial training may involve observation amp

practice with a group from the programbull Effective training ensures that necessary

background goals amp local strategies are considered together with info on assessment amp evaluation

bull In addition to materials supplied to students tutors are usually issued with handbooks highlighting issues for each problem

Tutorrsquos Role in Assessment

bull Individual StudentsGroups may be assessed Summatively (determining progression) or formatively (for feedback)

The GROUP

bull At the end of each problem groups review their processes to encourage self-reflection ampenhance their collective performance

Tutorrsquos Role in Assessment

Individual students

bull Tutors should provide formative feedback to each member

bull Ask students to complete a simple self-assessment questionnaire reviewing appropriate behaviors the tutor returns them with comments

bull Students will be a writtenoralclinical tests that will determine their progression amp ultimate graduation

Evaluating PBL Tutorials-II

bull At the end of each problem time is allocated for evaluation

bull Both the process amp learning in PBL can be evaluated against explicit goals

bull The tutorrsquos review of effectiveness of group processes offers insight for the members

bull Students normally evaluate their tutor helpfulness support for clinical reasoning encouragement for independent learning appropriate intervention provision for effective feedback

PBLbull 1048708 Enabling students to learn in the context in which the

information will be used which increases the ability to retrieve and apply information

bull 1048708 Focusing on important concepts which helps learners organize and store new information in a way that facilitates retrieval and application

bull 1048708 Exploring prior knowledge formulating inquiries derived from and defined by the learnersrsquo need to know and actively constructing meaning through dialogue and reflection

bull 1048708 Utilizing problems designed to simulate studentsrsquo perception of their future profession which serves as a powerful stimulus for studentsrsquo intrinsic motivation to learn

bull 1048708 Actively involving students in monitoring their own progress and reflecting on what works and what needs improvement frequently assessing student performance and providing feedback

PBL Starting the casebull After the introductions and discussion

are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it

bull Reading the case aloud keeps the group focused

bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here

PBL Case (contd)

bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session

PBL Case contdbull SECOND deciding which issues everyone will

tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)

bull THIRD deciding what SPECIFIC questions individuals will try to answer

bull FOURTH deciding how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet or consulting an expert)

The Process of PBL

bullWhat are the issues Identify the important issues in the problem

bull How well do you understand the issues

bull Are there any words or terms about which you are unclear

The Process of PBL contd

bull Consider the basic mechanisms that might explain each important aspect of each problem

bull Assess your current understanding of the basic structural andor functional mechanisms that may contribute to the presentation of the problem

bull Use the collective skills and experiences of group members to explore or explain these phenomena Identify current gaps in knowledge or understanding

Learn from each other

bullShare your own knowledge expertise or ability to reason and synthesize information Be receptive and appreciative of the contribution of your small group members

Determine priorities for learning

bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue

bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan

bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge

bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career

PBL

bull The problem comes first without advance readings lectures or preparation

bull The problem serves as a stimulus for the need to know

Learning Issues

bull Learning issues are questions that cannot be answered with studentsrsquo current knowledge and that can be explored and answered through systematic self-directed inquiry

bull The use of learning issues in tutorials prepares students to handle similar challenges in clinical practice and life-long learning

Learning Issues in PBL First Session1 Getting Started (Introductions Ground

Rules Expectations)2 Identifying Problem3 Exploring Pre-Existing Knowledge4 Generating Hypotheses and Explaining

Mechanisms5 Unfolding the Case Incrementally6 Re-EvaluatingReprioritizing Hypotheses

Based on New Information7 AssessmentReflection

PBL Second Session

8 Independent Self-Directed Study of Learning Issues

PBL Third Session

bull 9 Discussion of Learning Issues and Application of New Knowledge to the Case

bull 10 Continued Unfolding of the Case Incrementally

bull 11 AssessmentReflection

During Tutorial Session students will

1048708 Come prepared to discuss the case and learning issues researched since the last tutorial

1048708 Actively participate in group discussions and contribute to the learning process in a manner that allows for the balanced participation of everyone in the group

1048708 Develop learning issues at each session phrase them as full-sentence questions write them on the board and post them on the course web page

1048708 Consider biological population behaviormental health issuesexplanations and questions of professional attitudes values and ethics related to the patientrsquos problem(s) described in the case

Tutorial Session contd1048708 Go to the board to diagram outline draw etc in

explanation of mechanisms relatedto hypotheses1048708 Debate evidence related to the case and avoid

personal attacks on others1048708 Comply with ground rules with regard to how

the group will function and how itsmembers treat one another1048708 Participate in end-of-session reflection and

assessment by giving and receivingconstructive criticism regarding self tutor

student and group performance

Between Tutorial Session

1048708 Research key learning issues using a variety of resources

1048708 Critically evaluate the credibility of sources and the validity of the information they have obtained in their research

1048708 Integrate what they have learned through research lectures labs clinical skills Perspectives in Medicine (PIM) etc into what is discussed in tutorials

1048708 Synthesize what they have learned and be prepared to discuss it without reading directly from their materials as much as possible and apply it to the case at the next tutorial session

Determine priorities for learning

bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue

bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan

bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge

bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career

PBL Starting the casebull After the introductions and discussion

are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it

bull Reading the case aloud keeps the group focused

bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here

Problem-based learning is designed to develop

1048708 Integrated context-specific knowledge base

1048708 Decision-makingcritical thinking process and skills

1048708 Self-directed life-long learning skills 1048708 Interpersonal collaboration and

communication skills 1048708 Constructive self and peer

assessment skills 1048708 Professional ethics and behavior

PBL Case (contd)

bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session

What is problem based learning

bull In PBL students use triggers from the problem case or scenario to define their own learning objectives

bull Subsequently they do independent self directed study before returning to the group to discuss and refine their acquired knowledge

bull Thus PBL is not about problem solving per se but rather it uses appropriate problems to increase knowledge and understanding

bull The process is clearly defined

PBL

bull PBL uses clinical cases as the context for students to study basic and clinical sciences

bull Its possible advantages over traditional approaches include its greater relevance to the practice of medicine its ability to promote retention and application of knowledge and its encouragement of self-directed life-long learning

bull Possible disadvantages include higher costs both in resources and staff time

PBL

bull An educational method characterized by the use of patient problems as a context for students to learn problem-solving skills and acquire knowledge about the basic and clinical sciences

bull Students usually meet in small groups two or three times a week for PBL tutorials

bull They are presented with a clinical problem (eg a patient with chest pain) and in a series of steps they discuss possible mechanisms and causes develop hypotheses and strategies to test the hypotheses are presented with further information and use this new information to refine their hypotheses finally reaching a conclusion

bull A tutor usually acts as a facilitator guiding students in this group-learning process

bull In the course of this exercise students identify both their existing levels and gaps in their knowledge These gaps form the basis for independent learning outside the PBL tutorials The identification and pursuit of these so-called learning goals is a key element of the PBL process

Rationale for using PBL bull The PBL approach is based on principles of adult

education20 and cognitive psychology21 It differs fundamentally from traditional curricula in which students acquire background knowledge of the basic sciences in the early years of the course and in the later years apply this knowledge to the diagnosis and management of clinical problems This traditional approach has been criticised for a number of reasons42223

bull It creates an artificial divide between the basic and clinical sciences

bull Time is wasted in acquiring knowledge that is subsequently forgotten or found to be irrelevant

bull Application of the acquired knowledge can be difficult bull The acquisition and retention of information that has no

apparent relevance can be boring and even demoralising for students

The group learning process acquiring

desirable learning skills

Generic Skills amp attitudes

bull Teamwork bull Critical evaluation of literature bull Chairing a group bull Self directed learning and use of

resources bull Listening Presentation skills

Recording bull Cooperation bull Respect for colleagues views

bull Group learning facilitates not only the acquisition of knowledge but also several other desirable attributes such as communication skills teamwork problem solving independent responsibility for learning sharing information and respect for others PBL can therefore be thought of as a small group teaching method that combines the acquisition of knowledge with the development of generic skills and attitudes Presentation of clinical material as the stimulus for learning enables students to understand the relevance of underlying scientific knowledge and principles in clinical practice

bull when PBL is introduced into a curriculum several other issues for curriculum design and implementation need to be tackled PBL is generally introduced in the context of a defined core curriculum and integration of basic and clinical sciences It has implications for staffing and learning resources and demands a different approach to timetabling workload and assessment PBL is often used to deliver core material in non-clinical parts of the curriculum Paper based PBL scenarios form the basis of the core curriculum and ensure that all students are exposed to the same problems Recently modified PBL techniques have been introduced into clinical education with real patients being used as the stimulus for learning Despite the essential ad hoc nature of learning clinical medicine a key cases approach can enable PBL to be used to deliver the core clinical curriculum

Copyright copy2003 BMJ Publishing Group Ltd

Wood D F BMJ 2003326328-330

No CRoles of participants in a PBL tutorial aption Found

What happens in a PBL tutorial bull PBL tutorials are conducted in several ways In

this article the examples are modelled on the Maastricht seven jump process but its format of seven steps may be shortened

bull A typical PBL tutorial consists of a group of students (usually eight to 10) and a tutor who facilitates the session The length of time (number of sessions) that a group stays together with each other and with individual tutors varies between institutions A group needs to be together long enough to allow good group dynamics to develop but may need to be changed occasionally if personality clashes or other dysfunctional behaviour emerges

bull Students elect a chair for each PBL scenario and a scribe to record the discussion The roles are rotated for each scenario Suitable flip charts or a whiteboard should be used for recording the proceedings At the start of the session depending on the trigger material either the student chair reads out the scenario or all students study the material If the trigger is a real patient in a ward clinic or surgery then a student may be asked to take a clinical history or identify an abnormal physical sign before the group moves to a tutorial room For each module students may be given a handbook containing the problem scenarios and suggested learning resources or learning materials may be handed out at appropriate times as the tutorials progress

Examples of trigger material for PBL scenarios bull Paper based clinical scenarios bull Experimental or clinical laboratory data bull Photographs bull Video clips bull Newspaper articles bull All or part of an article from a scientific

journal bull A real or simulated patient bull A family tree showing an inherited

disorder

PBL tutorial process ndash Step 1 Identify and clarify unfamiliar terms presented in the scenario

scribe lists those that remain unexplained after discussion ndash Step 2 Define the problem or problems to be discussed students may

have different views on the issues but all should be considered scribe records a list of agreed problems

ndash Step 3 Brainstorming session to discuss the problem(s) suggestingpossible explanations on basis of prior knowledge students draw on each others knowledge and identify areas of incomplete knowledge scribe records all discussion

ndash Step 4 Review steps 2 and 3 and arrange explanations into tentativesolutions scribe organises the explanations and restructures if necessary

ndash Step 5 Formulate learning objectives group reaches consensus onthe learning objectives tutor ensures learning objectives are focused achievable comprehensive and appropriate

ndash Step 6 Private study (all students gather information related to eachlearning objective)

ndash Step 7 Group shares results of private study (students identify theirlearning resources and share their results) tutor checks learning and may assess the group

bull The role of the tutor is to facilitate the proceedings (helping the chair to maintain group dynamics and moving the group through the task) and to ensure that the group achieves appropriate learning objectives in line with those set by the curriculum design team The tutor may need to take a more active role in step 7 of the process to ensure that all the students have done the appropriate work and to help the chair to suggest a suitable format for group members to use to present the results of their private study The tutor should encourage students to check their understanding of the material He or she can do this by encouraging the students to ask open questions and ask each other to explain topics in their own words or by the use of drawings and diagrams

PBL in curriculum design bull PBL may be used either as the mainstay of an entire

curriculum or for the delivery of individual courses In practice PBL is usually part of an integrated curriculum using a systems based approach with non-clinical material delivered in the context of clinical practice A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge skills and attitudes A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios Sufficient time should be allowed each week for students to do the self directed learning required for PBL

bull

Copyright copy2003 BMJ Publishing Group Ltd

Wood D F BMJ 2003326328-330

No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found

Writing PBL scenarios

bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives

bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after

studying the scenario should be consistent with the faculty learning objectives

bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding

bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice

bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge

bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented

bull The problem should be sufficiently open so that discussion is not curtailed too early in the process

bull Scenarios should promote participation by the students in seeking information from various learning resources

bull Adapted from Dolmans et al Med Teacher 199719185-9

Staff development

bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)

A dysfunctional group a dominant character may

make it difficult for other students to be heard

A dysfunctional group a dominant character may make it difficult for other students to be heard

bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties

Advantages of PBL bull Student centred PBLIt fostersactive learning improved

understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks

Disadvantagesbull Tutors who cant teachTutorsenjoy passing on

their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful

Assessment of PBL

bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods

bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL

Conclusion

bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning

bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL

PBL 5 Easy Steps

bull Read the problem

Mrs Paula Embledon

Mrs Paula Embledon is a 78 year old woman who has come to the emergency room complaining of shortness of breath and pain in her chest She had been in relatively good health until three weeks previously when she sprained

2 Brain storm

bull Brainstorm

bull ndash hypotheses

bull - what do we know in support of the hypothesis

bull - what do we need to know to test the hypothesis

ndash learning issues

Brainstorm

bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)

ndash specific issues (for individuals to look up)

ndash overlapping issues

bull 4 Individual Reading - Research - Preparation

bull 5 Return

bull ndash review case so far ndash report and discuss

ndash assess progress - continue pagenext pagecomplete

ndash self-evaluation - How did things go Any suggestions for next time

ndash next problem

bull 5 Return

THE FIRST GROUP SESSION

bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day

bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session

bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr

bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine

bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise

bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator

bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues

bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know

bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)

bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)

bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)

  • PROBLEM BASED LEARNING
  • New Horizons in Medical Education
  • Slide 3
  • Domains of essential Global Requirements of ME
  • What was the response to these challenges
  • New Educational Strategies
  • New Tools amp Aids
  • PBL
  • PBL
  • Advantages
  • Slide 11
  • Slide 12
  • Slide 13
  • Slide 14
  • Framework for PBL
  • Framework for PBL - II
  • Characteristics of an effective PBL Group
  • Staff Development
  • Tutorrsquos Role in Assessment
  • Slide 20
  • Evaluating PBL Tutorials-II
  • PBL
  • Slide 23
  • PBL Starting the case
  • PBL Case (contd)
  • PBL Case contd
  • The Process of PBL
  • The Process of PBL contd
  • Learn from each other
  • Determine priorities for learning
  • Slide 31
  • Slide 32
  • Learning Issues
  • Learning Issues in PBL First Session
  • PBL Second Session
  • PBL Third Session
  • Slide 37
  • Slide 38
  • During Tutorial Session students will
  • Tutorial Session contd
  • Between Tutorial Session
  • Slide 42
  • Slide 43
  • Problem-based learning is designed to develop
  • Slide 45
  • What is problem based learning
  • Slide 47
  • Slide 48
  • Slide 49
  • Rationale for using PBL
  • Slide 51
  • Slide 52
  • The group learning process acquiring desirable learning skills
  • Generic Skills amp attitudes
  • Slide 55
  • Slide 56
  • Slide 57
  • What happens in a PBL tutorial
  • Slide 59
  • Examples of trigger material for PBL scenarios
  • PBL tutorial process
  • Slide 62
  • PBL in curriculum design
  • Slide 64
  • Writing PBL scenarios
  • Slide 66
  • Staff development
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • Slide 70
  • Advantages of PBL
  • Slide 72
  • Slide 73
  • Disadvantages
  • Assessment of PBL
  • Slide 76
  • Conclusion
  • Slide 78
  • PBL 5 Easy Steps
  • 2 Brain storm
  • Brainstorm
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • THE FIRST GROUP SESSION
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
Page 4: Problem based learning

Domains of essential Global Requirements of ME

What was the response to these challenges

bull The development of new curricula incorporating new curriculum themes amp different educational strategies

bull The introduction of new learning situations amp the use of new tools amp aids to learning

bull New methods of assessment [OSCE objective structured clinical exam Which can test performance amp competence in a wide diversity of settings Formative Assessment Portfolio assessment Work-based assess]

New Educational Strategies

bull New strategies appropriate for adult learning (instead of spoon-feeding)

bull Self-directed learningbull Problem Based Learningbull Integrated system based approachbull Task Based learningbull Core amp Student-selected

Componentsbull A spiral curriculum

New Tools amp Aids

bull Use of Study Guides

bull Use of Computer Assisted Programs amp Internet

bull Use of Videos to teach Clinical Skillsconsultation techniques

bull Role of Simulators amp Simulations in aspects of physical exam amp practical procedures

PBLbull Problem-based learning (PBL) is a method of

learning in which learners first encounter a problem followed by a systematic learner-centered inquiry and reflection process

bull PBL is a method designed to help students learn the sciences basic to medicine at the same time they develop the reasoning process used by physicians and other health professionals in their clinical practice

bull 1048708 The problem comes first without advance readings lectures or preparation

bull 1048708 The problem serves as a stimulus for the need to know

PBLbullHelps learners build a bridge

between what they already know and what they need to know to reachthe next level

bull Emphasizing active learning which has been shown to be more satisfying than

passive teacher-to-student learning and to enhance retention and recall

bull Emphasizing student-centered learning in which students are actively involved in setting their own learning goals

Advantages

Encourages bull effective amp self-directed learningbull Critical thinkingbull Team workbull understanding rather than

memorizationbull Facility with professional languagebull Both students amp staff enjoy the

process

Advantages

In preparing students for professional practice PBL

bull Encourages independence as students identify amp meet individual learning needs

bull Stimulates reflection amp self-direction for life-long learning

bull Supports ongoing self-assessmentbull Introduces clinical reasoningbull Enhances critical thinking amp evidence-based

decision makingbull Ensures that knowledge is transferred applied

amp retained by providing a relevant integrated context

bull A problem initiates the activitybull The Group is stimulated to explore

basic scientific amp clinical mechanisms together with social psychological ethical or professional issues

bull Problem stimulates students to reason think critically amp weigh evidence they seek out amp share relevant info

PBL

bull Groups do not need prior knowledge to generate lively ideas as they identify areas for further collective amp personal learning

bull Each student brings individual experience amp makes a distinctive contribution

bull the Tutorrsquos role is to manage interactions rather than supply info

bull An effective Group provides a safe environment for sharing amp testing new knowledge

bull Students practice the language of science amp medicine evaluate ideas and receive feedback from peers amp teacher

bull When clinical exposure is introduced concurrently intellectual amp practical skills develop in parallel

Framework for PBL

bull A trigger initiates the problem (papercomputervideo)

bull Groups brainstorm to identify key issues for discussion

bull Broad thinking produces a rich array of mechanisms amp ideas

bull Hypothesis are critically explored through reasoning

bull The need for additional info is identifiedbull A Conclusion is reachedbull Group reviews the process

Framework for PBL - II

bull In Breaks between Tutorials students identfy Learning Issues to be pursued

bull They are encouraged to adot an evidence-based approach

bull When they reconvene they share and review the learning

Characteristics of an effective PBL Group

An Effective Group is Cohesive motivated mutually supportive amp actively engaged in learning

bull The Group understands the process amp energetically pursues its task

bull Members respect each otherrsquos contribution but examine them critically

bull Discussions flow as students cooperate rather than compete

bull The atmosphere is friendly amp good humouredbull Roles are shared all take turns in scribing

leading discussion taking responsibility for acquiring information

Staff Development

bull Basic training is mandatorybull Further development may be a requirementbull Initial training may involve observation amp

practice with a group from the programbull Effective training ensures that necessary

background goals amp local strategies are considered together with info on assessment amp evaluation

bull In addition to materials supplied to students tutors are usually issued with handbooks highlighting issues for each problem

Tutorrsquos Role in Assessment

bull Individual StudentsGroups may be assessed Summatively (determining progression) or formatively (for feedback)

The GROUP

bull At the end of each problem groups review their processes to encourage self-reflection ampenhance their collective performance

Tutorrsquos Role in Assessment

Individual students

bull Tutors should provide formative feedback to each member

bull Ask students to complete a simple self-assessment questionnaire reviewing appropriate behaviors the tutor returns them with comments

bull Students will be a writtenoralclinical tests that will determine their progression amp ultimate graduation

Evaluating PBL Tutorials-II

bull At the end of each problem time is allocated for evaluation

bull Both the process amp learning in PBL can be evaluated against explicit goals

bull The tutorrsquos review of effectiveness of group processes offers insight for the members

bull Students normally evaluate their tutor helpfulness support for clinical reasoning encouragement for independent learning appropriate intervention provision for effective feedback

PBLbull 1048708 Enabling students to learn in the context in which the

information will be used which increases the ability to retrieve and apply information

bull 1048708 Focusing on important concepts which helps learners organize and store new information in a way that facilitates retrieval and application

bull 1048708 Exploring prior knowledge formulating inquiries derived from and defined by the learnersrsquo need to know and actively constructing meaning through dialogue and reflection

bull 1048708 Utilizing problems designed to simulate studentsrsquo perception of their future profession which serves as a powerful stimulus for studentsrsquo intrinsic motivation to learn

bull 1048708 Actively involving students in monitoring their own progress and reflecting on what works and what needs improvement frequently assessing student performance and providing feedback

PBL Starting the casebull After the introductions and discussion

are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it

bull Reading the case aloud keeps the group focused

bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here

PBL Case (contd)

bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session

PBL Case contdbull SECOND deciding which issues everyone will

tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)

bull THIRD deciding what SPECIFIC questions individuals will try to answer

bull FOURTH deciding how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet or consulting an expert)

The Process of PBL

bullWhat are the issues Identify the important issues in the problem

bull How well do you understand the issues

bull Are there any words or terms about which you are unclear

The Process of PBL contd

bull Consider the basic mechanisms that might explain each important aspect of each problem

bull Assess your current understanding of the basic structural andor functional mechanisms that may contribute to the presentation of the problem

bull Use the collective skills and experiences of group members to explore or explain these phenomena Identify current gaps in knowledge or understanding

Learn from each other

bullShare your own knowledge expertise or ability to reason and synthesize information Be receptive and appreciative of the contribution of your small group members

Determine priorities for learning

bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue

bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan

bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge

bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career

PBL

bull The problem comes first without advance readings lectures or preparation

bull The problem serves as a stimulus for the need to know

Learning Issues

bull Learning issues are questions that cannot be answered with studentsrsquo current knowledge and that can be explored and answered through systematic self-directed inquiry

bull The use of learning issues in tutorials prepares students to handle similar challenges in clinical practice and life-long learning

Learning Issues in PBL First Session1 Getting Started (Introductions Ground

Rules Expectations)2 Identifying Problem3 Exploring Pre-Existing Knowledge4 Generating Hypotheses and Explaining

Mechanisms5 Unfolding the Case Incrementally6 Re-EvaluatingReprioritizing Hypotheses

Based on New Information7 AssessmentReflection

PBL Second Session

8 Independent Self-Directed Study of Learning Issues

PBL Third Session

bull 9 Discussion of Learning Issues and Application of New Knowledge to the Case

bull 10 Continued Unfolding of the Case Incrementally

bull 11 AssessmentReflection

During Tutorial Session students will

1048708 Come prepared to discuss the case and learning issues researched since the last tutorial

1048708 Actively participate in group discussions and contribute to the learning process in a manner that allows for the balanced participation of everyone in the group

1048708 Develop learning issues at each session phrase them as full-sentence questions write them on the board and post them on the course web page

1048708 Consider biological population behaviormental health issuesexplanations and questions of professional attitudes values and ethics related to the patientrsquos problem(s) described in the case

Tutorial Session contd1048708 Go to the board to diagram outline draw etc in

explanation of mechanisms relatedto hypotheses1048708 Debate evidence related to the case and avoid

personal attacks on others1048708 Comply with ground rules with regard to how

the group will function and how itsmembers treat one another1048708 Participate in end-of-session reflection and

assessment by giving and receivingconstructive criticism regarding self tutor

student and group performance

Between Tutorial Session

1048708 Research key learning issues using a variety of resources

1048708 Critically evaluate the credibility of sources and the validity of the information they have obtained in their research

1048708 Integrate what they have learned through research lectures labs clinical skills Perspectives in Medicine (PIM) etc into what is discussed in tutorials

1048708 Synthesize what they have learned and be prepared to discuss it without reading directly from their materials as much as possible and apply it to the case at the next tutorial session

Determine priorities for learning

bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue

bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan

bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge

bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career

PBL Starting the casebull After the introductions and discussion

are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it

bull Reading the case aloud keeps the group focused

bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here

Problem-based learning is designed to develop

1048708 Integrated context-specific knowledge base

1048708 Decision-makingcritical thinking process and skills

1048708 Self-directed life-long learning skills 1048708 Interpersonal collaboration and

communication skills 1048708 Constructive self and peer

assessment skills 1048708 Professional ethics and behavior

PBL Case (contd)

bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session

What is problem based learning

bull In PBL students use triggers from the problem case or scenario to define their own learning objectives

bull Subsequently they do independent self directed study before returning to the group to discuss and refine their acquired knowledge

bull Thus PBL is not about problem solving per se but rather it uses appropriate problems to increase knowledge and understanding

bull The process is clearly defined

PBL

bull PBL uses clinical cases as the context for students to study basic and clinical sciences

bull Its possible advantages over traditional approaches include its greater relevance to the practice of medicine its ability to promote retention and application of knowledge and its encouragement of self-directed life-long learning

bull Possible disadvantages include higher costs both in resources and staff time

PBL

bull An educational method characterized by the use of patient problems as a context for students to learn problem-solving skills and acquire knowledge about the basic and clinical sciences

bull Students usually meet in small groups two or three times a week for PBL tutorials

bull They are presented with a clinical problem (eg a patient with chest pain) and in a series of steps they discuss possible mechanisms and causes develop hypotheses and strategies to test the hypotheses are presented with further information and use this new information to refine their hypotheses finally reaching a conclusion

bull A tutor usually acts as a facilitator guiding students in this group-learning process

bull In the course of this exercise students identify both their existing levels and gaps in their knowledge These gaps form the basis for independent learning outside the PBL tutorials The identification and pursuit of these so-called learning goals is a key element of the PBL process

Rationale for using PBL bull The PBL approach is based on principles of adult

education20 and cognitive psychology21 It differs fundamentally from traditional curricula in which students acquire background knowledge of the basic sciences in the early years of the course and in the later years apply this knowledge to the diagnosis and management of clinical problems This traditional approach has been criticised for a number of reasons42223

bull It creates an artificial divide between the basic and clinical sciences

bull Time is wasted in acquiring knowledge that is subsequently forgotten or found to be irrelevant

bull Application of the acquired knowledge can be difficult bull The acquisition and retention of information that has no

apparent relevance can be boring and even demoralising for students

The group learning process acquiring

desirable learning skills

Generic Skills amp attitudes

bull Teamwork bull Critical evaluation of literature bull Chairing a group bull Self directed learning and use of

resources bull Listening Presentation skills

Recording bull Cooperation bull Respect for colleagues views

bull Group learning facilitates not only the acquisition of knowledge but also several other desirable attributes such as communication skills teamwork problem solving independent responsibility for learning sharing information and respect for others PBL can therefore be thought of as a small group teaching method that combines the acquisition of knowledge with the development of generic skills and attitudes Presentation of clinical material as the stimulus for learning enables students to understand the relevance of underlying scientific knowledge and principles in clinical practice

bull when PBL is introduced into a curriculum several other issues for curriculum design and implementation need to be tackled PBL is generally introduced in the context of a defined core curriculum and integration of basic and clinical sciences It has implications for staffing and learning resources and demands a different approach to timetabling workload and assessment PBL is often used to deliver core material in non-clinical parts of the curriculum Paper based PBL scenarios form the basis of the core curriculum and ensure that all students are exposed to the same problems Recently modified PBL techniques have been introduced into clinical education with real patients being used as the stimulus for learning Despite the essential ad hoc nature of learning clinical medicine a key cases approach can enable PBL to be used to deliver the core clinical curriculum

Copyright copy2003 BMJ Publishing Group Ltd

Wood D F BMJ 2003326328-330

No CRoles of participants in a PBL tutorial aption Found

What happens in a PBL tutorial bull PBL tutorials are conducted in several ways In

this article the examples are modelled on the Maastricht seven jump process but its format of seven steps may be shortened

bull A typical PBL tutorial consists of a group of students (usually eight to 10) and a tutor who facilitates the session The length of time (number of sessions) that a group stays together with each other and with individual tutors varies between institutions A group needs to be together long enough to allow good group dynamics to develop but may need to be changed occasionally if personality clashes or other dysfunctional behaviour emerges

bull Students elect a chair for each PBL scenario and a scribe to record the discussion The roles are rotated for each scenario Suitable flip charts or a whiteboard should be used for recording the proceedings At the start of the session depending on the trigger material either the student chair reads out the scenario or all students study the material If the trigger is a real patient in a ward clinic or surgery then a student may be asked to take a clinical history or identify an abnormal physical sign before the group moves to a tutorial room For each module students may be given a handbook containing the problem scenarios and suggested learning resources or learning materials may be handed out at appropriate times as the tutorials progress

Examples of trigger material for PBL scenarios bull Paper based clinical scenarios bull Experimental or clinical laboratory data bull Photographs bull Video clips bull Newspaper articles bull All or part of an article from a scientific

journal bull A real or simulated patient bull A family tree showing an inherited

disorder

PBL tutorial process ndash Step 1 Identify and clarify unfamiliar terms presented in the scenario

scribe lists those that remain unexplained after discussion ndash Step 2 Define the problem or problems to be discussed students may

have different views on the issues but all should be considered scribe records a list of agreed problems

ndash Step 3 Brainstorming session to discuss the problem(s) suggestingpossible explanations on basis of prior knowledge students draw on each others knowledge and identify areas of incomplete knowledge scribe records all discussion

ndash Step 4 Review steps 2 and 3 and arrange explanations into tentativesolutions scribe organises the explanations and restructures if necessary

ndash Step 5 Formulate learning objectives group reaches consensus onthe learning objectives tutor ensures learning objectives are focused achievable comprehensive and appropriate

ndash Step 6 Private study (all students gather information related to eachlearning objective)

ndash Step 7 Group shares results of private study (students identify theirlearning resources and share their results) tutor checks learning and may assess the group

bull The role of the tutor is to facilitate the proceedings (helping the chair to maintain group dynamics and moving the group through the task) and to ensure that the group achieves appropriate learning objectives in line with those set by the curriculum design team The tutor may need to take a more active role in step 7 of the process to ensure that all the students have done the appropriate work and to help the chair to suggest a suitable format for group members to use to present the results of their private study The tutor should encourage students to check their understanding of the material He or she can do this by encouraging the students to ask open questions and ask each other to explain topics in their own words or by the use of drawings and diagrams

PBL in curriculum design bull PBL may be used either as the mainstay of an entire

curriculum or for the delivery of individual courses In practice PBL is usually part of an integrated curriculum using a systems based approach with non-clinical material delivered in the context of clinical practice A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge skills and attitudes A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios Sufficient time should be allowed each week for students to do the self directed learning required for PBL

bull

Copyright copy2003 BMJ Publishing Group Ltd

Wood D F BMJ 2003326328-330

No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found

Writing PBL scenarios

bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives

bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after

studying the scenario should be consistent with the faculty learning objectives

bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding

bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice

bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge

bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented

bull The problem should be sufficiently open so that discussion is not curtailed too early in the process

bull Scenarios should promote participation by the students in seeking information from various learning resources

bull Adapted from Dolmans et al Med Teacher 199719185-9

Staff development

bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)

A dysfunctional group a dominant character may

make it difficult for other students to be heard

A dysfunctional group a dominant character may make it difficult for other students to be heard

bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties

Advantages of PBL bull Student centred PBLIt fostersactive learning improved

understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks

Disadvantagesbull Tutors who cant teachTutorsenjoy passing on

their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful

Assessment of PBL

bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods

bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL

Conclusion

bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning

bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL

PBL 5 Easy Steps

bull Read the problem

Mrs Paula Embledon

Mrs Paula Embledon is a 78 year old woman who has come to the emergency room complaining of shortness of breath and pain in her chest She had been in relatively good health until three weeks previously when she sprained

2 Brain storm

bull Brainstorm

bull ndash hypotheses

bull - what do we know in support of the hypothesis

bull - what do we need to know to test the hypothesis

ndash learning issues

Brainstorm

bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)

ndash specific issues (for individuals to look up)

ndash overlapping issues

bull 4 Individual Reading - Research - Preparation

bull 5 Return

bull ndash review case so far ndash report and discuss

ndash assess progress - continue pagenext pagecomplete

ndash self-evaluation - How did things go Any suggestions for next time

ndash next problem

bull 5 Return

THE FIRST GROUP SESSION

bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day

bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session

bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr

bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine

bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise

bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator

bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues

bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know

bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)

bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)

bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)

  • PROBLEM BASED LEARNING
  • New Horizons in Medical Education
  • Slide 3
  • Domains of essential Global Requirements of ME
  • What was the response to these challenges
  • New Educational Strategies
  • New Tools amp Aids
  • PBL
  • PBL
  • Advantages
  • Slide 11
  • Slide 12
  • Slide 13
  • Slide 14
  • Framework for PBL
  • Framework for PBL - II
  • Characteristics of an effective PBL Group
  • Staff Development
  • Tutorrsquos Role in Assessment
  • Slide 20
  • Evaluating PBL Tutorials-II
  • PBL
  • Slide 23
  • PBL Starting the case
  • PBL Case (contd)
  • PBL Case contd
  • The Process of PBL
  • The Process of PBL contd
  • Learn from each other
  • Determine priorities for learning
  • Slide 31
  • Slide 32
  • Learning Issues
  • Learning Issues in PBL First Session
  • PBL Second Session
  • PBL Third Session
  • Slide 37
  • Slide 38
  • During Tutorial Session students will
  • Tutorial Session contd
  • Between Tutorial Session
  • Slide 42
  • Slide 43
  • Problem-based learning is designed to develop
  • Slide 45
  • What is problem based learning
  • Slide 47
  • Slide 48
  • Slide 49
  • Rationale for using PBL
  • Slide 51
  • Slide 52
  • The group learning process acquiring desirable learning skills
  • Generic Skills amp attitudes
  • Slide 55
  • Slide 56
  • Slide 57
  • What happens in a PBL tutorial
  • Slide 59
  • Examples of trigger material for PBL scenarios
  • PBL tutorial process
  • Slide 62
  • PBL in curriculum design
  • Slide 64
  • Writing PBL scenarios
  • Slide 66
  • Staff development
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • Slide 70
  • Advantages of PBL
  • Slide 72
  • Slide 73
  • Disadvantages
  • Assessment of PBL
  • Slide 76
  • Conclusion
  • Slide 78
  • PBL 5 Easy Steps
  • 2 Brain storm
  • Brainstorm
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • THE FIRST GROUP SESSION
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
Page 5: Problem based learning

What was the response to these challenges

bull The development of new curricula incorporating new curriculum themes amp different educational strategies

bull The introduction of new learning situations amp the use of new tools amp aids to learning

bull New methods of assessment [OSCE objective structured clinical exam Which can test performance amp competence in a wide diversity of settings Formative Assessment Portfolio assessment Work-based assess]

New Educational Strategies

bull New strategies appropriate for adult learning (instead of spoon-feeding)

bull Self-directed learningbull Problem Based Learningbull Integrated system based approachbull Task Based learningbull Core amp Student-selected

Componentsbull A spiral curriculum

New Tools amp Aids

bull Use of Study Guides

bull Use of Computer Assisted Programs amp Internet

bull Use of Videos to teach Clinical Skillsconsultation techniques

bull Role of Simulators amp Simulations in aspects of physical exam amp practical procedures

PBLbull Problem-based learning (PBL) is a method of

learning in which learners first encounter a problem followed by a systematic learner-centered inquiry and reflection process

bull PBL is a method designed to help students learn the sciences basic to medicine at the same time they develop the reasoning process used by physicians and other health professionals in their clinical practice

bull 1048708 The problem comes first without advance readings lectures or preparation

bull 1048708 The problem serves as a stimulus for the need to know

PBLbullHelps learners build a bridge

between what they already know and what they need to know to reachthe next level

bull Emphasizing active learning which has been shown to be more satisfying than

passive teacher-to-student learning and to enhance retention and recall

bull Emphasizing student-centered learning in which students are actively involved in setting their own learning goals

Advantages

Encourages bull effective amp self-directed learningbull Critical thinkingbull Team workbull understanding rather than

memorizationbull Facility with professional languagebull Both students amp staff enjoy the

process

Advantages

In preparing students for professional practice PBL

bull Encourages independence as students identify amp meet individual learning needs

bull Stimulates reflection amp self-direction for life-long learning

bull Supports ongoing self-assessmentbull Introduces clinical reasoningbull Enhances critical thinking amp evidence-based

decision makingbull Ensures that knowledge is transferred applied

amp retained by providing a relevant integrated context

bull A problem initiates the activitybull The Group is stimulated to explore

basic scientific amp clinical mechanisms together with social psychological ethical or professional issues

bull Problem stimulates students to reason think critically amp weigh evidence they seek out amp share relevant info

PBL

bull Groups do not need prior knowledge to generate lively ideas as they identify areas for further collective amp personal learning

bull Each student brings individual experience amp makes a distinctive contribution

bull the Tutorrsquos role is to manage interactions rather than supply info

bull An effective Group provides a safe environment for sharing amp testing new knowledge

bull Students practice the language of science amp medicine evaluate ideas and receive feedback from peers amp teacher

bull When clinical exposure is introduced concurrently intellectual amp practical skills develop in parallel

Framework for PBL

bull A trigger initiates the problem (papercomputervideo)

bull Groups brainstorm to identify key issues for discussion

bull Broad thinking produces a rich array of mechanisms amp ideas

bull Hypothesis are critically explored through reasoning

bull The need for additional info is identifiedbull A Conclusion is reachedbull Group reviews the process

Framework for PBL - II

bull In Breaks between Tutorials students identfy Learning Issues to be pursued

bull They are encouraged to adot an evidence-based approach

bull When they reconvene they share and review the learning

Characteristics of an effective PBL Group

An Effective Group is Cohesive motivated mutually supportive amp actively engaged in learning

bull The Group understands the process amp energetically pursues its task

bull Members respect each otherrsquos contribution but examine them critically

bull Discussions flow as students cooperate rather than compete

bull The atmosphere is friendly amp good humouredbull Roles are shared all take turns in scribing

leading discussion taking responsibility for acquiring information

Staff Development

bull Basic training is mandatorybull Further development may be a requirementbull Initial training may involve observation amp

practice with a group from the programbull Effective training ensures that necessary

background goals amp local strategies are considered together with info on assessment amp evaluation

bull In addition to materials supplied to students tutors are usually issued with handbooks highlighting issues for each problem

Tutorrsquos Role in Assessment

bull Individual StudentsGroups may be assessed Summatively (determining progression) or formatively (for feedback)

The GROUP

bull At the end of each problem groups review their processes to encourage self-reflection ampenhance their collective performance

Tutorrsquos Role in Assessment

Individual students

bull Tutors should provide formative feedback to each member

bull Ask students to complete a simple self-assessment questionnaire reviewing appropriate behaviors the tutor returns them with comments

bull Students will be a writtenoralclinical tests that will determine their progression amp ultimate graduation

Evaluating PBL Tutorials-II

bull At the end of each problem time is allocated for evaluation

bull Both the process amp learning in PBL can be evaluated against explicit goals

bull The tutorrsquos review of effectiveness of group processes offers insight for the members

bull Students normally evaluate their tutor helpfulness support for clinical reasoning encouragement for independent learning appropriate intervention provision for effective feedback

PBLbull 1048708 Enabling students to learn in the context in which the

information will be used which increases the ability to retrieve and apply information

bull 1048708 Focusing on important concepts which helps learners organize and store new information in a way that facilitates retrieval and application

bull 1048708 Exploring prior knowledge formulating inquiries derived from and defined by the learnersrsquo need to know and actively constructing meaning through dialogue and reflection

bull 1048708 Utilizing problems designed to simulate studentsrsquo perception of their future profession which serves as a powerful stimulus for studentsrsquo intrinsic motivation to learn

bull 1048708 Actively involving students in monitoring their own progress and reflecting on what works and what needs improvement frequently assessing student performance and providing feedback

PBL Starting the casebull After the introductions and discussion

are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it

bull Reading the case aloud keeps the group focused

bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here

PBL Case (contd)

bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session

PBL Case contdbull SECOND deciding which issues everyone will

tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)

bull THIRD deciding what SPECIFIC questions individuals will try to answer

bull FOURTH deciding how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet or consulting an expert)

The Process of PBL

bullWhat are the issues Identify the important issues in the problem

bull How well do you understand the issues

bull Are there any words or terms about which you are unclear

The Process of PBL contd

bull Consider the basic mechanisms that might explain each important aspect of each problem

bull Assess your current understanding of the basic structural andor functional mechanisms that may contribute to the presentation of the problem

bull Use the collective skills and experiences of group members to explore or explain these phenomena Identify current gaps in knowledge or understanding

Learn from each other

bullShare your own knowledge expertise or ability to reason and synthesize information Be receptive and appreciative of the contribution of your small group members

Determine priorities for learning

bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue

bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan

bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge

bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career

PBL

bull The problem comes first without advance readings lectures or preparation

bull The problem serves as a stimulus for the need to know

Learning Issues

bull Learning issues are questions that cannot be answered with studentsrsquo current knowledge and that can be explored and answered through systematic self-directed inquiry

bull The use of learning issues in tutorials prepares students to handle similar challenges in clinical practice and life-long learning

Learning Issues in PBL First Session1 Getting Started (Introductions Ground

Rules Expectations)2 Identifying Problem3 Exploring Pre-Existing Knowledge4 Generating Hypotheses and Explaining

Mechanisms5 Unfolding the Case Incrementally6 Re-EvaluatingReprioritizing Hypotheses

Based on New Information7 AssessmentReflection

PBL Second Session

8 Independent Self-Directed Study of Learning Issues

PBL Third Session

bull 9 Discussion of Learning Issues and Application of New Knowledge to the Case

bull 10 Continued Unfolding of the Case Incrementally

bull 11 AssessmentReflection

During Tutorial Session students will

1048708 Come prepared to discuss the case and learning issues researched since the last tutorial

1048708 Actively participate in group discussions and contribute to the learning process in a manner that allows for the balanced participation of everyone in the group

1048708 Develop learning issues at each session phrase them as full-sentence questions write them on the board and post them on the course web page

1048708 Consider biological population behaviormental health issuesexplanations and questions of professional attitudes values and ethics related to the patientrsquos problem(s) described in the case

Tutorial Session contd1048708 Go to the board to diagram outline draw etc in

explanation of mechanisms relatedto hypotheses1048708 Debate evidence related to the case and avoid

personal attacks on others1048708 Comply with ground rules with regard to how

the group will function and how itsmembers treat one another1048708 Participate in end-of-session reflection and

assessment by giving and receivingconstructive criticism regarding self tutor

student and group performance

Between Tutorial Session

1048708 Research key learning issues using a variety of resources

1048708 Critically evaluate the credibility of sources and the validity of the information they have obtained in their research

1048708 Integrate what they have learned through research lectures labs clinical skills Perspectives in Medicine (PIM) etc into what is discussed in tutorials

1048708 Synthesize what they have learned and be prepared to discuss it without reading directly from their materials as much as possible and apply it to the case at the next tutorial session

Determine priorities for learning

bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue

bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan

bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge

bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career

PBL Starting the casebull After the introductions and discussion

are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it

bull Reading the case aloud keeps the group focused

bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here

Problem-based learning is designed to develop

1048708 Integrated context-specific knowledge base

1048708 Decision-makingcritical thinking process and skills

1048708 Self-directed life-long learning skills 1048708 Interpersonal collaboration and

communication skills 1048708 Constructive self and peer

assessment skills 1048708 Professional ethics and behavior

PBL Case (contd)

bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session

What is problem based learning

bull In PBL students use triggers from the problem case or scenario to define their own learning objectives

bull Subsequently they do independent self directed study before returning to the group to discuss and refine their acquired knowledge

bull Thus PBL is not about problem solving per se but rather it uses appropriate problems to increase knowledge and understanding

bull The process is clearly defined

PBL

bull PBL uses clinical cases as the context for students to study basic and clinical sciences

bull Its possible advantages over traditional approaches include its greater relevance to the practice of medicine its ability to promote retention and application of knowledge and its encouragement of self-directed life-long learning

bull Possible disadvantages include higher costs both in resources and staff time

PBL

bull An educational method characterized by the use of patient problems as a context for students to learn problem-solving skills and acquire knowledge about the basic and clinical sciences

bull Students usually meet in small groups two or three times a week for PBL tutorials

bull They are presented with a clinical problem (eg a patient with chest pain) and in a series of steps they discuss possible mechanisms and causes develop hypotheses and strategies to test the hypotheses are presented with further information and use this new information to refine their hypotheses finally reaching a conclusion

bull A tutor usually acts as a facilitator guiding students in this group-learning process

bull In the course of this exercise students identify both their existing levels and gaps in their knowledge These gaps form the basis for independent learning outside the PBL tutorials The identification and pursuit of these so-called learning goals is a key element of the PBL process

Rationale for using PBL bull The PBL approach is based on principles of adult

education20 and cognitive psychology21 It differs fundamentally from traditional curricula in which students acquire background knowledge of the basic sciences in the early years of the course and in the later years apply this knowledge to the diagnosis and management of clinical problems This traditional approach has been criticised for a number of reasons42223

bull It creates an artificial divide between the basic and clinical sciences

bull Time is wasted in acquiring knowledge that is subsequently forgotten or found to be irrelevant

bull Application of the acquired knowledge can be difficult bull The acquisition and retention of information that has no

apparent relevance can be boring and even demoralising for students

The group learning process acquiring

desirable learning skills

Generic Skills amp attitudes

bull Teamwork bull Critical evaluation of literature bull Chairing a group bull Self directed learning and use of

resources bull Listening Presentation skills

Recording bull Cooperation bull Respect for colleagues views

bull Group learning facilitates not only the acquisition of knowledge but also several other desirable attributes such as communication skills teamwork problem solving independent responsibility for learning sharing information and respect for others PBL can therefore be thought of as a small group teaching method that combines the acquisition of knowledge with the development of generic skills and attitudes Presentation of clinical material as the stimulus for learning enables students to understand the relevance of underlying scientific knowledge and principles in clinical practice

bull when PBL is introduced into a curriculum several other issues for curriculum design and implementation need to be tackled PBL is generally introduced in the context of a defined core curriculum and integration of basic and clinical sciences It has implications for staffing and learning resources and demands a different approach to timetabling workload and assessment PBL is often used to deliver core material in non-clinical parts of the curriculum Paper based PBL scenarios form the basis of the core curriculum and ensure that all students are exposed to the same problems Recently modified PBL techniques have been introduced into clinical education with real patients being used as the stimulus for learning Despite the essential ad hoc nature of learning clinical medicine a key cases approach can enable PBL to be used to deliver the core clinical curriculum

Copyright copy2003 BMJ Publishing Group Ltd

Wood D F BMJ 2003326328-330

No CRoles of participants in a PBL tutorial aption Found

What happens in a PBL tutorial bull PBL tutorials are conducted in several ways In

this article the examples are modelled on the Maastricht seven jump process but its format of seven steps may be shortened

bull A typical PBL tutorial consists of a group of students (usually eight to 10) and a tutor who facilitates the session The length of time (number of sessions) that a group stays together with each other and with individual tutors varies between institutions A group needs to be together long enough to allow good group dynamics to develop but may need to be changed occasionally if personality clashes or other dysfunctional behaviour emerges

bull Students elect a chair for each PBL scenario and a scribe to record the discussion The roles are rotated for each scenario Suitable flip charts or a whiteboard should be used for recording the proceedings At the start of the session depending on the trigger material either the student chair reads out the scenario or all students study the material If the trigger is a real patient in a ward clinic or surgery then a student may be asked to take a clinical history or identify an abnormal physical sign before the group moves to a tutorial room For each module students may be given a handbook containing the problem scenarios and suggested learning resources or learning materials may be handed out at appropriate times as the tutorials progress

Examples of trigger material for PBL scenarios bull Paper based clinical scenarios bull Experimental or clinical laboratory data bull Photographs bull Video clips bull Newspaper articles bull All or part of an article from a scientific

journal bull A real or simulated patient bull A family tree showing an inherited

disorder

PBL tutorial process ndash Step 1 Identify and clarify unfamiliar terms presented in the scenario

scribe lists those that remain unexplained after discussion ndash Step 2 Define the problem or problems to be discussed students may

have different views on the issues but all should be considered scribe records a list of agreed problems

ndash Step 3 Brainstorming session to discuss the problem(s) suggestingpossible explanations on basis of prior knowledge students draw on each others knowledge and identify areas of incomplete knowledge scribe records all discussion

ndash Step 4 Review steps 2 and 3 and arrange explanations into tentativesolutions scribe organises the explanations and restructures if necessary

ndash Step 5 Formulate learning objectives group reaches consensus onthe learning objectives tutor ensures learning objectives are focused achievable comprehensive and appropriate

ndash Step 6 Private study (all students gather information related to eachlearning objective)

ndash Step 7 Group shares results of private study (students identify theirlearning resources and share their results) tutor checks learning and may assess the group

bull The role of the tutor is to facilitate the proceedings (helping the chair to maintain group dynamics and moving the group through the task) and to ensure that the group achieves appropriate learning objectives in line with those set by the curriculum design team The tutor may need to take a more active role in step 7 of the process to ensure that all the students have done the appropriate work and to help the chair to suggest a suitable format for group members to use to present the results of their private study The tutor should encourage students to check their understanding of the material He or she can do this by encouraging the students to ask open questions and ask each other to explain topics in their own words or by the use of drawings and diagrams

PBL in curriculum design bull PBL may be used either as the mainstay of an entire

curriculum or for the delivery of individual courses In practice PBL is usually part of an integrated curriculum using a systems based approach with non-clinical material delivered in the context of clinical practice A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge skills and attitudes A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios Sufficient time should be allowed each week for students to do the self directed learning required for PBL

bull

Copyright copy2003 BMJ Publishing Group Ltd

Wood D F BMJ 2003326328-330

No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found

Writing PBL scenarios

bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives

bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after

studying the scenario should be consistent with the faculty learning objectives

bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding

bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice

bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge

bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented

bull The problem should be sufficiently open so that discussion is not curtailed too early in the process

bull Scenarios should promote participation by the students in seeking information from various learning resources

bull Adapted from Dolmans et al Med Teacher 199719185-9

Staff development

bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)

A dysfunctional group a dominant character may

make it difficult for other students to be heard

A dysfunctional group a dominant character may make it difficult for other students to be heard

bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties

Advantages of PBL bull Student centred PBLIt fostersactive learning improved

understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks

Disadvantagesbull Tutors who cant teachTutorsenjoy passing on

their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful

Assessment of PBL

bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods

bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL

Conclusion

bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning

bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL

PBL 5 Easy Steps

bull Read the problem

Mrs Paula Embledon

Mrs Paula Embledon is a 78 year old woman who has come to the emergency room complaining of shortness of breath and pain in her chest She had been in relatively good health until three weeks previously when she sprained

2 Brain storm

bull Brainstorm

bull ndash hypotheses

bull - what do we know in support of the hypothesis

bull - what do we need to know to test the hypothesis

ndash learning issues

Brainstorm

bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)

ndash specific issues (for individuals to look up)

ndash overlapping issues

bull 4 Individual Reading - Research - Preparation

bull 5 Return

bull ndash review case so far ndash report and discuss

ndash assess progress - continue pagenext pagecomplete

ndash self-evaluation - How did things go Any suggestions for next time

ndash next problem

bull 5 Return

THE FIRST GROUP SESSION

bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day

bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session

bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr

bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine

bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise

bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator

bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues

bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know

bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)

bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)

bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)

  • PROBLEM BASED LEARNING
  • New Horizons in Medical Education
  • Slide 3
  • Domains of essential Global Requirements of ME
  • What was the response to these challenges
  • New Educational Strategies
  • New Tools amp Aids
  • PBL
  • PBL
  • Advantages
  • Slide 11
  • Slide 12
  • Slide 13
  • Slide 14
  • Framework for PBL
  • Framework for PBL - II
  • Characteristics of an effective PBL Group
  • Staff Development
  • Tutorrsquos Role in Assessment
  • Slide 20
  • Evaluating PBL Tutorials-II
  • PBL
  • Slide 23
  • PBL Starting the case
  • PBL Case (contd)
  • PBL Case contd
  • The Process of PBL
  • The Process of PBL contd
  • Learn from each other
  • Determine priorities for learning
  • Slide 31
  • Slide 32
  • Learning Issues
  • Learning Issues in PBL First Session
  • PBL Second Session
  • PBL Third Session
  • Slide 37
  • Slide 38
  • During Tutorial Session students will
  • Tutorial Session contd
  • Between Tutorial Session
  • Slide 42
  • Slide 43
  • Problem-based learning is designed to develop
  • Slide 45
  • What is problem based learning
  • Slide 47
  • Slide 48
  • Slide 49
  • Rationale for using PBL
  • Slide 51
  • Slide 52
  • The group learning process acquiring desirable learning skills
  • Generic Skills amp attitudes
  • Slide 55
  • Slide 56
  • Slide 57
  • What happens in a PBL tutorial
  • Slide 59
  • Examples of trigger material for PBL scenarios
  • PBL tutorial process
  • Slide 62
  • PBL in curriculum design
  • Slide 64
  • Writing PBL scenarios
  • Slide 66
  • Staff development
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • Slide 70
  • Advantages of PBL
  • Slide 72
  • Slide 73
  • Disadvantages
  • Assessment of PBL
  • Slide 76
  • Conclusion
  • Slide 78
  • PBL 5 Easy Steps
  • 2 Brain storm
  • Brainstorm
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • THE FIRST GROUP SESSION
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
Page 6: Problem based learning

New Educational Strategies

bull New strategies appropriate for adult learning (instead of spoon-feeding)

bull Self-directed learningbull Problem Based Learningbull Integrated system based approachbull Task Based learningbull Core amp Student-selected

Componentsbull A spiral curriculum

New Tools amp Aids

bull Use of Study Guides

bull Use of Computer Assisted Programs amp Internet

bull Use of Videos to teach Clinical Skillsconsultation techniques

bull Role of Simulators amp Simulations in aspects of physical exam amp practical procedures

PBLbull Problem-based learning (PBL) is a method of

learning in which learners first encounter a problem followed by a systematic learner-centered inquiry and reflection process

bull PBL is a method designed to help students learn the sciences basic to medicine at the same time they develop the reasoning process used by physicians and other health professionals in their clinical practice

bull 1048708 The problem comes first without advance readings lectures or preparation

bull 1048708 The problem serves as a stimulus for the need to know

PBLbullHelps learners build a bridge

between what they already know and what they need to know to reachthe next level

bull Emphasizing active learning which has been shown to be more satisfying than

passive teacher-to-student learning and to enhance retention and recall

bull Emphasizing student-centered learning in which students are actively involved in setting their own learning goals

Advantages

Encourages bull effective amp self-directed learningbull Critical thinkingbull Team workbull understanding rather than

memorizationbull Facility with professional languagebull Both students amp staff enjoy the

process

Advantages

In preparing students for professional practice PBL

bull Encourages independence as students identify amp meet individual learning needs

bull Stimulates reflection amp self-direction for life-long learning

bull Supports ongoing self-assessmentbull Introduces clinical reasoningbull Enhances critical thinking amp evidence-based

decision makingbull Ensures that knowledge is transferred applied

amp retained by providing a relevant integrated context

bull A problem initiates the activitybull The Group is stimulated to explore

basic scientific amp clinical mechanisms together with social psychological ethical or professional issues

bull Problem stimulates students to reason think critically amp weigh evidence they seek out amp share relevant info

PBL

bull Groups do not need prior knowledge to generate lively ideas as they identify areas for further collective amp personal learning

bull Each student brings individual experience amp makes a distinctive contribution

bull the Tutorrsquos role is to manage interactions rather than supply info

bull An effective Group provides a safe environment for sharing amp testing new knowledge

bull Students practice the language of science amp medicine evaluate ideas and receive feedback from peers amp teacher

bull When clinical exposure is introduced concurrently intellectual amp practical skills develop in parallel

Framework for PBL

bull A trigger initiates the problem (papercomputervideo)

bull Groups brainstorm to identify key issues for discussion

bull Broad thinking produces a rich array of mechanisms amp ideas

bull Hypothesis are critically explored through reasoning

bull The need for additional info is identifiedbull A Conclusion is reachedbull Group reviews the process

Framework for PBL - II

bull In Breaks between Tutorials students identfy Learning Issues to be pursued

bull They are encouraged to adot an evidence-based approach

bull When they reconvene they share and review the learning

Characteristics of an effective PBL Group

An Effective Group is Cohesive motivated mutually supportive amp actively engaged in learning

bull The Group understands the process amp energetically pursues its task

bull Members respect each otherrsquos contribution but examine them critically

bull Discussions flow as students cooperate rather than compete

bull The atmosphere is friendly amp good humouredbull Roles are shared all take turns in scribing

leading discussion taking responsibility for acquiring information

Staff Development

bull Basic training is mandatorybull Further development may be a requirementbull Initial training may involve observation amp

practice with a group from the programbull Effective training ensures that necessary

background goals amp local strategies are considered together with info on assessment amp evaluation

bull In addition to materials supplied to students tutors are usually issued with handbooks highlighting issues for each problem

Tutorrsquos Role in Assessment

bull Individual StudentsGroups may be assessed Summatively (determining progression) or formatively (for feedback)

The GROUP

bull At the end of each problem groups review their processes to encourage self-reflection ampenhance their collective performance

Tutorrsquos Role in Assessment

Individual students

bull Tutors should provide formative feedback to each member

bull Ask students to complete a simple self-assessment questionnaire reviewing appropriate behaviors the tutor returns them with comments

bull Students will be a writtenoralclinical tests that will determine their progression amp ultimate graduation

Evaluating PBL Tutorials-II

bull At the end of each problem time is allocated for evaluation

bull Both the process amp learning in PBL can be evaluated against explicit goals

bull The tutorrsquos review of effectiveness of group processes offers insight for the members

bull Students normally evaluate their tutor helpfulness support for clinical reasoning encouragement for independent learning appropriate intervention provision for effective feedback

PBLbull 1048708 Enabling students to learn in the context in which the

information will be used which increases the ability to retrieve and apply information

bull 1048708 Focusing on important concepts which helps learners organize and store new information in a way that facilitates retrieval and application

bull 1048708 Exploring prior knowledge formulating inquiries derived from and defined by the learnersrsquo need to know and actively constructing meaning through dialogue and reflection

bull 1048708 Utilizing problems designed to simulate studentsrsquo perception of their future profession which serves as a powerful stimulus for studentsrsquo intrinsic motivation to learn

bull 1048708 Actively involving students in monitoring their own progress and reflecting on what works and what needs improvement frequently assessing student performance and providing feedback

PBL Starting the casebull After the introductions and discussion

are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it

bull Reading the case aloud keeps the group focused

bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here

PBL Case (contd)

bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session

PBL Case contdbull SECOND deciding which issues everyone will

tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)

bull THIRD deciding what SPECIFIC questions individuals will try to answer

bull FOURTH deciding how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet or consulting an expert)

The Process of PBL

bullWhat are the issues Identify the important issues in the problem

bull How well do you understand the issues

bull Are there any words or terms about which you are unclear

The Process of PBL contd

bull Consider the basic mechanisms that might explain each important aspect of each problem

bull Assess your current understanding of the basic structural andor functional mechanisms that may contribute to the presentation of the problem

bull Use the collective skills and experiences of group members to explore or explain these phenomena Identify current gaps in knowledge or understanding

Learn from each other

bullShare your own knowledge expertise or ability to reason and synthesize information Be receptive and appreciative of the contribution of your small group members

Determine priorities for learning

bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue

bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan

bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge

bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career

PBL

bull The problem comes first without advance readings lectures or preparation

bull The problem serves as a stimulus for the need to know

Learning Issues

bull Learning issues are questions that cannot be answered with studentsrsquo current knowledge and that can be explored and answered through systematic self-directed inquiry

bull The use of learning issues in tutorials prepares students to handle similar challenges in clinical practice and life-long learning

Learning Issues in PBL First Session1 Getting Started (Introductions Ground

Rules Expectations)2 Identifying Problem3 Exploring Pre-Existing Knowledge4 Generating Hypotheses and Explaining

Mechanisms5 Unfolding the Case Incrementally6 Re-EvaluatingReprioritizing Hypotheses

Based on New Information7 AssessmentReflection

PBL Second Session

8 Independent Self-Directed Study of Learning Issues

PBL Third Session

bull 9 Discussion of Learning Issues and Application of New Knowledge to the Case

bull 10 Continued Unfolding of the Case Incrementally

bull 11 AssessmentReflection

During Tutorial Session students will

1048708 Come prepared to discuss the case and learning issues researched since the last tutorial

1048708 Actively participate in group discussions and contribute to the learning process in a manner that allows for the balanced participation of everyone in the group

1048708 Develop learning issues at each session phrase them as full-sentence questions write them on the board and post them on the course web page

1048708 Consider biological population behaviormental health issuesexplanations and questions of professional attitudes values and ethics related to the patientrsquos problem(s) described in the case

Tutorial Session contd1048708 Go to the board to diagram outline draw etc in

explanation of mechanisms relatedto hypotheses1048708 Debate evidence related to the case and avoid

personal attacks on others1048708 Comply with ground rules with regard to how

the group will function and how itsmembers treat one another1048708 Participate in end-of-session reflection and

assessment by giving and receivingconstructive criticism regarding self tutor

student and group performance

Between Tutorial Session

1048708 Research key learning issues using a variety of resources

1048708 Critically evaluate the credibility of sources and the validity of the information they have obtained in their research

1048708 Integrate what they have learned through research lectures labs clinical skills Perspectives in Medicine (PIM) etc into what is discussed in tutorials

1048708 Synthesize what they have learned and be prepared to discuss it without reading directly from their materials as much as possible and apply it to the case at the next tutorial session

Determine priorities for learning

bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue

bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan

bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge

bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career

PBL Starting the casebull After the introductions and discussion

are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it

bull Reading the case aloud keeps the group focused

bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here

Problem-based learning is designed to develop

1048708 Integrated context-specific knowledge base

1048708 Decision-makingcritical thinking process and skills

1048708 Self-directed life-long learning skills 1048708 Interpersonal collaboration and

communication skills 1048708 Constructive self and peer

assessment skills 1048708 Professional ethics and behavior

PBL Case (contd)

bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session

What is problem based learning

bull In PBL students use triggers from the problem case or scenario to define their own learning objectives

bull Subsequently they do independent self directed study before returning to the group to discuss and refine their acquired knowledge

bull Thus PBL is not about problem solving per se but rather it uses appropriate problems to increase knowledge and understanding

bull The process is clearly defined

PBL

bull PBL uses clinical cases as the context for students to study basic and clinical sciences

bull Its possible advantages over traditional approaches include its greater relevance to the practice of medicine its ability to promote retention and application of knowledge and its encouragement of self-directed life-long learning

bull Possible disadvantages include higher costs both in resources and staff time

PBL

bull An educational method characterized by the use of patient problems as a context for students to learn problem-solving skills and acquire knowledge about the basic and clinical sciences

bull Students usually meet in small groups two or three times a week for PBL tutorials

bull They are presented with a clinical problem (eg a patient with chest pain) and in a series of steps they discuss possible mechanisms and causes develop hypotheses and strategies to test the hypotheses are presented with further information and use this new information to refine their hypotheses finally reaching a conclusion

bull A tutor usually acts as a facilitator guiding students in this group-learning process

bull In the course of this exercise students identify both their existing levels and gaps in their knowledge These gaps form the basis for independent learning outside the PBL tutorials The identification and pursuit of these so-called learning goals is a key element of the PBL process

Rationale for using PBL bull The PBL approach is based on principles of adult

education20 and cognitive psychology21 It differs fundamentally from traditional curricula in which students acquire background knowledge of the basic sciences in the early years of the course and in the later years apply this knowledge to the diagnosis and management of clinical problems This traditional approach has been criticised for a number of reasons42223

bull It creates an artificial divide between the basic and clinical sciences

bull Time is wasted in acquiring knowledge that is subsequently forgotten or found to be irrelevant

bull Application of the acquired knowledge can be difficult bull The acquisition and retention of information that has no

apparent relevance can be boring and even demoralising for students

The group learning process acquiring

desirable learning skills

Generic Skills amp attitudes

bull Teamwork bull Critical evaluation of literature bull Chairing a group bull Self directed learning and use of

resources bull Listening Presentation skills

Recording bull Cooperation bull Respect for colleagues views

bull Group learning facilitates not only the acquisition of knowledge but also several other desirable attributes such as communication skills teamwork problem solving independent responsibility for learning sharing information and respect for others PBL can therefore be thought of as a small group teaching method that combines the acquisition of knowledge with the development of generic skills and attitudes Presentation of clinical material as the stimulus for learning enables students to understand the relevance of underlying scientific knowledge and principles in clinical practice

bull when PBL is introduced into a curriculum several other issues for curriculum design and implementation need to be tackled PBL is generally introduced in the context of a defined core curriculum and integration of basic and clinical sciences It has implications for staffing and learning resources and demands a different approach to timetabling workload and assessment PBL is often used to deliver core material in non-clinical parts of the curriculum Paper based PBL scenarios form the basis of the core curriculum and ensure that all students are exposed to the same problems Recently modified PBL techniques have been introduced into clinical education with real patients being used as the stimulus for learning Despite the essential ad hoc nature of learning clinical medicine a key cases approach can enable PBL to be used to deliver the core clinical curriculum

Copyright copy2003 BMJ Publishing Group Ltd

Wood D F BMJ 2003326328-330

No CRoles of participants in a PBL tutorial aption Found

What happens in a PBL tutorial bull PBL tutorials are conducted in several ways In

this article the examples are modelled on the Maastricht seven jump process but its format of seven steps may be shortened

bull A typical PBL tutorial consists of a group of students (usually eight to 10) and a tutor who facilitates the session The length of time (number of sessions) that a group stays together with each other and with individual tutors varies between institutions A group needs to be together long enough to allow good group dynamics to develop but may need to be changed occasionally if personality clashes or other dysfunctional behaviour emerges

bull Students elect a chair for each PBL scenario and a scribe to record the discussion The roles are rotated for each scenario Suitable flip charts or a whiteboard should be used for recording the proceedings At the start of the session depending on the trigger material either the student chair reads out the scenario or all students study the material If the trigger is a real patient in a ward clinic or surgery then a student may be asked to take a clinical history or identify an abnormal physical sign before the group moves to a tutorial room For each module students may be given a handbook containing the problem scenarios and suggested learning resources or learning materials may be handed out at appropriate times as the tutorials progress

Examples of trigger material for PBL scenarios bull Paper based clinical scenarios bull Experimental or clinical laboratory data bull Photographs bull Video clips bull Newspaper articles bull All or part of an article from a scientific

journal bull A real or simulated patient bull A family tree showing an inherited

disorder

PBL tutorial process ndash Step 1 Identify and clarify unfamiliar terms presented in the scenario

scribe lists those that remain unexplained after discussion ndash Step 2 Define the problem or problems to be discussed students may

have different views on the issues but all should be considered scribe records a list of agreed problems

ndash Step 3 Brainstorming session to discuss the problem(s) suggestingpossible explanations on basis of prior knowledge students draw on each others knowledge and identify areas of incomplete knowledge scribe records all discussion

ndash Step 4 Review steps 2 and 3 and arrange explanations into tentativesolutions scribe organises the explanations and restructures if necessary

ndash Step 5 Formulate learning objectives group reaches consensus onthe learning objectives tutor ensures learning objectives are focused achievable comprehensive and appropriate

ndash Step 6 Private study (all students gather information related to eachlearning objective)

ndash Step 7 Group shares results of private study (students identify theirlearning resources and share their results) tutor checks learning and may assess the group

bull The role of the tutor is to facilitate the proceedings (helping the chair to maintain group dynamics and moving the group through the task) and to ensure that the group achieves appropriate learning objectives in line with those set by the curriculum design team The tutor may need to take a more active role in step 7 of the process to ensure that all the students have done the appropriate work and to help the chair to suggest a suitable format for group members to use to present the results of their private study The tutor should encourage students to check their understanding of the material He or she can do this by encouraging the students to ask open questions and ask each other to explain topics in their own words or by the use of drawings and diagrams

PBL in curriculum design bull PBL may be used either as the mainstay of an entire

curriculum or for the delivery of individual courses In practice PBL is usually part of an integrated curriculum using a systems based approach with non-clinical material delivered in the context of clinical practice A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge skills and attitudes A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios Sufficient time should be allowed each week for students to do the self directed learning required for PBL

bull

Copyright copy2003 BMJ Publishing Group Ltd

Wood D F BMJ 2003326328-330

No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found

Writing PBL scenarios

bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives

bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after

studying the scenario should be consistent with the faculty learning objectives

bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding

bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice

bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge

bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented

bull The problem should be sufficiently open so that discussion is not curtailed too early in the process

bull Scenarios should promote participation by the students in seeking information from various learning resources

bull Adapted from Dolmans et al Med Teacher 199719185-9

Staff development

bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)

A dysfunctional group a dominant character may

make it difficult for other students to be heard

A dysfunctional group a dominant character may make it difficult for other students to be heard

bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties

Advantages of PBL bull Student centred PBLIt fostersactive learning improved

understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks

Disadvantagesbull Tutors who cant teachTutorsenjoy passing on

their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful

Assessment of PBL

bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods

bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL

Conclusion

bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning

bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL

PBL 5 Easy Steps

bull Read the problem

Mrs Paula Embledon

Mrs Paula Embledon is a 78 year old woman who has come to the emergency room complaining of shortness of breath and pain in her chest She had been in relatively good health until three weeks previously when she sprained

2 Brain storm

bull Brainstorm

bull ndash hypotheses

bull - what do we know in support of the hypothesis

bull - what do we need to know to test the hypothesis

ndash learning issues

Brainstorm

bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)

ndash specific issues (for individuals to look up)

ndash overlapping issues

bull 4 Individual Reading - Research - Preparation

bull 5 Return

bull ndash review case so far ndash report and discuss

ndash assess progress - continue pagenext pagecomplete

ndash self-evaluation - How did things go Any suggestions for next time

ndash next problem

bull 5 Return

THE FIRST GROUP SESSION

bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day

bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session

bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr

bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine

bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise

bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator

bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues

bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know

bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)

bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)

bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)

  • PROBLEM BASED LEARNING
  • New Horizons in Medical Education
  • Slide 3
  • Domains of essential Global Requirements of ME
  • What was the response to these challenges
  • New Educational Strategies
  • New Tools amp Aids
  • PBL
  • PBL
  • Advantages
  • Slide 11
  • Slide 12
  • Slide 13
  • Slide 14
  • Framework for PBL
  • Framework for PBL - II
  • Characteristics of an effective PBL Group
  • Staff Development
  • Tutorrsquos Role in Assessment
  • Slide 20
  • Evaluating PBL Tutorials-II
  • PBL
  • Slide 23
  • PBL Starting the case
  • PBL Case (contd)
  • PBL Case contd
  • The Process of PBL
  • The Process of PBL contd
  • Learn from each other
  • Determine priorities for learning
  • Slide 31
  • Slide 32
  • Learning Issues
  • Learning Issues in PBL First Session
  • PBL Second Session
  • PBL Third Session
  • Slide 37
  • Slide 38
  • During Tutorial Session students will
  • Tutorial Session contd
  • Between Tutorial Session
  • Slide 42
  • Slide 43
  • Problem-based learning is designed to develop
  • Slide 45
  • What is problem based learning
  • Slide 47
  • Slide 48
  • Slide 49
  • Rationale for using PBL
  • Slide 51
  • Slide 52
  • The group learning process acquiring desirable learning skills
  • Generic Skills amp attitudes
  • Slide 55
  • Slide 56
  • Slide 57
  • What happens in a PBL tutorial
  • Slide 59
  • Examples of trigger material for PBL scenarios
  • PBL tutorial process
  • Slide 62
  • PBL in curriculum design
  • Slide 64
  • Writing PBL scenarios
  • Slide 66
  • Staff development
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • Slide 70
  • Advantages of PBL
  • Slide 72
  • Slide 73
  • Disadvantages
  • Assessment of PBL
  • Slide 76
  • Conclusion
  • Slide 78
  • PBL 5 Easy Steps
  • 2 Brain storm
  • Brainstorm
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • THE FIRST GROUP SESSION
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
Page 7: Problem based learning

New Tools amp Aids

bull Use of Study Guides

bull Use of Computer Assisted Programs amp Internet

bull Use of Videos to teach Clinical Skillsconsultation techniques

bull Role of Simulators amp Simulations in aspects of physical exam amp practical procedures

PBLbull Problem-based learning (PBL) is a method of

learning in which learners first encounter a problem followed by a systematic learner-centered inquiry and reflection process

bull PBL is a method designed to help students learn the sciences basic to medicine at the same time they develop the reasoning process used by physicians and other health professionals in their clinical practice

bull 1048708 The problem comes first without advance readings lectures or preparation

bull 1048708 The problem serves as a stimulus for the need to know

PBLbullHelps learners build a bridge

between what they already know and what they need to know to reachthe next level

bull Emphasizing active learning which has been shown to be more satisfying than

passive teacher-to-student learning and to enhance retention and recall

bull Emphasizing student-centered learning in which students are actively involved in setting their own learning goals

Advantages

Encourages bull effective amp self-directed learningbull Critical thinkingbull Team workbull understanding rather than

memorizationbull Facility with professional languagebull Both students amp staff enjoy the

process

Advantages

In preparing students for professional practice PBL

bull Encourages independence as students identify amp meet individual learning needs

bull Stimulates reflection amp self-direction for life-long learning

bull Supports ongoing self-assessmentbull Introduces clinical reasoningbull Enhances critical thinking amp evidence-based

decision makingbull Ensures that knowledge is transferred applied

amp retained by providing a relevant integrated context

bull A problem initiates the activitybull The Group is stimulated to explore

basic scientific amp clinical mechanisms together with social psychological ethical or professional issues

bull Problem stimulates students to reason think critically amp weigh evidence they seek out amp share relevant info

PBL

bull Groups do not need prior knowledge to generate lively ideas as they identify areas for further collective amp personal learning

bull Each student brings individual experience amp makes a distinctive contribution

bull the Tutorrsquos role is to manage interactions rather than supply info

bull An effective Group provides a safe environment for sharing amp testing new knowledge

bull Students practice the language of science amp medicine evaluate ideas and receive feedback from peers amp teacher

bull When clinical exposure is introduced concurrently intellectual amp practical skills develop in parallel

Framework for PBL

bull A trigger initiates the problem (papercomputervideo)

bull Groups brainstorm to identify key issues for discussion

bull Broad thinking produces a rich array of mechanisms amp ideas

bull Hypothesis are critically explored through reasoning

bull The need for additional info is identifiedbull A Conclusion is reachedbull Group reviews the process

Framework for PBL - II

bull In Breaks between Tutorials students identfy Learning Issues to be pursued

bull They are encouraged to adot an evidence-based approach

bull When they reconvene they share and review the learning

Characteristics of an effective PBL Group

An Effective Group is Cohesive motivated mutually supportive amp actively engaged in learning

bull The Group understands the process amp energetically pursues its task

bull Members respect each otherrsquos contribution but examine them critically

bull Discussions flow as students cooperate rather than compete

bull The atmosphere is friendly amp good humouredbull Roles are shared all take turns in scribing

leading discussion taking responsibility for acquiring information

Staff Development

bull Basic training is mandatorybull Further development may be a requirementbull Initial training may involve observation amp

practice with a group from the programbull Effective training ensures that necessary

background goals amp local strategies are considered together with info on assessment amp evaluation

bull In addition to materials supplied to students tutors are usually issued with handbooks highlighting issues for each problem

Tutorrsquos Role in Assessment

bull Individual StudentsGroups may be assessed Summatively (determining progression) or formatively (for feedback)

The GROUP

bull At the end of each problem groups review their processes to encourage self-reflection ampenhance their collective performance

Tutorrsquos Role in Assessment

Individual students

bull Tutors should provide formative feedback to each member

bull Ask students to complete a simple self-assessment questionnaire reviewing appropriate behaviors the tutor returns them with comments

bull Students will be a writtenoralclinical tests that will determine their progression amp ultimate graduation

Evaluating PBL Tutorials-II

bull At the end of each problem time is allocated for evaluation

bull Both the process amp learning in PBL can be evaluated against explicit goals

bull The tutorrsquos review of effectiveness of group processes offers insight for the members

bull Students normally evaluate their tutor helpfulness support for clinical reasoning encouragement for independent learning appropriate intervention provision for effective feedback

PBLbull 1048708 Enabling students to learn in the context in which the

information will be used which increases the ability to retrieve and apply information

bull 1048708 Focusing on important concepts which helps learners organize and store new information in a way that facilitates retrieval and application

bull 1048708 Exploring prior knowledge formulating inquiries derived from and defined by the learnersrsquo need to know and actively constructing meaning through dialogue and reflection

bull 1048708 Utilizing problems designed to simulate studentsrsquo perception of their future profession which serves as a powerful stimulus for studentsrsquo intrinsic motivation to learn

bull 1048708 Actively involving students in monitoring their own progress and reflecting on what works and what needs improvement frequently assessing student performance and providing feedback

PBL Starting the casebull After the introductions and discussion

are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it

bull Reading the case aloud keeps the group focused

bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here

PBL Case (contd)

bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session

PBL Case contdbull SECOND deciding which issues everyone will

tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)

bull THIRD deciding what SPECIFIC questions individuals will try to answer

bull FOURTH deciding how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet or consulting an expert)

The Process of PBL

bullWhat are the issues Identify the important issues in the problem

bull How well do you understand the issues

bull Are there any words or terms about which you are unclear

The Process of PBL contd

bull Consider the basic mechanisms that might explain each important aspect of each problem

bull Assess your current understanding of the basic structural andor functional mechanisms that may contribute to the presentation of the problem

bull Use the collective skills and experiences of group members to explore or explain these phenomena Identify current gaps in knowledge or understanding

Learn from each other

bullShare your own knowledge expertise or ability to reason and synthesize information Be receptive and appreciative of the contribution of your small group members

Determine priorities for learning

bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue

bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan

bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge

bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career

PBL

bull The problem comes first without advance readings lectures or preparation

bull The problem serves as a stimulus for the need to know

Learning Issues

bull Learning issues are questions that cannot be answered with studentsrsquo current knowledge and that can be explored and answered through systematic self-directed inquiry

bull The use of learning issues in tutorials prepares students to handle similar challenges in clinical practice and life-long learning

Learning Issues in PBL First Session1 Getting Started (Introductions Ground

Rules Expectations)2 Identifying Problem3 Exploring Pre-Existing Knowledge4 Generating Hypotheses and Explaining

Mechanisms5 Unfolding the Case Incrementally6 Re-EvaluatingReprioritizing Hypotheses

Based on New Information7 AssessmentReflection

PBL Second Session

8 Independent Self-Directed Study of Learning Issues

PBL Third Session

bull 9 Discussion of Learning Issues and Application of New Knowledge to the Case

bull 10 Continued Unfolding of the Case Incrementally

bull 11 AssessmentReflection

During Tutorial Session students will

1048708 Come prepared to discuss the case and learning issues researched since the last tutorial

1048708 Actively participate in group discussions and contribute to the learning process in a manner that allows for the balanced participation of everyone in the group

1048708 Develop learning issues at each session phrase them as full-sentence questions write them on the board and post them on the course web page

1048708 Consider biological population behaviormental health issuesexplanations and questions of professional attitudes values and ethics related to the patientrsquos problem(s) described in the case

Tutorial Session contd1048708 Go to the board to diagram outline draw etc in

explanation of mechanisms relatedto hypotheses1048708 Debate evidence related to the case and avoid

personal attacks on others1048708 Comply with ground rules with regard to how

the group will function and how itsmembers treat one another1048708 Participate in end-of-session reflection and

assessment by giving and receivingconstructive criticism regarding self tutor

student and group performance

Between Tutorial Session

1048708 Research key learning issues using a variety of resources

1048708 Critically evaluate the credibility of sources and the validity of the information they have obtained in their research

1048708 Integrate what they have learned through research lectures labs clinical skills Perspectives in Medicine (PIM) etc into what is discussed in tutorials

1048708 Synthesize what they have learned and be prepared to discuss it without reading directly from their materials as much as possible and apply it to the case at the next tutorial session

Determine priorities for learning

bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue

bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan

bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge

bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career

PBL Starting the casebull After the introductions and discussion

are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it

bull Reading the case aloud keeps the group focused

bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here

Problem-based learning is designed to develop

1048708 Integrated context-specific knowledge base

1048708 Decision-makingcritical thinking process and skills

1048708 Self-directed life-long learning skills 1048708 Interpersonal collaboration and

communication skills 1048708 Constructive self and peer

assessment skills 1048708 Professional ethics and behavior

PBL Case (contd)

bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session

What is problem based learning

bull In PBL students use triggers from the problem case or scenario to define their own learning objectives

bull Subsequently they do independent self directed study before returning to the group to discuss and refine their acquired knowledge

bull Thus PBL is not about problem solving per se but rather it uses appropriate problems to increase knowledge and understanding

bull The process is clearly defined

PBL

bull PBL uses clinical cases as the context for students to study basic and clinical sciences

bull Its possible advantages over traditional approaches include its greater relevance to the practice of medicine its ability to promote retention and application of knowledge and its encouragement of self-directed life-long learning

bull Possible disadvantages include higher costs both in resources and staff time

PBL

bull An educational method characterized by the use of patient problems as a context for students to learn problem-solving skills and acquire knowledge about the basic and clinical sciences

bull Students usually meet in small groups two or three times a week for PBL tutorials

bull They are presented with a clinical problem (eg a patient with chest pain) and in a series of steps they discuss possible mechanisms and causes develop hypotheses and strategies to test the hypotheses are presented with further information and use this new information to refine their hypotheses finally reaching a conclusion

bull A tutor usually acts as a facilitator guiding students in this group-learning process

bull In the course of this exercise students identify both their existing levels and gaps in their knowledge These gaps form the basis for independent learning outside the PBL tutorials The identification and pursuit of these so-called learning goals is a key element of the PBL process

Rationale for using PBL bull The PBL approach is based on principles of adult

education20 and cognitive psychology21 It differs fundamentally from traditional curricula in which students acquire background knowledge of the basic sciences in the early years of the course and in the later years apply this knowledge to the diagnosis and management of clinical problems This traditional approach has been criticised for a number of reasons42223

bull It creates an artificial divide between the basic and clinical sciences

bull Time is wasted in acquiring knowledge that is subsequently forgotten or found to be irrelevant

bull Application of the acquired knowledge can be difficult bull The acquisition and retention of information that has no

apparent relevance can be boring and even demoralising for students

The group learning process acquiring

desirable learning skills

Generic Skills amp attitudes

bull Teamwork bull Critical evaluation of literature bull Chairing a group bull Self directed learning and use of

resources bull Listening Presentation skills

Recording bull Cooperation bull Respect for colleagues views

bull Group learning facilitates not only the acquisition of knowledge but also several other desirable attributes such as communication skills teamwork problem solving independent responsibility for learning sharing information and respect for others PBL can therefore be thought of as a small group teaching method that combines the acquisition of knowledge with the development of generic skills and attitudes Presentation of clinical material as the stimulus for learning enables students to understand the relevance of underlying scientific knowledge and principles in clinical practice

bull when PBL is introduced into a curriculum several other issues for curriculum design and implementation need to be tackled PBL is generally introduced in the context of a defined core curriculum and integration of basic and clinical sciences It has implications for staffing and learning resources and demands a different approach to timetabling workload and assessment PBL is often used to deliver core material in non-clinical parts of the curriculum Paper based PBL scenarios form the basis of the core curriculum and ensure that all students are exposed to the same problems Recently modified PBL techniques have been introduced into clinical education with real patients being used as the stimulus for learning Despite the essential ad hoc nature of learning clinical medicine a key cases approach can enable PBL to be used to deliver the core clinical curriculum

Copyright copy2003 BMJ Publishing Group Ltd

Wood D F BMJ 2003326328-330

No CRoles of participants in a PBL tutorial aption Found

What happens in a PBL tutorial bull PBL tutorials are conducted in several ways In

this article the examples are modelled on the Maastricht seven jump process but its format of seven steps may be shortened

bull A typical PBL tutorial consists of a group of students (usually eight to 10) and a tutor who facilitates the session The length of time (number of sessions) that a group stays together with each other and with individual tutors varies between institutions A group needs to be together long enough to allow good group dynamics to develop but may need to be changed occasionally if personality clashes or other dysfunctional behaviour emerges

bull Students elect a chair for each PBL scenario and a scribe to record the discussion The roles are rotated for each scenario Suitable flip charts or a whiteboard should be used for recording the proceedings At the start of the session depending on the trigger material either the student chair reads out the scenario or all students study the material If the trigger is a real patient in a ward clinic or surgery then a student may be asked to take a clinical history or identify an abnormal physical sign before the group moves to a tutorial room For each module students may be given a handbook containing the problem scenarios and suggested learning resources or learning materials may be handed out at appropriate times as the tutorials progress

Examples of trigger material for PBL scenarios bull Paper based clinical scenarios bull Experimental or clinical laboratory data bull Photographs bull Video clips bull Newspaper articles bull All or part of an article from a scientific

journal bull A real or simulated patient bull A family tree showing an inherited

disorder

PBL tutorial process ndash Step 1 Identify and clarify unfamiliar terms presented in the scenario

scribe lists those that remain unexplained after discussion ndash Step 2 Define the problem or problems to be discussed students may

have different views on the issues but all should be considered scribe records a list of agreed problems

ndash Step 3 Brainstorming session to discuss the problem(s) suggestingpossible explanations on basis of prior knowledge students draw on each others knowledge and identify areas of incomplete knowledge scribe records all discussion

ndash Step 4 Review steps 2 and 3 and arrange explanations into tentativesolutions scribe organises the explanations and restructures if necessary

ndash Step 5 Formulate learning objectives group reaches consensus onthe learning objectives tutor ensures learning objectives are focused achievable comprehensive and appropriate

ndash Step 6 Private study (all students gather information related to eachlearning objective)

ndash Step 7 Group shares results of private study (students identify theirlearning resources and share their results) tutor checks learning and may assess the group

bull The role of the tutor is to facilitate the proceedings (helping the chair to maintain group dynamics and moving the group through the task) and to ensure that the group achieves appropriate learning objectives in line with those set by the curriculum design team The tutor may need to take a more active role in step 7 of the process to ensure that all the students have done the appropriate work and to help the chair to suggest a suitable format for group members to use to present the results of their private study The tutor should encourage students to check their understanding of the material He or she can do this by encouraging the students to ask open questions and ask each other to explain topics in their own words or by the use of drawings and diagrams

PBL in curriculum design bull PBL may be used either as the mainstay of an entire

curriculum or for the delivery of individual courses In practice PBL is usually part of an integrated curriculum using a systems based approach with non-clinical material delivered in the context of clinical practice A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge skills and attitudes A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios Sufficient time should be allowed each week for students to do the self directed learning required for PBL

bull

Copyright copy2003 BMJ Publishing Group Ltd

Wood D F BMJ 2003326328-330

No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found

Writing PBL scenarios

bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives

bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after

studying the scenario should be consistent with the faculty learning objectives

bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding

bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice

bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge

bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented

bull The problem should be sufficiently open so that discussion is not curtailed too early in the process

bull Scenarios should promote participation by the students in seeking information from various learning resources

bull Adapted from Dolmans et al Med Teacher 199719185-9

Staff development

bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)

A dysfunctional group a dominant character may

make it difficult for other students to be heard

A dysfunctional group a dominant character may make it difficult for other students to be heard

bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties

Advantages of PBL bull Student centred PBLIt fostersactive learning improved

understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks

Disadvantagesbull Tutors who cant teachTutorsenjoy passing on

their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful

Assessment of PBL

bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods

bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL

Conclusion

bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning

bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL

PBL 5 Easy Steps

bull Read the problem

Mrs Paula Embledon

Mrs Paula Embledon is a 78 year old woman who has come to the emergency room complaining of shortness of breath and pain in her chest She had been in relatively good health until three weeks previously when she sprained

2 Brain storm

bull Brainstorm

bull ndash hypotheses

bull - what do we know in support of the hypothesis

bull - what do we need to know to test the hypothesis

ndash learning issues

Brainstorm

bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)

ndash specific issues (for individuals to look up)

ndash overlapping issues

bull 4 Individual Reading - Research - Preparation

bull 5 Return

bull ndash review case so far ndash report and discuss

ndash assess progress - continue pagenext pagecomplete

ndash self-evaluation - How did things go Any suggestions for next time

ndash next problem

bull 5 Return

THE FIRST GROUP SESSION

bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day

bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session

bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr

bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine

bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise

bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator

bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues

bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know

bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)

bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)

bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)

  • PROBLEM BASED LEARNING
  • New Horizons in Medical Education
  • Slide 3
  • Domains of essential Global Requirements of ME
  • What was the response to these challenges
  • New Educational Strategies
  • New Tools amp Aids
  • PBL
  • PBL
  • Advantages
  • Slide 11
  • Slide 12
  • Slide 13
  • Slide 14
  • Framework for PBL
  • Framework for PBL - II
  • Characteristics of an effective PBL Group
  • Staff Development
  • Tutorrsquos Role in Assessment
  • Slide 20
  • Evaluating PBL Tutorials-II
  • PBL
  • Slide 23
  • PBL Starting the case
  • PBL Case (contd)
  • PBL Case contd
  • The Process of PBL
  • The Process of PBL contd
  • Learn from each other
  • Determine priorities for learning
  • Slide 31
  • Slide 32
  • Learning Issues
  • Learning Issues in PBL First Session
  • PBL Second Session
  • PBL Third Session
  • Slide 37
  • Slide 38
  • During Tutorial Session students will
  • Tutorial Session contd
  • Between Tutorial Session
  • Slide 42
  • Slide 43
  • Problem-based learning is designed to develop
  • Slide 45
  • What is problem based learning
  • Slide 47
  • Slide 48
  • Slide 49
  • Rationale for using PBL
  • Slide 51
  • Slide 52
  • The group learning process acquiring desirable learning skills
  • Generic Skills amp attitudes
  • Slide 55
  • Slide 56
  • Slide 57
  • What happens in a PBL tutorial
  • Slide 59
  • Examples of trigger material for PBL scenarios
  • PBL tutorial process
  • Slide 62
  • PBL in curriculum design
  • Slide 64
  • Writing PBL scenarios
  • Slide 66
  • Staff development
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • Slide 70
  • Advantages of PBL
  • Slide 72
  • Slide 73
  • Disadvantages
  • Assessment of PBL
  • Slide 76
  • Conclusion
  • Slide 78
  • PBL 5 Easy Steps
  • 2 Brain storm
  • Brainstorm
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • THE FIRST GROUP SESSION
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
Page 8: Problem based learning

PBLbull Problem-based learning (PBL) is a method of

learning in which learners first encounter a problem followed by a systematic learner-centered inquiry and reflection process

bull PBL is a method designed to help students learn the sciences basic to medicine at the same time they develop the reasoning process used by physicians and other health professionals in their clinical practice

bull 1048708 The problem comes first without advance readings lectures or preparation

bull 1048708 The problem serves as a stimulus for the need to know

PBLbullHelps learners build a bridge

between what they already know and what they need to know to reachthe next level

bull Emphasizing active learning which has been shown to be more satisfying than

passive teacher-to-student learning and to enhance retention and recall

bull Emphasizing student-centered learning in which students are actively involved in setting their own learning goals

Advantages

Encourages bull effective amp self-directed learningbull Critical thinkingbull Team workbull understanding rather than

memorizationbull Facility with professional languagebull Both students amp staff enjoy the

process

Advantages

In preparing students for professional practice PBL

bull Encourages independence as students identify amp meet individual learning needs

bull Stimulates reflection amp self-direction for life-long learning

bull Supports ongoing self-assessmentbull Introduces clinical reasoningbull Enhances critical thinking amp evidence-based

decision makingbull Ensures that knowledge is transferred applied

amp retained by providing a relevant integrated context

bull A problem initiates the activitybull The Group is stimulated to explore

basic scientific amp clinical mechanisms together with social psychological ethical or professional issues

bull Problem stimulates students to reason think critically amp weigh evidence they seek out amp share relevant info

PBL

bull Groups do not need prior knowledge to generate lively ideas as they identify areas for further collective amp personal learning

bull Each student brings individual experience amp makes a distinctive contribution

bull the Tutorrsquos role is to manage interactions rather than supply info

bull An effective Group provides a safe environment for sharing amp testing new knowledge

bull Students practice the language of science amp medicine evaluate ideas and receive feedback from peers amp teacher

bull When clinical exposure is introduced concurrently intellectual amp practical skills develop in parallel

Framework for PBL

bull A trigger initiates the problem (papercomputervideo)

bull Groups brainstorm to identify key issues for discussion

bull Broad thinking produces a rich array of mechanisms amp ideas

bull Hypothesis are critically explored through reasoning

bull The need for additional info is identifiedbull A Conclusion is reachedbull Group reviews the process

Framework for PBL - II

bull In Breaks between Tutorials students identfy Learning Issues to be pursued

bull They are encouraged to adot an evidence-based approach

bull When they reconvene they share and review the learning

Characteristics of an effective PBL Group

An Effective Group is Cohesive motivated mutually supportive amp actively engaged in learning

bull The Group understands the process amp energetically pursues its task

bull Members respect each otherrsquos contribution but examine them critically

bull Discussions flow as students cooperate rather than compete

bull The atmosphere is friendly amp good humouredbull Roles are shared all take turns in scribing

leading discussion taking responsibility for acquiring information

Staff Development

bull Basic training is mandatorybull Further development may be a requirementbull Initial training may involve observation amp

practice with a group from the programbull Effective training ensures that necessary

background goals amp local strategies are considered together with info on assessment amp evaluation

bull In addition to materials supplied to students tutors are usually issued with handbooks highlighting issues for each problem

Tutorrsquos Role in Assessment

bull Individual StudentsGroups may be assessed Summatively (determining progression) or formatively (for feedback)

The GROUP

bull At the end of each problem groups review their processes to encourage self-reflection ampenhance their collective performance

Tutorrsquos Role in Assessment

Individual students

bull Tutors should provide formative feedback to each member

bull Ask students to complete a simple self-assessment questionnaire reviewing appropriate behaviors the tutor returns them with comments

bull Students will be a writtenoralclinical tests that will determine their progression amp ultimate graduation

Evaluating PBL Tutorials-II

bull At the end of each problem time is allocated for evaluation

bull Both the process amp learning in PBL can be evaluated against explicit goals

bull The tutorrsquos review of effectiveness of group processes offers insight for the members

bull Students normally evaluate their tutor helpfulness support for clinical reasoning encouragement for independent learning appropriate intervention provision for effective feedback

PBLbull 1048708 Enabling students to learn in the context in which the

information will be used which increases the ability to retrieve and apply information

bull 1048708 Focusing on important concepts which helps learners organize and store new information in a way that facilitates retrieval and application

bull 1048708 Exploring prior knowledge formulating inquiries derived from and defined by the learnersrsquo need to know and actively constructing meaning through dialogue and reflection

bull 1048708 Utilizing problems designed to simulate studentsrsquo perception of their future profession which serves as a powerful stimulus for studentsrsquo intrinsic motivation to learn

bull 1048708 Actively involving students in monitoring their own progress and reflecting on what works and what needs improvement frequently assessing student performance and providing feedback

PBL Starting the casebull After the introductions and discussion

are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it

bull Reading the case aloud keeps the group focused

bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here

PBL Case (contd)

bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session

PBL Case contdbull SECOND deciding which issues everyone will

tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)

bull THIRD deciding what SPECIFIC questions individuals will try to answer

bull FOURTH deciding how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet or consulting an expert)

The Process of PBL

bullWhat are the issues Identify the important issues in the problem

bull How well do you understand the issues

bull Are there any words or terms about which you are unclear

The Process of PBL contd

bull Consider the basic mechanisms that might explain each important aspect of each problem

bull Assess your current understanding of the basic structural andor functional mechanisms that may contribute to the presentation of the problem

bull Use the collective skills and experiences of group members to explore or explain these phenomena Identify current gaps in knowledge or understanding

Learn from each other

bullShare your own knowledge expertise or ability to reason and synthesize information Be receptive and appreciative of the contribution of your small group members

Determine priorities for learning

bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue

bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan

bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge

bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career

PBL

bull The problem comes first without advance readings lectures or preparation

bull The problem serves as a stimulus for the need to know

Learning Issues

bull Learning issues are questions that cannot be answered with studentsrsquo current knowledge and that can be explored and answered through systematic self-directed inquiry

bull The use of learning issues in tutorials prepares students to handle similar challenges in clinical practice and life-long learning

Learning Issues in PBL First Session1 Getting Started (Introductions Ground

Rules Expectations)2 Identifying Problem3 Exploring Pre-Existing Knowledge4 Generating Hypotheses and Explaining

Mechanisms5 Unfolding the Case Incrementally6 Re-EvaluatingReprioritizing Hypotheses

Based on New Information7 AssessmentReflection

PBL Second Session

8 Independent Self-Directed Study of Learning Issues

PBL Third Session

bull 9 Discussion of Learning Issues and Application of New Knowledge to the Case

bull 10 Continued Unfolding of the Case Incrementally

bull 11 AssessmentReflection

During Tutorial Session students will

1048708 Come prepared to discuss the case and learning issues researched since the last tutorial

1048708 Actively participate in group discussions and contribute to the learning process in a manner that allows for the balanced participation of everyone in the group

1048708 Develop learning issues at each session phrase them as full-sentence questions write them on the board and post them on the course web page

1048708 Consider biological population behaviormental health issuesexplanations and questions of professional attitudes values and ethics related to the patientrsquos problem(s) described in the case

Tutorial Session contd1048708 Go to the board to diagram outline draw etc in

explanation of mechanisms relatedto hypotheses1048708 Debate evidence related to the case and avoid

personal attacks on others1048708 Comply with ground rules with regard to how

the group will function and how itsmembers treat one another1048708 Participate in end-of-session reflection and

assessment by giving and receivingconstructive criticism regarding self tutor

student and group performance

Between Tutorial Session

1048708 Research key learning issues using a variety of resources

1048708 Critically evaluate the credibility of sources and the validity of the information they have obtained in their research

1048708 Integrate what they have learned through research lectures labs clinical skills Perspectives in Medicine (PIM) etc into what is discussed in tutorials

1048708 Synthesize what they have learned and be prepared to discuss it without reading directly from their materials as much as possible and apply it to the case at the next tutorial session

Determine priorities for learning

bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue

bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan

bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge

bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career

PBL Starting the casebull After the introductions and discussion

are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it

bull Reading the case aloud keeps the group focused

bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here

Problem-based learning is designed to develop

1048708 Integrated context-specific knowledge base

1048708 Decision-makingcritical thinking process and skills

1048708 Self-directed life-long learning skills 1048708 Interpersonal collaboration and

communication skills 1048708 Constructive self and peer

assessment skills 1048708 Professional ethics and behavior

PBL Case (contd)

bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session

What is problem based learning

bull In PBL students use triggers from the problem case or scenario to define their own learning objectives

bull Subsequently they do independent self directed study before returning to the group to discuss and refine their acquired knowledge

bull Thus PBL is not about problem solving per se but rather it uses appropriate problems to increase knowledge and understanding

bull The process is clearly defined

PBL

bull PBL uses clinical cases as the context for students to study basic and clinical sciences

bull Its possible advantages over traditional approaches include its greater relevance to the practice of medicine its ability to promote retention and application of knowledge and its encouragement of self-directed life-long learning

bull Possible disadvantages include higher costs both in resources and staff time

PBL

bull An educational method characterized by the use of patient problems as a context for students to learn problem-solving skills and acquire knowledge about the basic and clinical sciences

bull Students usually meet in small groups two or three times a week for PBL tutorials

bull They are presented with a clinical problem (eg a patient with chest pain) and in a series of steps they discuss possible mechanisms and causes develop hypotheses and strategies to test the hypotheses are presented with further information and use this new information to refine their hypotheses finally reaching a conclusion

bull A tutor usually acts as a facilitator guiding students in this group-learning process

bull In the course of this exercise students identify both their existing levels and gaps in their knowledge These gaps form the basis for independent learning outside the PBL tutorials The identification and pursuit of these so-called learning goals is a key element of the PBL process

Rationale for using PBL bull The PBL approach is based on principles of adult

education20 and cognitive psychology21 It differs fundamentally from traditional curricula in which students acquire background knowledge of the basic sciences in the early years of the course and in the later years apply this knowledge to the diagnosis and management of clinical problems This traditional approach has been criticised for a number of reasons42223

bull It creates an artificial divide between the basic and clinical sciences

bull Time is wasted in acquiring knowledge that is subsequently forgotten or found to be irrelevant

bull Application of the acquired knowledge can be difficult bull The acquisition and retention of information that has no

apparent relevance can be boring and even demoralising for students

The group learning process acquiring

desirable learning skills

Generic Skills amp attitudes

bull Teamwork bull Critical evaluation of literature bull Chairing a group bull Self directed learning and use of

resources bull Listening Presentation skills

Recording bull Cooperation bull Respect for colleagues views

bull Group learning facilitates not only the acquisition of knowledge but also several other desirable attributes such as communication skills teamwork problem solving independent responsibility for learning sharing information and respect for others PBL can therefore be thought of as a small group teaching method that combines the acquisition of knowledge with the development of generic skills and attitudes Presentation of clinical material as the stimulus for learning enables students to understand the relevance of underlying scientific knowledge and principles in clinical practice

bull when PBL is introduced into a curriculum several other issues for curriculum design and implementation need to be tackled PBL is generally introduced in the context of a defined core curriculum and integration of basic and clinical sciences It has implications for staffing and learning resources and demands a different approach to timetabling workload and assessment PBL is often used to deliver core material in non-clinical parts of the curriculum Paper based PBL scenarios form the basis of the core curriculum and ensure that all students are exposed to the same problems Recently modified PBL techniques have been introduced into clinical education with real patients being used as the stimulus for learning Despite the essential ad hoc nature of learning clinical medicine a key cases approach can enable PBL to be used to deliver the core clinical curriculum

Copyright copy2003 BMJ Publishing Group Ltd

Wood D F BMJ 2003326328-330

No CRoles of participants in a PBL tutorial aption Found

What happens in a PBL tutorial bull PBL tutorials are conducted in several ways In

this article the examples are modelled on the Maastricht seven jump process but its format of seven steps may be shortened

bull A typical PBL tutorial consists of a group of students (usually eight to 10) and a tutor who facilitates the session The length of time (number of sessions) that a group stays together with each other and with individual tutors varies between institutions A group needs to be together long enough to allow good group dynamics to develop but may need to be changed occasionally if personality clashes or other dysfunctional behaviour emerges

bull Students elect a chair for each PBL scenario and a scribe to record the discussion The roles are rotated for each scenario Suitable flip charts or a whiteboard should be used for recording the proceedings At the start of the session depending on the trigger material either the student chair reads out the scenario or all students study the material If the trigger is a real patient in a ward clinic or surgery then a student may be asked to take a clinical history or identify an abnormal physical sign before the group moves to a tutorial room For each module students may be given a handbook containing the problem scenarios and suggested learning resources or learning materials may be handed out at appropriate times as the tutorials progress

Examples of trigger material for PBL scenarios bull Paper based clinical scenarios bull Experimental or clinical laboratory data bull Photographs bull Video clips bull Newspaper articles bull All or part of an article from a scientific

journal bull A real or simulated patient bull A family tree showing an inherited

disorder

PBL tutorial process ndash Step 1 Identify and clarify unfamiliar terms presented in the scenario

scribe lists those that remain unexplained after discussion ndash Step 2 Define the problem or problems to be discussed students may

have different views on the issues but all should be considered scribe records a list of agreed problems

ndash Step 3 Brainstorming session to discuss the problem(s) suggestingpossible explanations on basis of prior knowledge students draw on each others knowledge and identify areas of incomplete knowledge scribe records all discussion

ndash Step 4 Review steps 2 and 3 and arrange explanations into tentativesolutions scribe organises the explanations and restructures if necessary

ndash Step 5 Formulate learning objectives group reaches consensus onthe learning objectives tutor ensures learning objectives are focused achievable comprehensive and appropriate

ndash Step 6 Private study (all students gather information related to eachlearning objective)

ndash Step 7 Group shares results of private study (students identify theirlearning resources and share their results) tutor checks learning and may assess the group

bull The role of the tutor is to facilitate the proceedings (helping the chair to maintain group dynamics and moving the group through the task) and to ensure that the group achieves appropriate learning objectives in line with those set by the curriculum design team The tutor may need to take a more active role in step 7 of the process to ensure that all the students have done the appropriate work and to help the chair to suggest a suitable format for group members to use to present the results of their private study The tutor should encourage students to check their understanding of the material He or she can do this by encouraging the students to ask open questions and ask each other to explain topics in their own words or by the use of drawings and diagrams

PBL in curriculum design bull PBL may be used either as the mainstay of an entire

curriculum or for the delivery of individual courses In practice PBL is usually part of an integrated curriculum using a systems based approach with non-clinical material delivered in the context of clinical practice A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge skills and attitudes A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios Sufficient time should be allowed each week for students to do the self directed learning required for PBL

bull

Copyright copy2003 BMJ Publishing Group Ltd

Wood D F BMJ 2003326328-330

No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found

Writing PBL scenarios

bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives

bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after

studying the scenario should be consistent with the faculty learning objectives

bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding

bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice

bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge

bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented

bull The problem should be sufficiently open so that discussion is not curtailed too early in the process

bull Scenarios should promote participation by the students in seeking information from various learning resources

bull Adapted from Dolmans et al Med Teacher 199719185-9

Staff development

bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)

A dysfunctional group a dominant character may

make it difficult for other students to be heard

A dysfunctional group a dominant character may make it difficult for other students to be heard

bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties

Advantages of PBL bull Student centred PBLIt fostersactive learning improved

understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks

Disadvantagesbull Tutors who cant teachTutorsenjoy passing on

their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful

Assessment of PBL

bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods

bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL

Conclusion

bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning

bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL

PBL 5 Easy Steps

bull Read the problem

Mrs Paula Embledon

Mrs Paula Embledon is a 78 year old woman who has come to the emergency room complaining of shortness of breath and pain in her chest She had been in relatively good health until three weeks previously when she sprained

2 Brain storm

bull Brainstorm

bull ndash hypotheses

bull - what do we know in support of the hypothesis

bull - what do we need to know to test the hypothesis

ndash learning issues

Brainstorm

bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)

ndash specific issues (for individuals to look up)

ndash overlapping issues

bull 4 Individual Reading - Research - Preparation

bull 5 Return

bull ndash review case so far ndash report and discuss

ndash assess progress - continue pagenext pagecomplete

ndash self-evaluation - How did things go Any suggestions for next time

ndash next problem

bull 5 Return

THE FIRST GROUP SESSION

bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day

bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session

bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr

bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine

bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise

bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator

bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues

bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know

bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)

bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)

bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)

  • PROBLEM BASED LEARNING
  • New Horizons in Medical Education
  • Slide 3
  • Domains of essential Global Requirements of ME
  • What was the response to these challenges
  • New Educational Strategies
  • New Tools amp Aids
  • PBL
  • PBL
  • Advantages
  • Slide 11
  • Slide 12
  • Slide 13
  • Slide 14
  • Framework for PBL
  • Framework for PBL - II
  • Characteristics of an effective PBL Group
  • Staff Development
  • Tutorrsquos Role in Assessment
  • Slide 20
  • Evaluating PBL Tutorials-II
  • PBL
  • Slide 23
  • PBL Starting the case
  • PBL Case (contd)
  • PBL Case contd
  • The Process of PBL
  • The Process of PBL contd
  • Learn from each other
  • Determine priorities for learning
  • Slide 31
  • Slide 32
  • Learning Issues
  • Learning Issues in PBL First Session
  • PBL Second Session
  • PBL Third Session
  • Slide 37
  • Slide 38
  • During Tutorial Session students will
  • Tutorial Session contd
  • Between Tutorial Session
  • Slide 42
  • Slide 43
  • Problem-based learning is designed to develop
  • Slide 45
  • What is problem based learning
  • Slide 47
  • Slide 48
  • Slide 49
  • Rationale for using PBL
  • Slide 51
  • Slide 52
  • The group learning process acquiring desirable learning skills
  • Generic Skills amp attitudes
  • Slide 55
  • Slide 56
  • Slide 57
  • What happens in a PBL tutorial
  • Slide 59
  • Examples of trigger material for PBL scenarios
  • PBL tutorial process
  • Slide 62
  • PBL in curriculum design
  • Slide 64
  • Writing PBL scenarios
  • Slide 66
  • Staff development
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • Slide 70
  • Advantages of PBL
  • Slide 72
  • Slide 73
  • Disadvantages
  • Assessment of PBL
  • Slide 76
  • Conclusion
  • Slide 78
  • PBL 5 Easy Steps
  • 2 Brain storm
  • Brainstorm
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • THE FIRST GROUP SESSION
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
Page 9: Problem based learning

PBLbullHelps learners build a bridge

between what they already know and what they need to know to reachthe next level

bull Emphasizing active learning which has been shown to be more satisfying than

passive teacher-to-student learning and to enhance retention and recall

bull Emphasizing student-centered learning in which students are actively involved in setting their own learning goals

Advantages

Encourages bull effective amp self-directed learningbull Critical thinkingbull Team workbull understanding rather than

memorizationbull Facility with professional languagebull Both students amp staff enjoy the

process

Advantages

In preparing students for professional practice PBL

bull Encourages independence as students identify amp meet individual learning needs

bull Stimulates reflection amp self-direction for life-long learning

bull Supports ongoing self-assessmentbull Introduces clinical reasoningbull Enhances critical thinking amp evidence-based

decision makingbull Ensures that knowledge is transferred applied

amp retained by providing a relevant integrated context

bull A problem initiates the activitybull The Group is stimulated to explore

basic scientific amp clinical mechanisms together with social psychological ethical or professional issues

bull Problem stimulates students to reason think critically amp weigh evidence they seek out amp share relevant info

PBL

bull Groups do not need prior knowledge to generate lively ideas as they identify areas for further collective amp personal learning

bull Each student brings individual experience amp makes a distinctive contribution

bull the Tutorrsquos role is to manage interactions rather than supply info

bull An effective Group provides a safe environment for sharing amp testing new knowledge

bull Students practice the language of science amp medicine evaluate ideas and receive feedback from peers amp teacher

bull When clinical exposure is introduced concurrently intellectual amp practical skills develop in parallel

Framework for PBL

bull A trigger initiates the problem (papercomputervideo)

bull Groups brainstorm to identify key issues for discussion

bull Broad thinking produces a rich array of mechanisms amp ideas

bull Hypothesis are critically explored through reasoning

bull The need for additional info is identifiedbull A Conclusion is reachedbull Group reviews the process

Framework for PBL - II

bull In Breaks between Tutorials students identfy Learning Issues to be pursued

bull They are encouraged to adot an evidence-based approach

bull When they reconvene they share and review the learning

Characteristics of an effective PBL Group

An Effective Group is Cohesive motivated mutually supportive amp actively engaged in learning

bull The Group understands the process amp energetically pursues its task

bull Members respect each otherrsquos contribution but examine them critically

bull Discussions flow as students cooperate rather than compete

bull The atmosphere is friendly amp good humouredbull Roles are shared all take turns in scribing

leading discussion taking responsibility for acquiring information

Staff Development

bull Basic training is mandatorybull Further development may be a requirementbull Initial training may involve observation amp

practice with a group from the programbull Effective training ensures that necessary

background goals amp local strategies are considered together with info on assessment amp evaluation

bull In addition to materials supplied to students tutors are usually issued with handbooks highlighting issues for each problem

Tutorrsquos Role in Assessment

bull Individual StudentsGroups may be assessed Summatively (determining progression) or formatively (for feedback)

The GROUP

bull At the end of each problem groups review their processes to encourage self-reflection ampenhance their collective performance

Tutorrsquos Role in Assessment

Individual students

bull Tutors should provide formative feedback to each member

bull Ask students to complete a simple self-assessment questionnaire reviewing appropriate behaviors the tutor returns them with comments

bull Students will be a writtenoralclinical tests that will determine their progression amp ultimate graduation

Evaluating PBL Tutorials-II

bull At the end of each problem time is allocated for evaluation

bull Both the process amp learning in PBL can be evaluated against explicit goals

bull The tutorrsquos review of effectiveness of group processes offers insight for the members

bull Students normally evaluate their tutor helpfulness support for clinical reasoning encouragement for independent learning appropriate intervention provision for effective feedback

PBLbull 1048708 Enabling students to learn in the context in which the

information will be used which increases the ability to retrieve and apply information

bull 1048708 Focusing on important concepts which helps learners organize and store new information in a way that facilitates retrieval and application

bull 1048708 Exploring prior knowledge formulating inquiries derived from and defined by the learnersrsquo need to know and actively constructing meaning through dialogue and reflection

bull 1048708 Utilizing problems designed to simulate studentsrsquo perception of their future profession which serves as a powerful stimulus for studentsrsquo intrinsic motivation to learn

bull 1048708 Actively involving students in monitoring their own progress and reflecting on what works and what needs improvement frequently assessing student performance and providing feedback

PBL Starting the casebull After the introductions and discussion

are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it

bull Reading the case aloud keeps the group focused

bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here

PBL Case (contd)

bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session

PBL Case contdbull SECOND deciding which issues everyone will

tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)

bull THIRD deciding what SPECIFIC questions individuals will try to answer

bull FOURTH deciding how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet or consulting an expert)

The Process of PBL

bullWhat are the issues Identify the important issues in the problem

bull How well do you understand the issues

bull Are there any words or terms about which you are unclear

The Process of PBL contd

bull Consider the basic mechanisms that might explain each important aspect of each problem

bull Assess your current understanding of the basic structural andor functional mechanisms that may contribute to the presentation of the problem

bull Use the collective skills and experiences of group members to explore or explain these phenomena Identify current gaps in knowledge or understanding

Learn from each other

bullShare your own knowledge expertise or ability to reason and synthesize information Be receptive and appreciative of the contribution of your small group members

Determine priorities for learning

bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue

bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan

bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge

bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career

PBL

bull The problem comes first without advance readings lectures or preparation

bull The problem serves as a stimulus for the need to know

Learning Issues

bull Learning issues are questions that cannot be answered with studentsrsquo current knowledge and that can be explored and answered through systematic self-directed inquiry

bull The use of learning issues in tutorials prepares students to handle similar challenges in clinical practice and life-long learning

Learning Issues in PBL First Session1 Getting Started (Introductions Ground

Rules Expectations)2 Identifying Problem3 Exploring Pre-Existing Knowledge4 Generating Hypotheses and Explaining

Mechanisms5 Unfolding the Case Incrementally6 Re-EvaluatingReprioritizing Hypotheses

Based on New Information7 AssessmentReflection

PBL Second Session

8 Independent Self-Directed Study of Learning Issues

PBL Third Session

bull 9 Discussion of Learning Issues and Application of New Knowledge to the Case

bull 10 Continued Unfolding of the Case Incrementally

bull 11 AssessmentReflection

During Tutorial Session students will

1048708 Come prepared to discuss the case and learning issues researched since the last tutorial

1048708 Actively participate in group discussions and contribute to the learning process in a manner that allows for the balanced participation of everyone in the group

1048708 Develop learning issues at each session phrase them as full-sentence questions write them on the board and post them on the course web page

1048708 Consider biological population behaviormental health issuesexplanations and questions of professional attitudes values and ethics related to the patientrsquos problem(s) described in the case

Tutorial Session contd1048708 Go to the board to diagram outline draw etc in

explanation of mechanisms relatedto hypotheses1048708 Debate evidence related to the case and avoid

personal attacks on others1048708 Comply with ground rules with regard to how

the group will function and how itsmembers treat one another1048708 Participate in end-of-session reflection and

assessment by giving and receivingconstructive criticism regarding self tutor

student and group performance

Between Tutorial Session

1048708 Research key learning issues using a variety of resources

1048708 Critically evaluate the credibility of sources and the validity of the information they have obtained in their research

1048708 Integrate what they have learned through research lectures labs clinical skills Perspectives in Medicine (PIM) etc into what is discussed in tutorials

1048708 Synthesize what they have learned and be prepared to discuss it without reading directly from their materials as much as possible and apply it to the case at the next tutorial session

Determine priorities for learning

bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue

bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan

bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge

bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career

PBL Starting the casebull After the introductions and discussion

are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it

bull Reading the case aloud keeps the group focused

bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here

Problem-based learning is designed to develop

1048708 Integrated context-specific knowledge base

1048708 Decision-makingcritical thinking process and skills

1048708 Self-directed life-long learning skills 1048708 Interpersonal collaboration and

communication skills 1048708 Constructive self and peer

assessment skills 1048708 Professional ethics and behavior

PBL Case (contd)

bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session

What is problem based learning

bull In PBL students use triggers from the problem case or scenario to define their own learning objectives

bull Subsequently they do independent self directed study before returning to the group to discuss and refine their acquired knowledge

bull Thus PBL is not about problem solving per se but rather it uses appropriate problems to increase knowledge and understanding

bull The process is clearly defined

PBL

bull PBL uses clinical cases as the context for students to study basic and clinical sciences

bull Its possible advantages over traditional approaches include its greater relevance to the practice of medicine its ability to promote retention and application of knowledge and its encouragement of self-directed life-long learning

bull Possible disadvantages include higher costs both in resources and staff time

PBL

bull An educational method characterized by the use of patient problems as a context for students to learn problem-solving skills and acquire knowledge about the basic and clinical sciences

bull Students usually meet in small groups two or three times a week for PBL tutorials

bull They are presented with a clinical problem (eg a patient with chest pain) and in a series of steps they discuss possible mechanisms and causes develop hypotheses and strategies to test the hypotheses are presented with further information and use this new information to refine their hypotheses finally reaching a conclusion

bull A tutor usually acts as a facilitator guiding students in this group-learning process

bull In the course of this exercise students identify both their existing levels and gaps in their knowledge These gaps form the basis for independent learning outside the PBL tutorials The identification and pursuit of these so-called learning goals is a key element of the PBL process

Rationale for using PBL bull The PBL approach is based on principles of adult

education20 and cognitive psychology21 It differs fundamentally from traditional curricula in which students acquire background knowledge of the basic sciences in the early years of the course and in the later years apply this knowledge to the diagnosis and management of clinical problems This traditional approach has been criticised for a number of reasons42223

bull It creates an artificial divide between the basic and clinical sciences

bull Time is wasted in acquiring knowledge that is subsequently forgotten or found to be irrelevant

bull Application of the acquired knowledge can be difficult bull The acquisition and retention of information that has no

apparent relevance can be boring and even demoralising for students

The group learning process acquiring

desirable learning skills

Generic Skills amp attitudes

bull Teamwork bull Critical evaluation of literature bull Chairing a group bull Self directed learning and use of

resources bull Listening Presentation skills

Recording bull Cooperation bull Respect for colleagues views

bull Group learning facilitates not only the acquisition of knowledge but also several other desirable attributes such as communication skills teamwork problem solving independent responsibility for learning sharing information and respect for others PBL can therefore be thought of as a small group teaching method that combines the acquisition of knowledge with the development of generic skills and attitudes Presentation of clinical material as the stimulus for learning enables students to understand the relevance of underlying scientific knowledge and principles in clinical practice

bull when PBL is introduced into a curriculum several other issues for curriculum design and implementation need to be tackled PBL is generally introduced in the context of a defined core curriculum and integration of basic and clinical sciences It has implications for staffing and learning resources and demands a different approach to timetabling workload and assessment PBL is often used to deliver core material in non-clinical parts of the curriculum Paper based PBL scenarios form the basis of the core curriculum and ensure that all students are exposed to the same problems Recently modified PBL techniques have been introduced into clinical education with real patients being used as the stimulus for learning Despite the essential ad hoc nature of learning clinical medicine a key cases approach can enable PBL to be used to deliver the core clinical curriculum

Copyright copy2003 BMJ Publishing Group Ltd

Wood D F BMJ 2003326328-330

No CRoles of participants in a PBL tutorial aption Found

What happens in a PBL tutorial bull PBL tutorials are conducted in several ways In

this article the examples are modelled on the Maastricht seven jump process but its format of seven steps may be shortened

bull A typical PBL tutorial consists of a group of students (usually eight to 10) and a tutor who facilitates the session The length of time (number of sessions) that a group stays together with each other and with individual tutors varies between institutions A group needs to be together long enough to allow good group dynamics to develop but may need to be changed occasionally if personality clashes or other dysfunctional behaviour emerges

bull Students elect a chair for each PBL scenario and a scribe to record the discussion The roles are rotated for each scenario Suitable flip charts or a whiteboard should be used for recording the proceedings At the start of the session depending on the trigger material either the student chair reads out the scenario or all students study the material If the trigger is a real patient in a ward clinic or surgery then a student may be asked to take a clinical history or identify an abnormal physical sign before the group moves to a tutorial room For each module students may be given a handbook containing the problem scenarios and suggested learning resources or learning materials may be handed out at appropriate times as the tutorials progress

Examples of trigger material for PBL scenarios bull Paper based clinical scenarios bull Experimental or clinical laboratory data bull Photographs bull Video clips bull Newspaper articles bull All or part of an article from a scientific

journal bull A real or simulated patient bull A family tree showing an inherited

disorder

PBL tutorial process ndash Step 1 Identify and clarify unfamiliar terms presented in the scenario

scribe lists those that remain unexplained after discussion ndash Step 2 Define the problem or problems to be discussed students may

have different views on the issues but all should be considered scribe records a list of agreed problems

ndash Step 3 Brainstorming session to discuss the problem(s) suggestingpossible explanations on basis of prior knowledge students draw on each others knowledge and identify areas of incomplete knowledge scribe records all discussion

ndash Step 4 Review steps 2 and 3 and arrange explanations into tentativesolutions scribe organises the explanations and restructures if necessary

ndash Step 5 Formulate learning objectives group reaches consensus onthe learning objectives tutor ensures learning objectives are focused achievable comprehensive and appropriate

ndash Step 6 Private study (all students gather information related to eachlearning objective)

ndash Step 7 Group shares results of private study (students identify theirlearning resources and share their results) tutor checks learning and may assess the group

bull The role of the tutor is to facilitate the proceedings (helping the chair to maintain group dynamics and moving the group through the task) and to ensure that the group achieves appropriate learning objectives in line with those set by the curriculum design team The tutor may need to take a more active role in step 7 of the process to ensure that all the students have done the appropriate work and to help the chair to suggest a suitable format for group members to use to present the results of their private study The tutor should encourage students to check their understanding of the material He or she can do this by encouraging the students to ask open questions and ask each other to explain topics in their own words or by the use of drawings and diagrams

PBL in curriculum design bull PBL may be used either as the mainstay of an entire

curriculum or for the delivery of individual courses In practice PBL is usually part of an integrated curriculum using a systems based approach with non-clinical material delivered in the context of clinical practice A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge skills and attitudes A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios Sufficient time should be allowed each week for students to do the self directed learning required for PBL

bull

Copyright copy2003 BMJ Publishing Group Ltd

Wood D F BMJ 2003326328-330

No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found

Writing PBL scenarios

bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives

bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after

studying the scenario should be consistent with the faculty learning objectives

bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding

bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice

bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge

bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented

bull The problem should be sufficiently open so that discussion is not curtailed too early in the process

bull Scenarios should promote participation by the students in seeking information from various learning resources

bull Adapted from Dolmans et al Med Teacher 199719185-9

Staff development

bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)

A dysfunctional group a dominant character may

make it difficult for other students to be heard

A dysfunctional group a dominant character may make it difficult for other students to be heard

bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties

Advantages of PBL bull Student centred PBLIt fostersactive learning improved

understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks

Disadvantagesbull Tutors who cant teachTutorsenjoy passing on

their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful

Assessment of PBL

bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods

bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL

Conclusion

bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning

bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL

PBL 5 Easy Steps

bull Read the problem

Mrs Paula Embledon

Mrs Paula Embledon is a 78 year old woman who has come to the emergency room complaining of shortness of breath and pain in her chest She had been in relatively good health until three weeks previously when she sprained

2 Brain storm

bull Brainstorm

bull ndash hypotheses

bull - what do we know in support of the hypothesis

bull - what do we need to know to test the hypothesis

ndash learning issues

Brainstorm

bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)

ndash specific issues (for individuals to look up)

ndash overlapping issues

bull 4 Individual Reading - Research - Preparation

bull 5 Return

bull ndash review case so far ndash report and discuss

ndash assess progress - continue pagenext pagecomplete

ndash self-evaluation - How did things go Any suggestions for next time

ndash next problem

bull 5 Return

THE FIRST GROUP SESSION

bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day

bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session

bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr

bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine

bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise

bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator

bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues

bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know

bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)

bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)

bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)

  • PROBLEM BASED LEARNING
  • New Horizons in Medical Education
  • Slide 3
  • Domains of essential Global Requirements of ME
  • What was the response to these challenges
  • New Educational Strategies
  • New Tools amp Aids
  • PBL
  • PBL
  • Advantages
  • Slide 11
  • Slide 12
  • Slide 13
  • Slide 14
  • Framework for PBL
  • Framework for PBL - II
  • Characteristics of an effective PBL Group
  • Staff Development
  • Tutorrsquos Role in Assessment
  • Slide 20
  • Evaluating PBL Tutorials-II
  • PBL
  • Slide 23
  • PBL Starting the case
  • PBL Case (contd)
  • PBL Case contd
  • The Process of PBL
  • The Process of PBL contd
  • Learn from each other
  • Determine priorities for learning
  • Slide 31
  • Slide 32
  • Learning Issues
  • Learning Issues in PBL First Session
  • PBL Second Session
  • PBL Third Session
  • Slide 37
  • Slide 38
  • During Tutorial Session students will
  • Tutorial Session contd
  • Between Tutorial Session
  • Slide 42
  • Slide 43
  • Problem-based learning is designed to develop
  • Slide 45
  • What is problem based learning
  • Slide 47
  • Slide 48
  • Slide 49
  • Rationale for using PBL
  • Slide 51
  • Slide 52
  • The group learning process acquiring desirable learning skills
  • Generic Skills amp attitudes
  • Slide 55
  • Slide 56
  • Slide 57
  • What happens in a PBL tutorial
  • Slide 59
  • Examples of trigger material for PBL scenarios
  • PBL tutorial process
  • Slide 62
  • PBL in curriculum design
  • Slide 64
  • Writing PBL scenarios
  • Slide 66
  • Staff development
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • Slide 70
  • Advantages of PBL
  • Slide 72
  • Slide 73
  • Disadvantages
  • Assessment of PBL
  • Slide 76
  • Conclusion
  • Slide 78
  • PBL 5 Easy Steps
  • 2 Brain storm
  • Brainstorm
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • THE FIRST GROUP SESSION
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
Page 10: Problem based learning

Advantages

Encourages bull effective amp self-directed learningbull Critical thinkingbull Team workbull understanding rather than

memorizationbull Facility with professional languagebull Both students amp staff enjoy the

process

Advantages

In preparing students for professional practice PBL

bull Encourages independence as students identify amp meet individual learning needs

bull Stimulates reflection amp self-direction for life-long learning

bull Supports ongoing self-assessmentbull Introduces clinical reasoningbull Enhances critical thinking amp evidence-based

decision makingbull Ensures that knowledge is transferred applied

amp retained by providing a relevant integrated context

bull A problem initiates the activitybull The Group is stimulated to explore

basic scientific amp clinical mechanisms together with social psychological ethical or professional issues

bull Problem stimulates students to reason think critically amp weigh evidence they seek out amp share relevant info

PBL

bull Groups do not need prior knowledge to generate lively ideas as they identify areas for further collective amp personal learning

bull Each student brings individual experience amp makes a distinctive contribution

bull the Tutorrsquos role is to manage interactions rather than supply info

bull An effective Group provides a safe environment for sharing amp testing new knowledge

bull Students practice the language of science amp medicine evaluate ideas and receive feedback from peers amp teacher

bull When clinical exposure is introduced concurrently intellectual amp practical skills develop in parallel

Framework for PBL

bull A trigger initiates the problem (papercomputervideo)

bull Groups brainstorm to identify key issues for discussion

bull Broad thinking produces a rich array of mechanisms amp ideas

bull Hypothesis are critically explored through reasoning

bull The need for additional info is identifiedbull A Conclusion is reachedbull Group reviews the process

Framework for PBL - II

bull In Breaks between Tutorials students identfy Learning Issues to be pursued

bull They are encouraged to adot an evidence-based approach

bull When they reconvene they share and review the learning

Characteristics of an effective PBL Group

An Effective Group is Cohesive motivated mutually supportive amp actively engaged in learning

bull The Group understands the process amp energetically pursues its task

bull Members respect each otherrsquos contribution but examine them critically

bull Discussions flow as students cooperate rather than compete

bull The atmosphere is friendly amp good humouredbull Roles are shared all take turns in scribing

leading discussion taking responsibility for acquiring information

Staff Development

bull Basic training is mandatorybull Further development may be a requirementbull Initial training may involve observation amp

practice with a group from the programbull Effective training ensures that necessary

background goals amp local strategies are considered together with info on assessment amp evaluation

bull In addition to materials supplied to students tutors are usually issued with handbooks highlighting issues for each problem

Tutorrsquos Role in Assessment

bull Individual StudentsGroups may be assessed Summatively (determining progression) or formatively (for feedback)

The GROUP

bull At the end of each problem groups review their processes to encourage self-reflection ampenhance their collective performance

Tutorrsquos Role in Assessment

Individual students

bull Tutors should provide formative feedback to each member

bull Ask students to complete a simple self-assessment questionnaire reviewing appropriate behaviors the tutor returns them with comments

bull Students will be a writtenoralclinical tests that will determine their progression amp ultimate graduation

Evaluating PBL Tutorials-II

bull At the end of each problem time is allocated for evaluation

bull Both the process amp learning in PBL can be evaluated against explicit goals

bull The tutorrsquos review of effectiveness of group processes offers insight for the members

bull Students normally evaluate their tutor helpfulness support for clinical reasoning encouragement for independent learning appropriate intervention provision for effective feedback

PBLbull 1048708 Enabling students to learn in the context in which the

information will be used which increases the ability to retrieve and apply information

bull 1048708 Focusing on important concepts which helps learners organize and store new information in a way that facilitates retrieval and application

bull 1048708 Exploring prior knowledge formulating inquiries derived from and defined by the learnersrsquo need to know and actively constructing meaning through dialogue and reflection

bull 1048708 Utilizing problems designed to simulate studentsrsquo perception of their future profession which serves as a powerful stimulus for studentsrsquo intrinsic motivation to learn

bull 1048708 Actively involving students in monitoring their own progress and reflecting on what works and what needs improvement frequently assessing student performance and providing feedback

PBL Starting the casebull After the introductions and discussion

are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it

bull Reading the case aloud keeps the group focused

bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here

PBL Case (contd)

bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session

PBL Case contdbull SECOND deciding which issues everyone will

tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)

bull THIRD deciding what SPECIFIC questions individuals will try to answer

bull FOURTH deciding how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet or consulting an expert)

The Process of PBL

bullWhat are the issues Identify the important issues in the problem

bull How well do you understand the issues

bull Are there any words or terms about which you are unclear

The Process of PBL contd

bull Consider the basic mechanisms that might explain each important aspect of each problem

bull Assess your current understanding of the basic structural andor functional mechanisms that may contribute to the presentation of the problem

bull Use the collective skills and experiences of group members to explore or explain these phenomena Identify current gaps in knowledge or understanding

Learn from each other

bullShare your own knowledge expertise or ability to reason and synthesize information Be receptive and appreciative of the contribution of your small group members

Determine priorities for learning

bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue

bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan

bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge

bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career

PBL

bull The problem comes first without advance readings lectures or preparation

bull The problem serves as a stimulus for the need to know

Learning Issues

bull Learning issues are questions that cannot be answered with studentsrsquo current knowledge and that can be explored and answered through systematic self-directed inquiry

bull The use of learning issues in tutorials prepares students to handle similar challenges in clinical practice and life-long learning

Learning Issues in PBL First Session1 Getting Started (Introductions Ground

Rules Expectations)2 Identifying Problem3 Exploring Pre-Existing Knowledge4 Generating Hypotheses and Explaining

Mechanisms5 Unfolding the Case Incrementally6 Re-EvaluatingReprioritizing Hypotheses

Based on New Information7 AssessmentReflection

PBL Second Session

8 Independent Self-Directed Study of Learning Issues

PBL Third Session

bull 9 Discussion of Learning Issues and Application of New Knowledge to the Case

bull 10 Continued Unfolding of the Case Incrementally

bull 11 AssessmentReflection

During Tutorial Session students will

1048708 Come prepared to discuss the case and learning issues researched since the last tutorial

1048708 Actively participate in group discussions and contribute to the learning process in a manner that allows for the balanced participation of everyone in the group

1048708 Develop learning issues at each session phrase them as full-sentence questions write them on the board and post them on the course web page

1048708 Consider biological population behaviormental health issuesexplanations and questions of professional attitudes values and ethics related to the patientrsquos problem(s) described in the case

Tutorial Session contd1048708 Go to the board to diagram outline draw etc in

explanation of mechanisms relatedto hypotheses1048708 Debate evidence related to the case and avoid

personal attacks on others1048708 Comply with ground rules with regard to how

the group will function and how itsmembers treat one another1048708 Participate in end-of-session reflection and

assessment by giving and receivingconstructive criticism regarding self tutor

student and group performance

Between Tutorial Session

1048708 Research key learning issues using a variety of resources

1048708 Critically evaluate the credibility of sources and the validity of the information they have obtained in their research

1048708 Integrate what they have learned through research lectures labs clinical skills Perspectives in Medicine (PIM) etc into what is discussed in tutorials

1048708 Synthesize what they have learned and be prepared to discuss it without reading directly from their materials as much as possible and apply it to the case at the next tutorial session

Determine priorities for learning

bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue

bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan

bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge

bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career

PBL Starting the casebull After the introductions and discussion

are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it

bull Reading the case aloud keeps the group focused

bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here

Problem-based learning is designed to develop

1048708 Integrated context-specific knowledge base

1048708 Decision-makingcritical thinking process and skills

1048708 Self-directed life-long learning skills 1048708 Interpersonal collaboration and

communication skills 1048708 Constructive self and peer

assessment skills 1048708 Professional ethics and behavior

PBL Case (contd)

bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session

What is problem based learning

bull In PBL students use triggers from the problem case or scenario to define their own learning objectives

bull Subsequently they do independent self directed study before returning to the group to discuss and refine their acquired knowledge

bull Thus PBL is not about problem solving per se but rather it uses appropriate problems to increase knowledge and understanding

bull The process is clearly defined

PBL

bull PBL uses clinical cases as the context for students to study basic and clinical sciences

bull Its possible advantages over traditional approaches include its greater relevance to the practice of medicine its ability to promote retention and application of knowledge and its encouragement of self-directed life-long learning

bull Possible disadvantages include higher costs both in resources and staff time

PBL

bull An educational method characterized by the use of patient problems as a context for students to learn problem-solving skills and acquire knowledge about the basic and clinical sciences

bull Students usually meet in small groups two or three times a week for PBL tutorials

bull They are presented with a clinical problem (eg a patient with chest pain) and in a series of steps they discuss possible mechanisms and causes develop hypotheses and strategies to test the hypotheses are presented with further information and use this new information to refine their hypotheses finally reaching a conclusion

bull A tutor usually acts as a facilitator guiding students in this group-learning process

bull In the course of this exercise students identify both their existing levels and gaps in their knowledge These gaps form the basis for independent learning outside the PBL tutorials The identification and pursuit of these so-called learning goals is a key element of the PBL process

Rationale for using PBL bull The PBL approach is based on principles of adult

education20 and cognitive psychology21 It differs fundamentally from traditional curricula in which students acquire background knowledge of the basic sciences in the early years of the course and in the later years apply this knowledge to the diagnosis and management of clinical problems This traditional approach has been criticised for a number of reasons42223

bull It creates an artificial divide between the basic and clinical sciences

bull Time is wasted in acquiring knowledge that is subsequently forgotten or found to be irrelevant

bull Application of the acquired knowledge can be difficult bull The acquisition and retention of information that has no

apparent relevance can be boring and even demoralising for students

The group learning process acquiring

desirable learning skills

Generic Skills amp attitudes

bull Teamwork bull Critical evaluation of literature bull Chairing a group bull Self directed learning and use of

resources bull Listening Presentation skills

Recording bull Cooperation bull Respect for colleagues views

bull Group learning facilitates not only the acquisition of knowledge but also several other desirable attributes such as communication skills teamwork problem solving independent responsibility for learning sharing information and respect for others PBL can therefore be thought of as a small group teaching method that combines the acquisition of knowledge with the development of generic skills and attitudes Presentation of clinical material as the stimulus for learning enables students to understand the relevance of underlying scientific knowledge and principles in clinical practice

bull when PBL is introduced into a curriculum several other issues for curriculum design and implementation need to be tackled PBL is generally introduced in the context of a defined core curriculum and integration of basic and clinical sciences It has implications for staffing and learning resources and demands a different approach to timetabling workload and assessment PBL is often used to deliver core material in non-clinical parts of the curriculum Paper based PBL scenarios form the basis of the core curriculum and ensure that all students are exposed to the same problems Recently modified PBL techniques have been introduced into clinical education with real patients being used as the stimulus for learning Despite the essential ad hoc nature of learning clinical medicine a key cases approach can enable PBL to be used to deliver the core clinical curriculum

Copyright copy2003 BMJ Publishing Group Ltd

Wood D F BMJ 2003326328-330

No CRoles of participants in a PBL tutorial aption Found

What happens in a PBL tutorial bull PBL tutorials are conducted in several ways In

this article the examples are modelled on the Maastricht seven jump process but its format of seven steps may be shortened

bull A typical PBL tutorial consists of a group of students (usually eight to 10) and a tutor who facilitates the session The length of time (number of sessions) that a group stays together with each other and with individual tutors varies between institutions A group needs to be together long enough to allow good group dynamics to develop but may need to be changed occasionally if personality clashes or other dysfunctional behaviour emerges

bull Students elect a chair for each PBL scenario and a scribe to record the discussion The roles are rotated for each scenario Suitable flip charts or a whiteboard should be used for recording the proceedings At the start of the session depending on the trigger material either the student chair reads out the scenario or all students study the material If the trigger is a real patient in a ward clinic or surgery then a student may be asked to take a clinical history or identify an abnormal physical sign before the group moves to a tutorial room For each module students may be given a handbook containing the problem scenarios and suggested learning resources or learning materials may be handed out at appropriate times as the tutorials progress

Examples of trigger material for PBL scenarios bull Paper based clinical scenarios bull Experimental or clinical laboratory data bull Photographs bull Video clips bull Newspaper articles bull All or part of an article from a scientific

journal bull A real or simulated patient bull A family tree showing an inherited

disorder

PBL tutorial process ndash Step 1 Identify and clarify unfamiliar terms presented in the scenario

scribe lists those that remain unexplained after discussion ndash Step 2 Define the problem or problems to be discussed students may

have different views on the issues but all should be considered scribe records a list of agreed problems

ndash Step 3 Brainstorming session to discuss the problem(s) suggestingpossible explanations on basis of prior knowledge students draw on each others knowledge and identify areas of incomplete knowledge scribe records all discussion

ndash Step 4 Review steps 2 and 3 and arrange explanations into tentativesolutions scribe organises the explanations and restructures if necessary

ndash Step 5 Formulate learning objectives group reaches consensus onthe learning objectives tutor ensures learning objectives are focused achievable comprehensive and appropriate

ndash Step 6 Private study (all students gather information related to eachlearning objective)

ndash Step 7 Group shares results of private study (students identify theirlearning resources and share their results) tutor checks learning and may assess the group

bull The role of the tutor is to facilitate the proceedings (helping the chair to maintain group dynamics and moving the group through the task) and to ensure that the group achieves appropriate learning objectives in line with those set by the curriculum design team The tutor may need to take a more active role in step 7 of the process to ensure that all the students have done the appropriate work and to help the chair to suggest a suitable format for group members to use to present the results of their private study The tutor should encourage students to check their understanding of the material He or she can do this by encouraging the students to ask open questions and ask each other to explain topics in their own words or by the use of drawings and diagrams

PBL in curriculum design bull PBL may be used either as the mainstay of an entire

curriculum or for the delivery of individual courses In practice PBL is usually part of an integrated curriculum using a systems based approach with non-clinical material delivered in the context of clinical practice A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge skills and attitudes A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios Sufficient time should be allowed each week for students to do the self directed learning required for PBL

bull

Copyright copy2003 BMJ Publishing Group Ltd

Wood D F BMJ 2003326328-330

No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found

Writing PBL scenarios

bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives

bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after

studying the scenario should be consistent with the faculty learning objectives

bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding

bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice

bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge

bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented

bull The problem should be sufficiently open so that discussion is not curtailed too early in the process

bull Scenarios should promote participation by the students in seeking information from various learning resources

bull Adapted from Dolmans et al Med Teacher 199719185-9

Staff development

bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)

A dysfunctional group a dominant character may

make it difficult for other students to be heard

A dysfunctional group a dominant character may make it difficult for other students to be heard

bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties

Advantages of PBL bull Student centred PBLIt fostersactive learning improved

understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks

Disadvantagesbull Tutors who cant teachTutorsenjoy passing on

their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful

Assessment of PBL

bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods

bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL

Conclusion

bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning

bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL

PBL 5 Easy Steps

bull Read the problem

Mrs Paula Embledon

Mrs Paula Embledon is a 78 year old woman who has come to the emergency room complaining of shortness of breath and pain in her chest She had been in relatively good health until three weeks previously when she sprained

2 Brain storm

bull Brainstorm

bull ndash hypotheses

bull - what do we know in support of the hypothesis

bull - what do we need to know to test the hypothesis

ndash learning issues

Brainstorm

bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)

ndash specific issues (for individuals to look up)

ndash overlapping issues

bull 4 Individual Reading - Research - Preparation

bull 5 Return

bull ndash review case so far ndash report and discuss

ndash assess progress - continue pagenext pagecomplete

ndash self-evaluation - How did things go Any suggestions for next time

ndash next problem

bull 5 Return

THE FIRST GROUP SESSION

bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day

bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session

bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr

bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine

bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise

bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator

bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues

bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know

bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)

bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)

bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)

  • PROBLEM BASED LEARNING
  • New Horizons in Medical Education
  • Slide 3
  • Domains of essential Global Requirements of ME
  • What was the response to these challenges
  • New Educational Strategies
  • New Tools amp Aids
  • PBL
  • PBL
  • Advantages
  • Slide 11
  • Slide 12
  • Slide 13
  • Slide 14
  • Framework for PBL
  • Framework for PBL - II
  • Characteristics of an effective PBL Group
  • Staff Development
  • Tutorrsquos Role in Assessment
  • Slide 20
  • Evaluating PBL Tutorials-II
  • PBL
  • Slide 23
  • PBL Starting the case
  • PBL Case (contd)
  • PBL Case contd
  • The Process of PBL
  • The Process of PBL contd
  • Learn from each other
  • Determine priorities for learning
  • Slide 31
  • Slide 32
  • Learning Issues
  • Learning Issues in PBL First Session
  • PBL Second Session
  • PBL Third Session
  • Slide 37
  • Slide 38
  • During Tutorial Session students will
  • Tutorial Session contd
  • Between Tutorial Session
  • Slide 42
  • Slide 43
  • Problem-based learning is designed to develop
  • Slide 45
  • What is problem based learning
  • Slide 47
  • Slide 48
  • Slide 49
  • Rationale for using PBL
  • Slide 51
  • Slide 52
  • The group learning process acquiring desirable learning skills
  • Generic Skills amp attitudes
  • Slide 55
  • Slide 56
  • Slide 57
  • What happens in a PBL tutorial
  • Slide 59
  • Examples of trigger material for PBL scenarios
  • PBL tutorial process
  • Slide 62
  • PBL in curriculum design
  • Slide 64
  • Writing PBL scenarios
  • Slide 66
  • Staff development
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • Slide 70
  • Advantages of PBL
  • Slide 72
  • Slide 73
  • Disadvantages
  • Assessment of PBL
  • Slide 76
  • Conclusion
  • Slide 78
  • PBL 5 Easy Steps
  • 2 Brain storm
  • Brainstorm
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • THE FIRST GROUP SESSION
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
Page 11: Problem based learning

Advantages

In preparing students for professional practice PBL

bull Encourages independence as students identify amp meet individual learning needs

bull Stimulates reflection amp self-direction for life-long learning

bull Supports ongoing self-assessmentbull Introduces clinical reasoningbull Enhances critical thinking amp evidence-based

decision makingbull Ensures that knowledge is transferred applied

amp retained by providing a relevant integrated context

bull A problem initiates the activitybull The Group is stimulated to explore

basic scientific amp clinical mechanisms together with social psychological ethical or professional issues

bull Problem stimulates students to reason think critically amp weigh evidence they seek out amp share relevant info

PBL

bull Groups do not need prior knowledge to generate lively ideas as they identify areas for further collective amp personal learning

bull Each student brings individual experience amp makes a distinctive contribution

bull the Tutorrsquos role is to manage interactions rather than supply info

bull An effective Group provides a safe environment for sharing amp testing new knowledge

bull Students practice the language of science amp medicine evaluate ideas and receive feedback from peers amp teacher

bull When clinical exposure is introduced concurrently intellectual amp practical skills develop in parallel

Framework for PBL

bull A trigger initiates the problem (papercomputervideo)

bull Groups brainstorm to identify key issues for discussion

bull Broad thinking produces a rich array of mechanisms amp ideas

bull Hypothesis are critically explored through reasoning

bull The need for additional info is identifiedbull A Conclusion is reachedbull Group reviews the process

Framework for PBL - II

bull In Breaks between Tutorials students identfy Learning Issues to be pursued

bull They are encouraged to adot an evidence-based approach

bull When they reconvene they share and review the learning

Characteristics of an effective PBL Group

An Effective Group is Cohesive motivated mutually supportive amp actively engaged in learning

bull The Group understands the process amp energetically pursues its task

bull Members respect each otherrsquos contribution but examine them critically

bull Discussions flow as students cooperate rather than compete

bull The atmosphere is friendly amp good humouredbull Roles are shared all take turns in scribing

leading discussion taking responsibility for acquiring information

Staff Development

bull Basic training is mandatorybull Further development may be a requirementbull Initial training may involve observation amp

practice with a group from the programbull Effective training ensures that necessary

background goals amp local strategies are considered together with info on assessment amp evaluation

bull In addition to materials supplied to students tutors are usually issued with handbooks highlighting issues for each problem

Tutorrsquos Role in Assessment

bull Individual StudentsGroups may be assessed Summatively (determining progression) or formatively (for feedback)

The GROUP

bull At the end of each problem groups review their processes to encourage self-reflection ampenhance their collective performance

Tutorrsquos Role in Assessment

Individual students

bull Tutors should provide formative feedback to each member

bull Ask students to complete a simple self-assessment questionnaire reviewing appropriate behaviors the tutor returns them with comments

bull Students will be a writtenoralclinical tests that will determine their progression amp ultimate graduation

Evaluating PBL Tutorials-II

bull At the end of each problem time is allocated for evaluation

bull Both the process amp learning in PBL can be evaluated against explicit goals

bull The tutorrsquos review of effectiveness of group processes offers insight for the members

bull Students normally evaluate their tutor helpfulness support for clinical reasoning encouragement for independent learning appropriate intervention provision for effective feedback

PBLbull 1048708 Enabling students to learn in the context in which the

information will be used which increases the ability to retrieve and apply information

bull 1048708 Focusing on important concepts which helps learners organize and store new information in a way that facilitates retrieval and application

bull 1048708 Exploring prior knowledge formulating inquiries derived from and defined by the learnersrsquo need to know and actively constructing meaning through dialogue and reflection

bull 1048708 Utilizing problems designed to simulate studentsrsquo perception of their future profession which serves as a powerful stimulus for studentsrsquo intrinsic motivation to learn

bull 1048708 Actively involving students in monitoring their own progress and reflecting on what works and what needs improvement frequently assessing student performance and providing feedback

PBL Starting the casebull After the introductions and discussion

are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it

bull Reading the case aloud keeps the group focused

bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here

PBL Case (contd)

bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session

PBL Case contdbull SECOND deciding which issues everyone will

tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)

bull THIRD deciding what SPECIFIC questions individuals will try to answer

bull FOURTH deciding how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet or consulting an expert)

The Process of PBL

bullWhat are the issues Identify the important issues in the problem

bull How well do you understand the issues

bull Are there any words or terms about which you are unclear

The Process of PBL contd

bull Consider the basic mechanisms that might explain each important aspect of each problem

bull Assess your current understanding of the basic structural andor functional mechanisms that may contribute to the presentation of the problem

bull Use the collective skills and experiences of group members to explore or explain these phenomena Identify current gaps in knowledge or understanding

Learn from each other

bullShare your own knowledge expertise or ability to reason and synthesize information Be receptive and appreciative of the contribution of your small group members

Determine priorities for learning

bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue

bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan

bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge

bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career

PBL

bull The problem comes first without advance readings lectures or preparation

bull The problem serves as a stimulus for the need to know

Learning Issues

bull Learning issues are questions that cannot be answered with studentsrsquo current knowledge and that can be explored and answered through systematic self-directed inquiry

bull The use of learning issues in tutorials prepares students to handle similar challenges in clinical practice and life-long learning

Learning Issues in PBL First Session1 Getting Started (Introductions Ground

Rules Expectations)2 Identifying Problem3 Exploring Pre-Existing Knowledge4 Generating Hypotheses and Explaining

Mechanisms5 Unfolding the Case Incrementally6 Re-EvaluatingReprioritizing Hypotheses

Based on New Information7 AssessmentReflection

PBL Second Session

8 Independent Self-Directed Study of Learning Issues

PBL Third Session

bull 9 Discussion of Learning Issues and Application of New Knowledge to the Case

bull 10 Continued Unfolding of the Case Incrementally

bull 11 AssessmentReflection

During Tutorial Session students will

1048708 Come prepared to discuss the case and learning issues researched since the last tutorial

1048708 Actively participate in group discussions and contribute to the learning process in a manner that allows for the balanced participation of everyone in the group

1048708 Develop learning issues at each session phrase them as full-sentence questions write them on the board and post them on the course web page

1048708 Consider biological population behaviormental health issuesexplanations and questions of professional attitudes values and ethics related to the patientrsquos problem(s) described in the case

Tutorial Session contd1048708 Go to the board to diagram outline draw etc in

explanation of mechanisms relatedto hypotheses1048708 Debate evidence related to the case and avoid

personal attacks on others1048708 Comply with ground rules with regard to how

the group will function and how itsmembers treat one another1048708 Participate in end-of-session reflection and

assessment by giving and receivingconstructive criticism regarding self tutor

student and group performance

Between Tutorial Session

1048708 Research key learning issues using a variety of resources

1048708 Critically evaluate the credibility of sources and the validity of the information they have obtained in their research

1048708 Integrate what they have learned through research lectures labs clinical skills Perspectives in Medicine (PIM) etc into what is discussed in tutorials

1048708 Synthesize what they have learned and be prepared to discuss it without reading directly from their materials as much as possible and apply it to the case at the next tutorial session

Determine priorities for learning

bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue

bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan

bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge

bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career

PBL Starting the casebull After the introductions and discussion

are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it

bull Reading the case aloud keeps the group focused

bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here

Problem-based learning is designed to develop

1048708 Integrated context-specific knowledge base

1048708 Decision-makingcritical thinking process and skills

1048708 Self-directed life-long learning skills 1048708 Interpersonal collaboration and

communication skills 1048708 Constructive self and peer

assessment skills 1048708 Professional ethics and behavior

PBL Case (contd)

bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session

What is problem based learning

bull In PBL students use triggers from the problem case or scenario to define their own learning objectives

bull Subsequently they do independent self directed study before returning to the group to discuss and refine their acquired knowledge

bull Thus PBL is not about problem solving per se but rather it uses appropriate problems to increase knowledge and understanding

bull The process is clearly defined

PBL

bull PBL uses clinical cases as the context for students to study basic and clinical sciences

bull Its possible advantages over traditional approaches include its greater relevance to the practice of medicine its ability to promote retention and application of knowledge and its encouragement of self-directed life-long learning

bull Possible disadvantages include higher costs both in resources and staff time

PBL

bull An educational method characterized by the use of patient problems as a context for students to learn problem-solving skills and acquire knowledge about the basic and clinical sciences

bull Students usually meet in small groups two or three times a week for PBL tutorials

bull They are presented with a clinical problem (eg a patient with chest pain) and in a series of steps they discuss possible mechanisms and causes develop hypotheses and strategies to test the hypotheses are presented with further information and use this new information to refine their hypotheses finally reaching a conclusion

bull A tutor usually acts as a facilitator guiding students in this group-learning process

bull In the course of this exercise students identify both their existing levels and gaps in their knowledge These gaps form the basis for independent learning outside the PBL tutorials The identification and pursuit of these so-called learning goals is a key element of the PBL process

Rationale for using PBL bull The PBL approach is based on principles of adult

education20 and cognitive psychology21 It differs fundamentally from traditional curricula in which students acquire background knowledge of the basic sciences in the early years of the course and in the later years apply this knowledge to the diagnosis and management of clinical problems This traditional approach has been criticised for a number of reasons42223

bull It creates an artificial divide between the basic and clinical sciences

bull Time is wasted in acquiring knowledge that is subsequently forgotten or found to be irrelevant

bull Application of the acquired knowledge can be difficult bull The acquisition and retention of information that has no

apparent relevance can be boring and even demoralising for students

The group learning process acquiring

desirable learning skills

Generic Skills amp attitudes

bull Teamwork bull Critical evaluation of literature bull Chairing a group bull Self directed learning and use of

resources bull Listening Presentation skills

Recording bull Cooperation bull Respect for colleagues views

bull Group learning facilitates not only the acquisition of knowledge but also several other desirable attributes such as communication skills teamwork problem solving independent responsibility for learning sharing information and respect for others PBL can therefore be thought of as a small group teaching method that combines the acquisition of knowledge with the development of generic skills and attitudes Presentation of clinical material as the stimulus for learning enables students to understand the relevance of underlying scientific knowledge and principles in clinical practice

bull when PBL is introduced into a curriculum several other issues for curriculum design and implementation need to be tackled PBL is generally introduced in the context of a defined core curriculum and integration of basic and clinical sciences It has implications for staffing and learning resources and demands a different approach to timetabling workload and assessment PBL is often used to deliver core material in non-clinical parts of the curriculum Paper based PBL scenarios form the basis of the core curriculum and ensure that all students are exposed to the same problems Recently modified PBL techniques have been introduced into clinical education with real patients being used as the stimulus for learning Despite the essential ad hoc nature of learning clinical medicine a key cases approach can enable PBL to be used to deliver the core clinical curriculum

Copyright copy2003 BMJ Publishing Group Ltd

Wood D F BMJ 2003326328-330

No CRoles of participants in a PBL tutorial aption Found

What happens in a PBL tutorial bull PBL tutorials are conducted in several ways In

this article the examples are modelled on the Maastricht seven jump process but its format of seven steps may be shortened

bull A typical PBL tutorial consists of a group of students (usually eight to 10) and a tutor who facilitates the session The length of time (number of sessions) that a group stays together with each other and with individual tutors varies between institutions A group needs to be together long enough to allow good group dynamics to develop but may need to be changed occasionally if personality clashes or other dysfunctional behaviour emerges

bull Students elect a chair for each PBL scenario and a scribe to record the discussion The roles are rotated for each scenario Suitable flip charts or a whiteboard should be used for recording the proceedings At the start of the session depending on the trigger material either the student chair reads out the scenario or all students study the material If the trigger is a real patient in a ward clinic or surgery then a student may be asked to take a clinical history or identify an abnormal physical sign before the group moves to a tutorial room For each module students may be given a handbook containing the problem scenarios and suggested learning resources or learning materials may be handed out at appropriate times as the tutorials progress

Examples of trigger material for PBL scenarios bull Paper based clinical scenarios bull Experimental or clinical laboratory data bull Photographs bull Video clips bull Newspaper articles bull All or part of an article from a scientific

journal bull A real or simulated patient bull A family tree showing an inherited

disorder

PBL tutorial process ndash Step 1 Identify and clarify unfamiliar terms presented in the scenario

scribe lists those that remain unexplained after discussion ndash Step 2 Define the problem or problems to be discussed students may

have different views on the issues but all should be considered scribe records a list of agreed problems

ndash Step 3 Brainstorming session to discuss the problem(s) suggestingpossible explanations on basis of prior knowledge students draw on each others knowledge and identify areas of incomplete knowledge scribe records all discussion

ndash Step 4 Review steps 2 and 3 and arrange explanations into tentativesolutions scribe organises the explanations and restructures if necessary

ndash Step 5 Formulate learning objectives group reaches consensus onthe learning objectives tutor ensures learning objectives are focused achievable comprehensive and appropriate

ndash Step 6 Private study (all students gather information related to eachlearning objective)

ndash Step 7 Group shares results of private study (students identify theirlearning resources and share their results) tutor checks learning and may assess the group

bull The role of the tutor is to facilitate the proceedings (helping the chair to maintain group dynamics and moving the group through the task) and to ensure that the group achieves appropriate learning objectives in line with those set by the curriculum design team The tutor may need to take a more active role in step 7 of the process to ensure that all the students have done the appropriate work and to help the chair to suggest a suitable format for group members to use to present the results of their private study The tutor should encourage students to check their understanding of the material He or she can do this by encouraging the students to ask open questions and ask each other to explain topics in their own words or by the use of drawings and diagrams

PBL in curriculum design bull PBL may be used either as the mainstay of an entire

curriculum or for the delivery of individual courses In practice PBL is usually part of an integrated curriculum using a systems based approach with non-clinical material delivered in the context of clinical practice A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge skills and attitudes A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios Sufficient time should be allowed each week for students to do the self directed learning required for PBL

bull

Copyright copy2003 BMJ Publishing Group Ltd

Wood D F BMJ 2003326328-330

No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found

Writing PBL scenarios

bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives

bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after

studying the scenario should be consistent with the faculty learning objectives

bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding

bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice

bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge

bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented

bull The problem should be sufficiently open so that discussion is not curtailed too early in the process

bull Scenarios should promote participation by the students in seeking information from various learning resources

bull Adapted from Dolmans et al Med Teacher 199719185-9

Staff development

bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)

A dysfunctional group a dominant character may

make it difficult for other students to be heard

A dysfunctional group a dominant character may make it difficult for other students to be heard

bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties

Advantages of PBL bull Student centred PBLIt fostersactive learning improved

understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks

Disadvantagesbull Tutors who cant teachTutorsenjoy passing on

their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful

Assessment of PBL

bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods

bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL

Conclusion

bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning

bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL

PBL 5 Easy Steps

bull Read the problem

Mrs Paula Embledon

Mrs Paula Embledon is a 78 year old woman who has come to the emergency room complaining of shortness of breath and pain in her chest She had been in relatively good health until three weeks previously when she sprained

2 Brain storm

bull Brainstorm

bull ndash hypotheses

bull - what do we know in support of the hypothesis

bull - what do we need to know to test the hypothesis

ndash learning issues

Brainstorm

bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)

ndash specific issues (for individuals to look up)

ndash overlapping issues

bull 4 Individual Reading - Research - Preparation

bull 5 Return

bull ndash review case so far ndash report and discuss

ndash assess progress - continue pagenext pagecomplete

ndash self-evaluation - How did things go Any suggestions for next time

ndash next problem

bull 5 Return

THE FIRST GROUP SESSION

bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day

bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session

bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr

bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine

bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise

bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator

bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues

bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know

bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)

bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)

bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)

  • PROBLEM BASED LEARNING
  • New Horizons in Medical Education
  • Slide 3
  • Domains of essential Global Requirements of ME
  • What was the response to these challenges
  • New Educational Strategies
  • New Tools amp Aids
  • PBL
  • PBL
  • Advantages
  • Slide 11
  • Slide 12
  • Slide 13
  • Slide 14
  • Framework for PBL
  • Framework for PBL - II
  • Characteristics of an effective PBL Group
  • Staff Development
  • Tutorrsquos Role in Assessment
  • Slide 20
  • Evaluating PBL Tutorials-II
  • PBL
  • Slide 23
  • PBL Starting the case
  • PBL Case (contd)
  • PBL Case contd
  • The Process of PBL
  • The Process of PBL contd
  • Learn from each other
  • Determine priorities for learning
  • Slide 31
  • Slide 32
  • Learning Issues
  • Learning Issues in PBL First Session
  • PBL Second Session
  • PBL Third Session
  • Slide 37
  • Slide 38
  • During Tutorial Session students will
  • Tutorial Session contd
  • Between Tutorial Session
  • Slide 42
  • Slide 43
  • Problem-based learning is designed to develop
  • Slide 45
  • What is problem based learning
  • Slide 47
  • Slide 48
  • Slide 49
  • Rationale for using PBL
  • Slide 51
  • Slide 52
  • The group learning process acquiring desirable learning skills
  • Generic Skills amp attitudes
  • Slide 55
  • Slide 56
  • Slide 57
  • What happens in a PBL tutorial
  • Slide 59
  • Examples of trigger material for PBL scenarios
  • PBL tutorial process
  • Slide 62
  • PBL in curriculum design
  • Slide 64
  • Writing PBL scenarios
  • Slide 66
  • Staff development
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • Slide 70
  • Advantages of PBL
  • Slide 72
  • Slide 73
  • Disadvantages
  • Assessment of PBL
  • Slide 76
  • Conclusion
  • Slide 78
  • PBL 5 Easy Steps
  • 2 Brain storm
  • Brainstorm
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • THE FIRST GROUP SESSION
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
Page 12: Problem based learning

bull A problem initiates the activitybull The Group is stimulated to explore

basic scientific amp clinical mechanisms together with social psychological ethical or professional issues

bull Problem stimulates students to reason think critically amp weigh evidence they seek out amp share relevant info

PBL

bull Groups do not need prior knowledge to generate lively ideas as they identify areas for further collective amp personal learning

bull Each student brings individual experience amp makes a distinctive contribution

bull the Tutorrsquos role is to manage interactions rather than supply info

bull An effective Group provides a safe environment for sharing amp testing new knowledge

bull Students practice the language of science amp medicine evaluate ideas and receive feedback from peers amp teacher

bull When clinical exposure is introduced concurrently intellectual amp practical skills develop in parallel

Framework for PBL

bull A trigger initiates the problem (papercomputervideo)

bull Groups brainstorm to identify key issues for discussion

bull Broad thinking produces a rich array of mechanisms amp ideas

bull Hypothesis are critically explored through reasoning

bull The need for additional info is identifiedbull A Conclusion is reachedbull Group reviews the process

Framework for PBL - II

bull In Breaks between Tutorials students identfy Learning Issues to be pursued

bull They are encouraged to adot an evidence-based approach

bull When they reconvene they share and review the learning

Characteristics of an effective PBL Group

An Effective Group is Cohesive motivated mutually supportive amp actively engaged in learning

bull The Group understands the process amp energetically pursues its task

bull Members respect each otherrsquos contribution but examine them critically

bull Discussions flow as students cooperate rather than compete

bull The atmosphere is friendly amp good humouredbull Roles are shared all take turns in scribing

leading discussion taking responsibility for acquiring information

Staff Development

bull Basic training is mandatorybull Further development may be a requirementbull Initial training may involve observation amp

practice with a group from the programbull Effective training ensures that necessary

background goals amp local strategies are considered together with info on assessment amp evaluation

bull In addition to materials supplied to students tutors are usually issued with handbooks highlighting issues for each problem

Tutorrsquos Role in Assessment

bull Individual StudentsGroups may be assessed Summatively (determining progression) or formatively (for feedback)

The GROUP

bull At the end of each problem groups review their processes to encourage self-reflection ampenhance their collective performance

Tutorrsquos Role in Assessment

Individual students

bull Tutors should provide formative feedback to each member

bull Ask students to complete a simple self-assessment questionnaire reviewing appropriate behaviors the tutor returns them with comments

bull Students will be a writtenoralclinical tests that will determine their progression amp ultimate graduation

Evaluating PBL Tutorials-II

bull At the end of each problem time is allocated for evaluation

bull Both the process amp learning in PBL can be evaluated against explicit goals

bull The tutorrsquos review of effectiveness of group processes offers insight for the members

bull Students normally evaluate their tutor helpfulness support for clinical reasoning encouragement for independent learning appropriate intervention provision for effective feedback

PBLbull 1048708 Enabling students to learn in the context in which the

information will be used which increases the ability to retrieve and apply information

bull 1048708 Focusing on important concepts which helps learners organize and store new information in a way that facilitates retrieval and application

bull 1048708 Exploring prior knowledge formulating inquiries derived from and defined by the learnersrsquo need to know and actively constructing meaning through dialogue and reflection

bull 1048708 Utilizing problems designed to simulate studentsrsquo perception of their future profession which serves as a powerful stimulus for studentsrsquo intrinsic motivation to learn

bull 1048708 Actively involving students in monitoring their own progress and reflecting on what works and what needs improvement frequently assessing student performance and providing feedback

PBL Starting the casebull After the introductions and discussion

are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it

bull Reading the case aloud keeps the group focused

bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here

PBL Case (contd)

bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session

PBL Case contdbull SECOND deciding which issues everyone will

tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)

bull THIRD deciding what SPECIFIC questions individuals will try to answer

bull FOURTH deciding how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet or consulting an expert)

The Process of PBL

bullWhat are the issues Identify the important issues in the problem

bull How well do you understand the issues

bull Are there any words or terms about which you are unclear

The Process of PBL contd

bull Consider the basic mechanisms that might explain each important aspect of each problem

bull Assess your current understanding of the basic structural andor functional mechanisms that may contribute to the presentation of the problem

bull Use the collective skills and experiences of group members to explore or explain these phenomena Identify current gaps in knowledge or understanding

Learn from each other

bullShare your own knowledge expertise or ability to reason and synthesize information Be receptive and appreciative of the contribution of your small group members

Determine priorities for learning

bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue

bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan

bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge

bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career

PBL

bull The problem comes first without advance readings lectures or preparation

bull The problem serves as a stimulus for the need to know

Learning Issues

bull Learning issues are questions that cannot be answered with studentsrsquo current knowledge and that can be explored and answered through systematic self-directed inquiry

bull The use of learning issues in tutorials prepares students to handle similar challenges in clinical practice and life-long learning

Learning Issues in PBL First Session1 Getting Started (Introductions Ground

Rules Expectations)2 Identifying Problem3 Exploring Pre-Existing Knowledge4 Generating Hypotheses and Explaining

Mechanisms5 Unfolding the Case Incrementally6 Re-EvaluatingReprioritizing Hypotheses

Based on New Information7 AssessmentReflection

PBL Second Session

8 Independent Self-Directed Study of Learning Issues

PBL Third Session

bull 9 Discussion of Learning Issues and Application of New Knowledge to the Case

bull 10 Continued Unfolding of the Case Incrementally

bull 11 AssessmentReflection

During Tutorial Session students will

1048708 Come prepared to discuss the case and learning issues researched since the last tutorial

1048708 Actively participate in group discussions and contribute to the learning process in a manner that allows for the balanced participation of everyone in the group

1048708 Develop learning issues at each session phrase them as full-sentence questions write them on the board and post them on the course web page

1048708 Consider biological population behaviormental health issuesexplanations and questions of professional attitudes values and ethics related to the patientrsquos problem(s) described in the case

Tutorial Session contd1048708 Go to the board to diagram outline draw etc in

explanation of mechanisms relatedto hypotheses1048708 Debate evidence related to the case and avoid

personal attacks on others1048708 Comply with ground rules with regard to how

the group will function and how itsmembers treat one another1048708 Participate in end-of-session reflection and

assessment by giving and receivingconstructive criticism regarding self tutor

student and group performance

Between Tutorial Session

1048708 Research key learning issues using a variety of resources

1048708 Critically evaluate the credibility of sources and the validity of the information they have obtained in their research

1048708 Integrate what they have learned through research lectures labs clinical skills Perspectives in Medicine (PIM) etc into what is discussed in tutorials

1048708 Synthesize what they have learned and be prepared to discuss it without reading directly from their materials as much as possible and apply it to the case at the next tutorial session

Determine priorities for learning

bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue

bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan

bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge

bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career

PBL Starting the casebull After the introductions and discussion

are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it

bull Reading the case aloud keeps the group focused

bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here

Problem-based learning is designed to develop

1048708 Integrated context-specific knowledge base

1048708 Decision-makingcritical thinking process and skills

1048708 Self-directed life-long learning skills 1048708 Interpersonal collaboration and

communication skills 1048708 Constructive self and peer

assessment skills 1048708 Professional ethics and behavior

PBL Case (contd)

bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session

What is problem based learning

bull In PBL students use triggers from the problem case or scenario to define their own learning objectives

bull Subsequently they do independent self directed study before returning to the group to discuss and refine their acquired knowledge

bull Thus PBL is not about problem solving per se but rather it uses appropriate problems to increase knowledge and understanding

bull The process is clearly defined

PBL

bull PBL uses clinical cases as the context for students to study basic and clinical sciences

bull Its possible advantages over traditional approaches include its greater relevance to the practice of medicine its ability to promote retention and application of knowledge and its encouragement of self-directed life-long learning

bull Possible disadvantages include higher costs both in resources and staff time

PBL

bull An educational method characterized by the use of patient problems as a context for students to learn problem-solving skills and acquire knowledge about the basic and clinical sciences

bull Students usually meet in small groups two or three times a week for PBL tutorials

bull They are presented with a clinical problem (eg a patient with chest pain) and in a series of steps they discuss possible mechanisms and causes develop hypotheses and strategies to test the hypotheses are presented with further information and use this new information to refine their hypotheses finally reaching a conclusion

bull A tutor usually acts as a facilitator guiding students in this group-learning process

bull In the course of this exercise students identify both their existing levels and gaps in their knowledge These gaps form the basis for independent learning outside the PBL tutorials The identification and pursuit of these so-called learning goals is a key element of the PBL process

Rationale for using PBL bull The PBL approach is based on principles of adult

education20 and cognitive psychology21 It differs fundamentally from traditional curricula in which students acquire background knowledge of the basic sciences in the early years of the course and in the later years apply this knowledge to the diagnosis and management of clinical problems This traditional approach has been criticised for a number of reasons42223

bull It creates an artificial divide between the basic and clinical sciences

bull Time is wasted in acquiring knowledge that is subsequently forgotten or found to be irrelevant

bull Application of the acquired knowledge can be difficult bull The acquisition and retention of information that has no

apparent relevance can be boring and even demoralising for students

The group learning process acquiring

desirable learning skills

Generic Skills amp attitudes

bull Teamwork bull Critical evaluation of literature bull Chairing a group bull Self directed learning and use of

resources bull Listening Presentation skills

Recording bull Cooperation bull Respect for colleagues views

bull Group learning facilitates not only the acquisition of knowledge but also several other desirable attributes such as communication skills teamwork problem solving independent responsibility for learning sharing information and respect for others PBL can therefore be thought of as a small group teaching method that combines the acquisition of knowledge with the development of generic skills and attitudes Presentation of clinical material as the stimulus for learning enables students to understand the relevance of underlying scientific knowledge and principles in clinical practice

bull when PBL is introduced into a curriculum several other issues for curriculum design and implementation need to be tackled PBL is generally introduced in the context of a defined core curriculum and integration of basic and clinical sciences It has implications for staffing and learning resources and demands a different approach to timetabling workload and assessment PBL is often used to deliver core material in non-clinical parts of the curriculum Paper based PBL scenarios form the basis of the core curriculum and ensure that all students are exposed to the same problems Recently modified PBL techniques have been introduced into clinical education with real patients being used as the stimulus for learning Despite the essential ad hoc nature of learning clinical medicine a key cases approach can enable PBL to be used to deliver the core clinical curriculum

Copyright copy2003 BMJ Publishing Group Ltd

Wood D F BMJ 2003326328-330

No CRoles of participants in a PBL tutorial aption Found

What happens in a PBL tutorial bull PBL tutorials are conducted in several ways In

this article the examples are modelled on the Maastricht seven jump process but its format of seven steps may be shortened

bull A typical PBL tutorial consists of a group of students (usually eight to 10) and a tutor who facilitates the session The length of time (number of sessions) that a group stays together with each other and with individual tutors varies between institutions A group needs to be together long enough to allow good group dynamics to develop but may need to be changed occasionally if personality clashes or other dysfunctional behaviour emerges

bull Students elect a chair for each PBL scenario and a scribe to record the discussion The roles are rotated for each scenario Suitable flip charts or a whiteboard should be used for recording the proceedings At the start of the session depending on the trigger material either the student chair reads out the scenario or all students study the material If the trigger is a real patient in a ward clinic or surgery then a student may be asked to take a clinical history or identify an abnormal physical sign before the group moves to a tutorial room For each module students may be given a handbook containing the problem scenarios and suggested learning resources or learning materials may be handed out at appropriate times as the tutorials progress

Examples of trigger material for PBL scenarios bull Paper based clinical scenarios bull Experimental or clinical laboratory data bull Photographs bull Video clips bull Newspaper articles bull All or part of an article from a scientific

journal bull A real or simulated patient bull A family tree showing an inherited

disorder

PBL tutorial process ndash Step 1 Identify and clarify unfamiliar terms presented in the scenario

scribe lists those that remain unexplained after discussion ndash Step 2 Define the problem or problems to be discussed students may

have different views on the issues but all should be considered scribe records a list of agreed problems

ndash Step 3 Brainstorming session to discuss the problem(s) suggestingpossible explanations on basis of prior knowledge students draw on each others knowledge and identify areas of incomplete knowledge scribe records all discussion

ndash Step 4 Review steps 2 and 3 and arrange explanations into tentativesolutions scribe organises the explanations and restructures if necessary

ndash Step 5 Formulate learning objectives group reaches consensus onthe learning objectives tutor ensures learning objectives are focused achievable comprehensive and appropriate

ndash Step 6 Private study (all students gather information related to eachlearning objective)

ndash Step 7 Group shares results of private study (students identify theirlearning resources and share their results) tutor checks learning and may assess the group

bull The role of the tutor is to facilitate the proceedings (helping the chair to maintain group dynamics and moving the group through the task) and to ensure that the group achieves appropriate learning objectives in line with those set by the curriculum design team The tutor may need to take a more active role in step 7 of the process to ensure that all the students have done the appropriate work and to help the chair to suggest a suitable format for group members to use to present the results of their private study The tutor should encourage students to check their understanding of the material He or she can do this by encouraging the students to ask open questions and ask each other to explain topics in their own words or by the use of drawings and diagrams

PBL in curriculum design bull PBL may be used either as the mainstay of an entire

curriculum or for the delivery of individual courses In practice PBL is usually part of an integrated curriculum using a systems based approach with non-clinical material delivered in the context of clinical practice A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge skills and attitudes A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios Sufficient time should be allowed each week for students to do the self directed learning required for PBL

bull

Copyright copy2003 BMJ Publishing Group Ltd

Wood D F BMJ 2003326328-330

No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found

Writing PBL scenarios

bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives

bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after

studying the scenario should be consistent with the faculty learning objectives

bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding

bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice

bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge

bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented

bull The problem should be sufficiently open so that discussion is not curtailed too early in the process

bull Scenarios should promote participation by the students in seeking information from various learning resources

bull Adapted from Dolmans et al Med Teacher 199719185-9

Staff development

bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)

A dysfunctional group a dominant character may

make it difficult for other students to be heard

A dysfunctional group a dominant character may make it difficult for other students to be heard

bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties

Advantages of PBL bull Student centred PBLIt fostersactive learning improved

understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks

Disadvantagesbull Tutors who cant teachTutorsenjoy passing on

their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful

Assessment of PBL

bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods

bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL

Conclusion

bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning

bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL

PBL 5 Easy Steps

bull Read the problem

Mrs Paula Embledon

Mrs Paula Embledon is a 78 year old woman who has come to the emergency room complaining of shortness of breath and pain in her chest She had been in relatively good health until three weeks previously when she sprained

2 Brain storm

bull Brainstorm

bull ndash hypotheses

bull - what do we know in support of the hypothesis

bull - what do we need to know to test the hypothesis

ndash learning issues

Brainstorm

bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)

ndash specific issues (for individuals to look up)

ndash overlapping issues

bull 4 Individual Reading - Research - Preparation

bull 5 Return

bull ndash review case so far ndash report and discuss

ndash assess progress - continue pagenext pagecomplete

ndash self-evaluation - How did things go Any suggestions for next time

ndash next problem

bull 5 Return

THE FIRST GROUP SESSION

bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day

bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session

bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr

bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine

bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise

bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator

bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues

bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know

bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)

bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)

bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)

  • PROBLEM BASED LEARNING
  • New Horizons in Medical Education
  • Slide 3
  • Domains of essential Global Requirements of ME
  • What was the response to these challenges
  • New Educational Strategies
  • New Tools amp Aids
  • PBL
  • PBL
  • Advantages
  • Slide 11
  • Slide 12
  • Slide 13
  • Slide 14
  • Framework for PBL
  • Framework for PBL - II
  • Characteristics of an effective PBL Group
  • Staff Development
  • Tutorrsquos Role in Assessment
  • Slide 20
  • Evaluating PBL Tutorials-II
  • PBL
  • Slide 23
  • PBL Starting the case
  • PBL Case (contd)
  • PBL Case contd
  • The Process of PBL
  • The Process of PBL contd
  • Learn from each other
  • Determine priorities for learning
  • Slide 31
  • Slide 32
  • Learning Issues
  • Learning Issues in PBL First Session
  • PBL Second Session
  • PBL Third Session
  • Slide 37
  • Slide 38
  • During Tutorial Session students will
  • Tutorial Session contd
  • Between Tutorial Session
  • Slide 42
  • Slide 43
  • Problem-based learning is designed to develop
  • Slide 45
  • What is problem based learning
  • Slide 47
  • Slide 48
  • Slide 49
  • Rationale for using PBL
  • Slide 51
  • Slide 52
  • The group learning process acquiring desirable learning skills
  • Generic Skills amp attitudes
  • Slide 55
  • Slide 56
  • Slide 57
  • What happens in a PBL tutorial
  • Slide 59
  • Examples of trigger material for PBL scenarios
  • PBL tutorial process
  • Slide 62
  • PBL in curriculum design
  • Slide 64
  • Writing PBL scenarios
  • Slide 66
  • Staff development
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • Slide 70
  • Advantages of PBL
  • Slide 72
  • Slide 73
  • Disadvantages
  • Assessment of PBL
  • Slide 76
  • Conclusion
  • Slide 78
  • PBL 5 Easy Steps
  • 2 Brain storm
  • Brainstorm
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • THE FIRST GROUP SESSION
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
Page 13: Problem based learning

PBL

bull Groups do not need prior knowledge to generate lively ideas as they identify areas for further collective amp personal learning

bull Each student brings individual experience amp makes a distinctive contribution

bull the Tutorrsquos role is to manage interactions rather than supply info

bull An effective Group provides a safe environment for sharing amp testing new knowledge

bull Students practice the language of science amp medicine evaluate ideas and receive feedback from peers amp teacher

bull When clinical exposure is introduced concurrently intellectual amp practical skills develop in parallel

Framework for PBL

bull A trigger initiates the problem (papercomputervideo)

bull Groups brainstorm to identify key issues for discussion

bull Broad thinking produces a rich array of mechanisms amp ideas

bull Hypothesis are critically explored through reasoning

bull The need for additional info is identifiedbull A Conclusion is reachedbull Group reviews the process

Framework for PBL - II

bull In Breaks between Tutorials students identfy Learning Issues to be pursued

bull They are encouraged to adot an evidence-based approach

bull When they reconvene they share and review the learning

Characteristics of an effective PBL Group

An Effective Group is Cohesive motivated mutually supportive amp actively engaged in learning

bull The Group understands the process amp energetically pursues its task

bull Members respect each otherrsquos contribution but examine them critically

bull Discussions flow as students cooperate rather than compete

bull The atmosphere is friendly amp good humouredbull Roles are shared all take turns in scribing

leading discussion taking responsibility for acquiring information

Staff Development

bull Basic training is mandatorybull Further development may be a requirementbull Initial training may involve observation amp

practice with a group from the programbull Effective training ensures that necessary

background goals amp local strategies are considered together with info on assessment amp evaluation

bull In addition to materials supplied to students tutors are usually issued with handbooks highlighting issues for each problem

Tutorrsquos Role in Assessment

bull Individual StudentsGroups may be assessed Summatively (determining progression) or formatively (for feedback)

The GROUP

bull At the end of each problem groups review their processes to encourage self-reflection ampenhance their collective performance

Tutorrsquos Role in Assessment

Individual students

bull Tutors should provide formative feedback to each member

bull Ask students to complete a simple self-assessment questionnaire reviewing appropriate behaviors the tutor returns them with comments

bull Students will be a writtenoralclinical tests that will determine their progression amp ultimate graduation

Evaluating PBL Tutorials-II

bull At the end of each problem time is allocated for evaluation

bull Both the process amp learning in PBL can be evaluated against explicit goals

bull The tutorrsquos review of effectiveness of group processes offers insight for the members

bull Students normally evaluate their tutor helpfulness support for clinical reasoning encouragement for independent learning appropriate intervention provision for effective feedback

PBLbull 1048708 Enabling students to learn in the context in which the

information will be used which increases the ability to retrieve and apply information

bull 1048708 Focusing on important concepts which helps learners organize and store new information in a way that facilitates retrieval and application

bull 1048708 Exploring prior knowledge formulating inquiries derived from and defined by the learnersrsquo need to know and actively constructing meaning through dialogue and reflection

bull 1048708 Utilizing problems designed to simulate studentsrsquo perception of their future profession which serves as a powerful stimulus for studentsrsquo intrinsic motivation to learn

bull 1048708 Actively involving students in monitoring their own progress and reflecting on what works and what needs improvement frequently assessing student performance and providing feedback

PBL Starting the casebull After the introductions and discussion

are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it

bull Reading the case aloud keeps the group focused

bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here

PBL Case (contd)

bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session

PBL Case contdbull SECOND deciding which issues everyone will

tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)

bull THIRD deciding what SPECIFIC questions individuals will try to answer

bull FOURTH deciding how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet or consulting an expert)

The Process of PBL

bullWhat are the issues Identify the important issues in the problem

bull How well do you understand the issues

bull Are there any words or terms about which you are unclear

The Process of PBL contd

bull Consider the basic mechanisms that might explain each important aspect of each problem

bull Assess your current understanding of the basic structural andor functional mechanisms that may contribute to the presentation of the problem

bull Use the collective skills and experiences of group members to explore or explain these phenomena Identify current gaps in knowledge or understanding

Learn from each other

bullShare your own knowledge expertise or ability to reason and synthesize information Be receptive and appreciative of the contribution of your small group members

Determine priorities for learning

bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue

bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan

bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge

bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career

PBL

bull The problem comes first without advance readings lectures or preparation

bull The problem serves as a stimulus for the need to know

Learning Issues

bull Learning issues are questions that cannot be answered with studentsrsquo current knowledge and that can be explored and answered through systematic self-directed inquiry

bull The use of learning issues in tutorials prepares students to handle similar challenges in clinical practice and life-long learning

Learning Issues in PBL First Session1 Getting Started (Introductions Ground

Rules Expectations)2 Identifying Problem3 Exploring Pre-Existing Knowledge4 Generating Hypotheses and Explaining

Mechanisms5 Unfolding the Case Incrementally6 Re-EvaluatingReprioritizing Hypotheses

Based on New Information7 AssessmentReflection

PBL Second Session

8 Independent Self-Directed Study of Learning Issues

PBL Third Session

bull 9 Discussion of Learning Issues and Application of New Knowledge to the Case

bull 10 Continued Unfolding of the Case Incrementally

bull 11 AssessmentReflection

During Tutorial Session students will

1048708 Come prepared to discuss the case and learning issues researched since the last tutorial

1048708 Actively participate in group discussions and contribute to the learning process in a manner that allows for the balanced participation of everyone in the group

1048708 Develop learning issues at each session phrase them as full-sentence questions write them on the board and post them on the course web page

1048708 Consider biological population behaviormental health issuesexplanations and questions of professional attitudes values and ethics related to the patientrsquos problem(s) described in the case

Tutorial Session contd1048708 Go to the board to diagram outline draw etc in

explanation of mechanisms relatedto hypotheses1048708 Debate evidence related to the case and avoid

personal attacks on others1048708 Comply with ground rules with regard to how

the group will function and how itsmembers treat one another1048708 Participate in end-of-session reflection and

assessment by giving and receivingconstructive criticism regarding self tutor

student and group performance

Between Tutorial Session

1048708 Research key learning issues using a variety of resources

1048708 Critically evaluate the credibility of sources and the validity of the information they have obtained in their research

1048708 Integrate what they have learned through research lectures labs clinical skills Perspectives in Medicine (PIM) etc into what is discussed in tutorials

1048708 Synthesize what they have learned and be prepared to discuss it without reading directly from their materials as much as possible and apply it to the case at the next tutorial session

Determine priorities for learning

bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue

bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan

bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge

bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career

PBL Starting the casebull After the introductions and discussion

are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it

bull Reading the case aloud keeps the group focused

bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here

Problem-based learning is designed to develop

1048708 Integrated context-specific knowledge base

1048708 Decision-makingcritical thinking process and skills

1048708 Self-directed life-long learning skills 1048708 Interpersonal collaboration and

communication skills 1048708 Constructive self and peer

assessment skills 1048708 Professional ethics and behavior

PBL Case (contd)

bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session

What is problem based learning

bull In PBL students use triggers from the problem case or scenario to define their own learning objectives

bull Subsequently they do independent self directed study before returning to the group to discuss and refine their acquired knowledge

bull Thus PBL is not about problem solving per se but rather it uses appropriate problems to increase knowledge and understanding

bull The process is clearly defined

PBL

bull PBL uses clinical cases as the context for students to study basic and clinical sciences

bull Its possible advantages over traditional approaches include its greater relevance to the practice of medicine its ability to promote retention and application of knowledge and its encouragement of self-directed life-long learning

bull Possible disadvantages include higher costs both in resources and staff time

PBL

bull An educational method characterized by the use of patient problems as a context for students to learn problem-solving skills and acquire knowledge about the basic and clinical sciences

bull Students usually meet in small groups two or three times a week for PBL tutorials

bull They are presented with a clinical problem (eg a patient with chest pain) and in a series of steps they discuss possible mechanisms and causes develop hypotheses and strategies to test the hypotheses are presented with further information and use this new information to refine their hypotheses finally reaching a conclusion

bull A tutor usually acts as a facilitator guiding students in this group-learning process

bull In the course of this exercise students identify both their existing levels and gaps in their knowledge These gaps form the basis for independent learning outside the PBL tutorials The identification and pursuit of these so-called learning goals is a key element of the PBL process

Rationale for using PBL bull The PBL approach is based on principles of adult

education20 and cognitive psychology21 It differs fundamentally from traditional curricula in which students acquire background knowledge of the basic sciences in the early years of the course and in the later years apply this knowledge to the diagnosis and management of clinical problems This traditional approach has been criticised for a number of reasons42223

bull It creates an artificial divide between the basic and clinical sciences

bull Time is wasted in acquiring knowledge that is subsequently forgotten or found to be irrelevant

bull Application of the acquired knowledge can be difficult bull The acquisition and retention of information that has no

apparent relevance can be boring and even demoralising for students

The group learning process acquiring

desirable learning skills

Generic Skills amp attitudes

bull Teamwork bull Critical evaluation of literature bull Chairing a group bull Self directed learning and use of

resources bull Listening Presentation skills

Recording bull Cooperation bull Respect for colleagues views

bull Group learning facilitates not only the acquisition of knowledge but also several other desirable attributes such as communication skills teamwork problem solving independent responsibility for learning sharing information and respect for others PBL can therefore be thought of as a small group teaching method that combines the acquisition of knowledge with the development of generic skills and attitudes Presentation of clinical material as the stimulus for learning enables students to understand the relevance of underlying scientific knowledge and principles in clinical practice

bull when PBL is introduced into a curriculum several other issues for curriculum design and implementation need to be tackled PBL is generally introduced in the context of a defined core curriculum and integration of basic and clinical sciences It has implications for staffing and learning resources and demands a different approach to timetabling workload and assessment PBL is often used to deliver core material in non-clinical parts of the curriculum Paper based PBL scenarios form the basis of the core curriculum and ensure that all students are exposed to the same problems Recently modified PBL techniques have been introduced into clinical education with real patients being used as the stimulus for learning Despite the essential ad hoc nature of learning clinical medicine a key cases approach can enable PBL to be used to deliver the core clinical curriculum

Copyright copy2003 BMJ Publishing Group Ltd

Wood D F BMJ 2003326328-330

No CRoles of participants in a PBL tutorial aption Found

What happens in a PBL tutorial bull PBL tutorials are conducted in several ways In

this article the examples are modelled on the Maastricht seven jump process but its format of seven steps may be shortened

bull A typical PBL tutorial consists of a group of students (usually eight to 10) and a tutor who facilitates the session The length of time (number of sessions) that a group stays together with each other and with individual tutors varies between institutions A group needs to be together long enough to allow good group dynamics to develop but may need to be changed occasionally if personality clashes or other dysfunctional behaviour emerges

bull Students elect a chair for each PBL scenario and a scribe to record the discussion The roles are rotated for each scenario Suitable flip charts or a whiteboard should be used for recording the proceedings At the start of the session depending on the trigger material either the student chair reads out the scenario or all students study the material If the trigger is a real patient in a ward clinic or surgery then a student may be asked to take a clinical history or identify an abnormal physical sign before the group moves to a tutorial room For each module students may be given a handbook containing the problem scenarios and suggested learning resources or learning materials may be handed out at appropriate times as the tutorials progress

Examples of trigger material for PBL scenarios bull Paper based clinical scenarios bull Experimental or clinical laboratory data bull Photographs bull Video clips bull Newspaper articles bull All or part of an article from a scientific

journal bull A real or simulated patient bull A family tree showing an inherited

disorder

PBL tutorial process ndash Step 1 Identify and clarify unfamiliar terms presented in the scenario

scribe lists those that remain unexplained after discussion ndash Step 2 Define the problem or problems to be discussed students may

have different views on the issues but all should be considered scribe records a list of agreed problems

ndash Step 3 Brainstorming session to discuss the problem(s) suggestingpossible explanations on basis of prior knowledge students draw on each others knowledge and identify areas of incomplete knowledge scribe records all discussion

ndash Step 4 Review steps 2 and 3 and arrange explanations into tentativesolutions scribe organises the explanations and restructures if necessary

ndash Step 5 Formulate learning objectives group reaches consensus onthe learning objectives tutor ensures learning objectives are focused achievable comprehensive and appropriate

ndash Step 6 Private study (all students gather information related to eachlearning objective)

ndash Step 7 Group shares results of private study (students identify theirlearning resources and share their results) tutor checks learning and may assess the group

bull The role of the tutor is to facilitate the proceedings (helping the chair to maintain group dynamics and moving the group through the task) and to ensure that the group achieves appropriate learning objectives in line with those set by the curriculum design team The tutor may need to take a more active role in step 7 of the process to ensure that all the students have done the appropriate work and to help the chair to suggest a suitable format for group members to use to present the results of their private study The tutor should encourage students to check their understanding of the material He or she can do this by encouraging the students to ask open questions and ask each other to explain topics in their own words or by the use of drawings and diagrams

PBL in curriculum design bull PBL may be used either as the mainstay of an entire

curriculum or for the delivery of individual courses In practice PBL is usually part of an integrated curriculum using a systems based approach with non-clinical material delivered in the context of clinical practice A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge skills and attitudes A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios Sufficient time should be allowed each week for students to do the self directed learning required for PBL

bull

Copyright copy2003 BMJ Publishing Group Ltd

Wood D F BMJ 2003326328-330

No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found

Writing PBL scenarios

bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives

bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after

studying the scenario should be consistent with the faculty learning objectives

bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding

bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice

bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge

bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented

bull The problem should be sufficiently open so that discussion is not curtailed too early in the process

bull Scenarios should promote participation by the students in seeking information from various learning resources

bull Adapted from Dolmans et al Med Teacher 199719185-9

Staff development

bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)

A dysfunctional group a dominant character may

make it difficult for other students to be heard

A dysfunctional group a dominant character may make it difficult for other students to be heard

bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties

Advantages of PBL bull Student centred PBLIt fostersactive learning improved

understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks

Disadvantagesbull Tutors who cant teachTutorsenjoy passing on

their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful

Assessment of PBL

bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods

bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL

Conclusion

bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning

bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL

PBL 5 Easy Steps

bull Read the problem

Mrs Paula Embledon

Mrs Paula Embledon is a 78 year old woman who has come to the emergency room complaining of shortness of breath and pain in her chest She had been in relatively good health until three weeks previously when she sprained

2 Brain storm

bull Brainstorm

bull ndash hypotheses

bull - what do we know in support of the hypothesis

bull - what do we need to know to test the hypothesis

ndash learning issues

Brainstorm

bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)

ndash specific issues (for individuals to look up)

ndash overlapping issues

bull 4 Individual Reading - Research - Preparation

bull 5 Return

bull ndash review case so far ndash report and discuss

ndash assess progress - continue pagenext pagecomplete

ndash self-evaluation - How did things go Any suggestions for next time

ndash next problem

bull 5 Return

THE FIRST GROUP SESSION

bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day

bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session

bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr

bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine

bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise

bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator

bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues

bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know

bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)

bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)

bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)

  • PROBLEM BASED LEARNING
  • New Horizons in Medical Education
  • Slide 3
  • Domains of essential Global Requirements of ME
  • What was the response to these challenges
  • New Educational Strategies
  • New Tools amp Aids
  • PBL
  • PBL
  • Advantages
  • Slide 11
  • Slide 12
  • Slide 13
  • Slide 14
  • Framework for PBL
  • Framework for PBL - II
  • Characteristics of an effective PBL Group
  • Staff Development
  • Tutorrsquos Role in Assessment
  • Slide 20
  • Evaluating PBL Tutorials-II
  • PBL
  • Slide 23
  • PBL Starting the case
  • PBL Case (contd)
  • PBL Case contd
  • The Process of PBL
  • The Process of PBL contd
  • Learn from each other
  • Determine priorities for learning
  • Slide 31
  • Slide 32
  • Learning Issues
  • Learning Issues in PBL First Session
  • PBL Second Session
  • PBL Third Session
  • Slide 37
  • Slide 38
  • During Tutorial Session students will
  • Tutorial Session contd
  • Between Tutorial Session
  • Slide 42
  • Slide 43
  • Problem-based learning is designed to develop
  • Slide 45
  • What is problem based learning
  • Slide 47
  • Slide 48
  • Slide 49
  • Rationale for using PBL
  • Slide 51
  • Slide 52
  • The group learning process acquiring desirable learning skills
  • Generic Skills amp attitudes
  • Slide 55
  • Slide 56
  • Slide 57
  • What happens in a PBL tutorial
  • Slide 59
  • Examples of trigger material for PBL scenarios
  • PBL tutorial process
  • Slide 62
  • PBL in curriculum design
  • Slide 64
  • Writing PBL scenarios
  • Slide 66
  • Staff development
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • Slide 70
  • Advantages of PBL
  • Slide 72
  • Slide 73
  • Disadvantages
  • Assessment of PBL
  • Slide 76
  • Conclusion
  • Slide 78
  • PBL 5 Easy Steps
  • 2 Brain storm
  • Brainstorm
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • THE FIRST GROUP SESSION
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
Page 14: Problem based learning

bull An effective Group provides a safe environment for sharing amp testing new knowledge

bull Students practice the language of science amp medicine evaluate ideas and receive feedback from peers amp teacher

bull When clinical exposure is introduced concurrently intellectual amp practical skills develop in parallel

Framework for PBL

bull A trigger initiates the problem (papercomputervideo)

bull Groups brainstorm to identify key issues for discussion

bull Broad thinking produces a rich array of mechanisms amp ideas

bull Hypothesis are critically explored through reasoning

bull The need for additional info is identifiedbull A Conclusion is reachedbull Group reviews the process

Framework for PBL - II

bull In Breaks between Tutorials students identfy Learning Issues to be pursued

bull They are encouraged to adot an evidence-based approach

bull When they reconvene they share and review the learning

Characteristics of an effective PBL Group

An Effective Group is Cohesive motivated mutually supportive amp actively engaged in learning

bull The Group understands the process amp energetically pursues its task

bull Members respect each otherrsquos contribution but examine them critically

bull Discussions flow as students cooperate rather than compete

bull The atmosphere is friendly amp good humouredbull Roles are shared all take turns in scribing

leading discussion taking responsibility for acquiring information

Staff Development

bull Basic training is mandatorybull Further development may be a requirementbull Initial training may involve observation amp

practice with a group from the programbull Effective training ensures that necessary

background goals amp local strategies are considered together with info on assessment amp evaluation

bull In addition to materials supplied to students tutors are usually issued with handbooks highlighting issues for each problem

Tutorrsquos Role in Assessment

bull Individual StudentsGroups may be assessed Summatively (determining progression) or formatively (for feedback)

The GROUP

bull At the end of each problem groups review their processes to encourage self-reflection ampenhance their collective performance

Tutorrsquos Role in Assessment

Individual students

bull Tutors should provide formative feedback to each member

bull Ask students to complete a simple self-assessment questionnaire reviewing appropriate behaviors the tutor returns them with comments

bull Students will be a writtenoralclinical tests that will determine their progression amp ultimate graduation

Evaluating PBL Tutorials-II

bull At the end of each problem time is allocated for evaluation

bull Both the process amp learning in PBL can be evaluated against explicit goals

bull The tutorrsquos review of effectiveness of group processes offers insight for the members

bull Students normally evaluate their tutor helpfulness support for clinical reasoning encouragement for independent learning appropriate intervention provision for effective feedback

PBLbull 1048708 Enabling students to learn in the context in which the

information will be used which increases the ability to retrieve and apply information

bull 1048708 Focusing on important concepts which helps learners organize and store new information in a way that facilitates retrieval and application

bull 1048708 Exploring prior knowledge formulating inquiries derived from and defined by the learnersrsquo need to know and actively constructing meaning through dialogue and reflection

bull 1048708 Utilizing problems designed to simulate studentsrsquo perception of their future profession which serves as a powerful stimulus for studentsrsquo intrinsic motivation to learn

bull 1048708 Actively involving students in monitoring their own progress and reflecting on what works and what needs improvement frequently assessing student performance and providing feedback

PBL Starting the casebull After the introductions and discussion

are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it

bull Reading the case aloud keeps the group focused

bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here

PBL Case (contd)

bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session

PBL Case contdbull SECOND deciding which issues everyone will

tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)

bull THIRD deciding what SPECIFIC questions individuals will try to answer

bull FOURTH deciding how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet or consulting an expert)

The Process of PBL

bullWhat are the issues Identify the important issues in the problem

bull How well do you understand the issues

bull Are there any words or terms about which you are unclear

The Process of PBL contd

bull Consider the basic mechanisms that might explain each important aspect of each problem

bull Assess your current understanding of the basic structural andor functional mechanisms that may contribute to the presentation of the problem

bull Use the collective skills and experiences of group members to explore or explain these phenomena Identify current gaps in knowledge or understanding

Learn from each other

bullShare your own knowledge expertise or ability to reason and synthesize information Be receptive and appreciative of the contribution of your small group members

Determine priorities for learning

bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue

bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan

bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge

bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career

PBL

bull The problem comes first without advance readings lectures or preparation

bull The problem serves as a stimulus for the need to know

Learning Issues

bull Learning issues are questions that cannot be answered with studentsrsquo current knowledge and that can be explored and answered through systematic self-directed inquiry

bull The use of learning issues in tutorials prepares students to handle similar challenges in clinical practice and life-long learning

Learning Issues in PBL First Session1 Getting Started (Introductions Ground

Rules Expectations)2 Identifying Problem3 Exploring Pre-Existing Knowledge4 Generating Hypotheses and Explaining

Mechanisms5 Unfolding the Case Incrementally6 Re-EvaluatingReprioritizing Hypotheses

Based on New Information7 AssessmentReflection

PBL Second Session

8 Independent Self-Directed Study of Learning Issues

PBL Third Session

bull 9 Discussion of Learning Issues and Application of New Knowledge to the Case

bull 10 Continued Unfolding of the Case Incrementally

bull 11 AssessmentReflection

During Tutorial Session students will

1048708 Come prepared to discuss the case and learning issues researched since the last tutorial

1048708 Actively participate in group discussions and contribute to the learning process in a manner that allows for the balanced participation of everyone in the group

1048708 Develop learning issues at each session phrase them as full-sentence questions write them on the board and post them on the course web page

1048708 Consider biological population behaviormental health issuesexplanations and questions of professional attitudes values and ethics related to the patientrsquos problem(s) described in the case

Tutorial Session contd1048708 Go to the board to diagram outline draw etc in

explanation of mechanisms relatedto hypotheses1048708 Debate evidence related to the case and avoid

personal attacks on others1048708 Comply with ground rules with regard to how

the group will function and how itsmembers treat one another1048708 Participate in end-of-session reflection and

assessment by giving and receivingconstructive criticism regarding self tutor

student and group performance

Between Tutorial Session

1048708 Research key learning issues using a variety of resources

1048708 Critically evaluate the credibility of sources and the validity of the information they have obtained in their research

1048708 Integrate what they have learned through research lectures labs clinical skills Perspectives in Medicine (PIM) etc into what is discussed in tutorials

1048708 Synthesize what they have learned and be prepared to discuss it without reading directly from their materials as much as possible and apply it to the case at the next tutorial session

Determine priorities for learning

bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue

bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan

bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge

bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career

PBL Starting the casebull After the introductions and discussion

are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it

bull Reading the case aloud keeps the group focused

bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here

Problem-based learning is designed to develop

1048708 Integrated context-specific knowledge base

1048708 Decision-makingcritical thinking process and skills

1048708 Self-directed life-long learning skills 1048708 Interpersonal collaboration and

communication skills 1048708 Constructive self and peer

assessment skills 1048708 Professional ethics and behavior

PBL Case (contd)

bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session

What is problem based learning

bull In PBL students use triggers from the problem case or scenario to define their own learning objectives

bull Subsequently they do independent self directed study before returning to the group to discuss and refine their acquired knowledge

bull Thus PBL is not about problem solving per se but rather it uses appropriate problems to increase knowledge and understanding

bull The process is clearly defined

PBL

bull PBL uses clinical cases as the context for students to study basic and clinical sciences

bull Its possible advantages over traditional approaches include its greater relevance to the practice of medicine its ability to promote retention and application of knowledge and its encouragement of self-directed life-long learning

bull Possible disadvantages include higher costs both in resources and staff time

PBL

bull An educational method characterized by the use of patient problems as a context for students to learn problem-solving skills and acquire knowledge about the basic and clinical sciences

bull Students usually meet in small groups two or three times a week for PBL tutorials

bull They are presented with a clinical problem (eg a patient with chest pain) and in a series of steps they discuss possible mechanisms and causes develop hypotheses and strategies to test the hypotheses are presented with further information and use this new information to refine their hypotheses finally reaching a conclusion

bull A tutor usually acts as a facilitator guiding students in this group-learning process

bull In the course of this exercise students identify both their existing levels and gaps in their knowledge These gaps form the basis for independent learning outside the PBL tutorials The identification and pursuit of these so-called learning goals is a key element of the PBL process

Rationale for using PBL bull The PBL approach is based on principles of adult

education20 and cognitive psychology21 It differs fundamentally from traditional curricula in which students acquire background knowledge of the basic sciences in the early years of the course and in the later years apply this knowledge to the diagnosis and management of clinical problems This traditional approach has been criticised for a number of reasons42223

bull It creates an artificial divide between the basic and clinical sciences

bull Time is wasted in acquiring knowledge that is subsequently forgotten or found to be irrelevant

bull Application of the acquired knowledge can be difficult bull The acquisition and retention of information that has no

apparent relevance can be boring and even demoralising for students

The group learning process acquiring

desirable learning skills

Generic Skills amp attitudes

bull Teamwork bull Critical evaluation of literature bull Chairing a group bull Self directed learning and use of

resources bull Listening Presentation skills

Recording bull Cooperation bull Respect for colleagues views

bull Group learning facilitates not only the acquisition of knowledge but also several other desirable attributes such as communication skills teamwork problem solving independent responsibility for learning sharing information and respect for others PBL can therefore be thought of as a small group teaching method that combines the acquisition of knowledge with the development of generic skills and attitudes Presentation of clinical material as the stimulus for learning enables students to understand the relevance of underlying scientific knowledge and principles in clinical practice

bull when PBL is introduced into a curriculum several other issues for curriculum design and implementation need to be tackled PBL is generally introduced in the context of a defined core curriculum and integration of basic and clinical sciences It has implications for staffing and learning resources and demands a different approach to timetabling workload and assessment PBL is often used to deliver core material in non-clinical parts of the curriculum Paper based PBL scenarios form the basis of the core curriculum and ensure that all students are exposed to the same problems Recently modified PBL techniques have been introduced into clinical education with real patients being used as the stimulus for learning Despite the essential ad hoc nature of learning clinical medicine a key cases approach can enable PBL to be used to deliver the core clinical curriculum

Copyright copy2003 BMJ Publishing Group Ltd

Wood D F BMJ 2003326328-330

No CRoles of participants in a PBL tutorial aption Found

What happens in a PBL tutorial bull PBL tutorials are conducted in several ways In

this article the examples are modelled on the Maastricht seven jump process but its format of seven steps may be shortened

bull A typical PBL tutorial consists of a group of students (usually eight to 10) and a tutor who facilitates the session The length of time (number of sessions) that a group stays together with each other and with individual tutors varies between institutions A group needs to be together long enough to allow good group dynamics to develop but may need to be changed occasionally if personality clashes or other dysfunctional behaviour emerges

bull Students elect a chair for each PBL scenario and a scribe to record the discussion The roles are rotated for each scenario Suitable flip charts or a whiteboard should be used for recording the proceedings At the start of the session depending on the trigger material either the student chair reads out the scenario or all students study the material If the trigger is a real patient in a ward clinic or surgery then a student may be asked to take a clinical history or identify an abnormal physical sign before the group moves to a tutorial room For each module students may be given a handbook containing the problem scenarios and suggested learning resources or learning materials may be handed out at appropriate times as the tutorials progress

Examples of trigger material for PBL scenarios bull Paper based clinical scenarios bull Experimental or clinical laboratory data bull Photographs bull Video clips bull Newspaper articles bull All or part of an article from a scientific

journal bull A real or simulated patient bull A family tree showing an inherited

disorder

PBL tutorial process ndash Step 1 Identify and clarify unfamiliar terms presented in the scenario

scribe lists those that remain unexplained after discussion ndash Step 2 Define the problem or problems to be discussed students may

have different views on the issues but all should be considered scribe records a list of agreed problems

ndash Step 3 Brainstorming session to discuss the problem(s) suggestingpossible explanations on basis of prior knowledge students draw on each others knowledge and identify areas of incomplete knowledge scribe records all discussion

ndash Step 4 Review steps 2 and 3 and arrange explanations into tentativesolutions scribe organises the explanations and restructures if necessary

ndash Step 5 Formulate learning objectives group reaches consensus onthe learning objectives tutor ensures learning objectives are focused achievable comprehensive and appropriate

ndash Step 6 Private study (all students gather information related to eachlearning objective)

ndash Step 7 Group shares results of private study (students identify theirlearning resources and share their results) tutor checks learning and may assess the group

bull The role of the tutor is to facilitate the proceedings (helping the chair to maintain group dynamics and moving the group through the task) and to ensure that the group achieves appropriate learning objectives in line with those set by the curriculum design team The tutor may need to take a more active role in step 7 of the process to ensure that all the students have done the appropriate work and to help the chair to suggest a suitable format for group members to use to present the results of their private study The tutor should encourage students to check their understanding of the material He or she can do this by encouraging the students to ask open questions and ask each other to explain topics in their own words or by the use of drawings and diagrams

PBL in curriculum design bull PBL may be used either as the mainstay of an entire

curriculum or for the delivery of individual courses In practice PBL is usually part of an integrated curriculum using a systems based approach with non-clinical material delivered in the context of clinical practice A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge skills and attitudes A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios Sufficient time should be allowed each week for students to do the self directed learning required for PBL

bull

Copyright copy2003 BMJ Publishing Group Ltd

Wood D F BMJ 2003326328-330

No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found

Writing PBL scenarios

bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives

bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after

studying the scenario should be consistent with the faculty learning objectives

bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding

bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice

bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge

bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented

bull The problem should be sufficiently open so that discussion is not curtailed too early in the process

bull Scenarios should promote participation by the students in seeking information from various learning resources

bull Adapted from Dolmans et al Med Teacher 199719185-9

Staff development

bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)

A dysfunctional group a dominant character may

make it difficult for other students to be heard

A dysfunctional group a dominant character may make it difficult for other students to be heard

bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties

Advantages of PBL bull Student centred PBLIt fostersactive learning improved

understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks

Disadvantagesbull Tutors who cant teachTutorsenjoy passing on

their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful

Assessment of PBL

bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods

bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL

Conclusion

bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning

bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL

PBL 5 Easy Steps

bull Read the problem

Mrs Paula Embledon

Mrs Paula Embledon is a 78 year old woman who has come to the emergency room complaining of shortness of breath and pain in her chest She had been in relatively good health until three weeks previously when she sprained

2 Brain storm

bull Brainstorm

bull ndash hypotheses

bull - what do we know in support of the hypothesis

bull - what do we need to know to test the hypothesis

ndash learning issues

Brainstorm

bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)

ndash specific issues (for individuals to look up)

ndash overlapping issues

bull 4 Individual Reading - Research - Preparation

bull 5 Return

bull ndash review case so far ndash report and discuss

ndash assess progress - continue pagenext pagecomplete

ndash self-evaluation - How did things go Any suggestions for next time

ndash next problem

bull 5 Return

THE FIRST GROUP SESSION

bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day

bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session

bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr

bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine

bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise

bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator

bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues

bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know

bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)

bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)

bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)

  • PROBLEM BASED LEARNING
  • New Horizons in Medical Education
  • Slide 3
  • Domains of essential Global Requirements of ME
  • What was the response to these challenges
  • New Educational Strategies
  • New Tools amp Aids
  • PBL
  • PBL
  • Advantages
  • Slide 11
  • Slide 12
  • Slide 13
  • Slide 14
  • Framework for PBL
  • Framework for PBL - II
  • Characteristics of an effective PBL Group
  • Staff Development
  • Tutorrsquos Role in Assessment
  • Slide 20
  • Evaluating PBL Tutorials-II
  • PBL
  • Slide 23
  • PBL Starting the case
  • PBL Case (contd)
  • PBL Case contd
  • The Process of PBL
  • The Process of PBL contd
  • Learn from each other
  • Determine priorities for learning
  • Slide 31
  • Slide 32
  • Learning Issues
  • Learning Issues in PBL First Session
  • PBL Second Session
  • PBL Third Session
  • Slide 37
  • Slide 38
  • During Tutorial Session students will
  • Tutorial Session contd
  • Between Tutorial Session
  • Slide 42
  • Slide 43
  • Problem-based learning is designed to develop
  • Slide 45
  • What is problem based learning
  • Slide 47
  • Slide 48
  • Slide 49
  • Rationale for using PBL
  • Slide 51
  • Slide 52
  • The group learning process acquiring desirable learning skills
  • Generic Skills amp attitudes
  • Slide 55
  • Slide 56
  • Slide 57
  • What happens in a PBL tutorial
  • Slide 59
  • Examples of trigger material for PBL scenarios
  • PBL tutorial process
  • Slide 62
  • PBL in curriculum design
  • Slide 64
  • Writing PBL scenarios
  • Slide 66
  • Staff development
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • Slide 70
  • Advantages of PBL
  • Slide 72
  • Slide 73
  • Disadvantages
  • Assessment of PBL
  • Slide 76
  • Conclusion
  • Slide 78
  • PBL 5 Easy Steps
  • 2 Brain storm
  • Brainstorm
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • THE FIRST GROUP SESSION
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
Page 15: Problem based learning

Framework for PBL

bull A trigger initiates the problem (papercomputervideo)

bull Groups brainstorm to identify key issues for discussion

bull Broad thinking produces a rich array of mechanisms amp ideas

bull Hypothesis are critically explored through reasoning

bull The need for additional info is identifiedbull A Conclusion is reachedbull Group reviews the process

Framework for PBL - II

bull In Breaks between Tutorials students identfy Learning Issues to be pursued

bull They are encouraged to adot an evidence-based approach

bull When they reconvene they share and review the learning

Characteristics of an effective PBL Group

An Effective Group is Cohesive motivated mutually supportive amp actively engaged in learning

bull The Group understands the process amp energetically pursues its task

bull Members respect each otherrsquos contribution but examine them critically

bull Discussions flow as students cooperate rather than compete

bull The atmosphere is friendly amp good humouredbull Roles are shared all take turns in scribing

leading discussion taking responsibility for acquiring information

Staff Development

bull Basic training is mandatorybull Further development may be a requirementbull Initial training may involve observation amp

practice with a group from the programbull Effective training ensures that necessary

background goals amp local strategies are considered together with info on assessment amp evaluation

bull In addition to materials supplied to students tutors are usually issued with handbooks highlighting issues for each problem

Tutorrsquos Role in Assessment

bull Individual StudentsGroups may be assessed Summatively (determining progression) or formatively (for feedback)

The GROUP

bull At the end of each problem groups review their processes to encourage self-reflection ampenhance their collective performance

Tutorrsquos Role in Assessment

Individual students

bull Tutors should provide formative feedback to each member

bull Ask students to complete a simple self-assessment questionnaire reviewing appropriate behaviors the tutor returns them with comments

bull Students will be a writtenoralclinical tests that will determine their progression amp ultimate graduation

Evaluating PBL Tutorials-II

bull At the end of each problem time is allocated for evaluation

bull Both the process amp learning in PBL can be evaluated against explicit goals

bull The tutorrsquos review of effectiveness of group processes offers insight for the members

bull Students normally evaluate their tutor helpfulness support for clinical reasoning encouragement for independent learning appropriate intervention provision for effective feedback

PBLbull 1048708 Enabling students to learn in the context in which the

information will be used which increases the ability to retrieve and apply information

bull 1048708 Focusing on important concepts which helps learners organize and store new information in a way that facilitates retrieval and application

bull 1048708 Exploring prior knowledge formulating inquiries derived from and defined by the learnersrsquo need to know and actively constructing meaning through dialogue and reflection

bull 1048708 Utilizing problems designed to simulate studentsrsquo perception of their future profession which serves as a powerful stimulus for studentsrsquo intrinsic motivation to learn

bull 1048708 Actively involving students in monitoring their own progress and reflecting on what works and what needs improvement frequently assessing student performance and providing feedback

PBL Starting the casebull After the introductions and discussion

are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it

bull Reading the case aloud keeps the group focused

bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here

PBL Case (contd)

bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session

PBL Case contdbull SECOND deciding which issues everyone will

tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)

bull THIRD deciding what SPECIFIC questions individuals will try to answer

bull FOURTH deciding how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet or consulting an expert)

The Process of PBL

bullWhat are the issues Identify the important issues in the problem

bull How well do you understand the issues

bull Are there any words or terms about which you are unclear

The Process of PBL contd

bull Consider the basic mechanisms that might explain each important aspect of each problem

bull Assess your current understanding of the basic structural andor functional mechanisms that may contribute to the presentation of the problem

bull Use the collective skills and experiences of group members to explore or explain these phenomena Identify current gaps in knowledge or understanding

Learn from each other

bullShare your own knowledge expertise or ability to reason and synthesize information Be receptive and appreciative of the contribution of your small group members

Determine priorities for learning

bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue

bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan

bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge

bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career

PBL

bull The problem comes first without advance readings lectures or preparation

bull The problem serves as a stimulus for the need to know

Learning Issues

bull Learning issues are questions that cannot be answered with studentsrsquo current knowledge and that can be explored and answered through systematic self-directed inquiry

bull The use of learning issues in tutorials prepares students to handle similar challenges in clinical practice and life-long learning

Learning Issues in PBL First Session1 Getting Started (Introductions Ground

Rules Expectations)2 Identifying Problem3 Exploring Pre-Existing Knowledge4 Generating Hypotheses and Explaining

Mechanisms5 Unfolding the Case Incrementally6 Re-EvaluatingReprioritizing Hypotheses

Based on New Information7 AssessmentReflection

PBL Second Session

8 Independent Self-Directed Study of Learning Issues

PBL Third Session

bull 9 Discussion of Learning Issues and Application of New Knowledge to the Case

bull 10 Continued Unfolding of the Case Incrementally

bull 11 AssessmentReflection

During Tutorial Session students will

1048708 Come prepared to discuss the case and learning issues researched since the last tutorial

1048708 Actively participate in group discussions and contribute to the learning process in a manner that allows for the balanced participation of everyone in the group

1048708 Develop learning issues at each session phrase them as full-sentence questions write them on the board and post them on the course web page

1048708 Consider biological population behaviormental health issuesexplanations and questions of professional attitudes values and ethics related to the patientrsquos problem(s) described in the case

Tutorial Session contd1048708 Go to the board to diagram outline draw etc in

explanation of mechanisms relatedto hypotheses1048708 Debate evidence related to the case and avoid

personal attacks on others1048708 Comply with ground rules with regard to how

the group will function and how itsmembers treat one another1048708 Participate in end-of-session reflection and

assessment by giving and receivingconstructive criticism regarding self tutor

student and group performance

Between Tutorial Session

1048708 Research key learning issues using a variety of resources

1048708 Critically evaluate the credibility of sources and the validity of the information they have obtained in their research

1048708 Integrate what they have learned through research lectures labs clinical skills Perspectives in Medicine (PIM) etc into what is discussed in tutorials

1048708 Synthesize what they have learned and be prepared to discuss it without reading directly from their materials as much as possible and apply it to the case at the next tutorial session

Determine priorities for learning

bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue

bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan

bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge

bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career

PBL Starting the casebull After the introductions and discussion

are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it

bull Reading the case aloud keeps the group focused

bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here

Problem-based learning is designed to develop

1048708 Integrated context-specific knowledge base

1048708 Decision-makingcritical thinking process and skills

1048708 Self-directed life-long learning skills 1048708 Interpersonal collaboration and

communication skills 1048708 Constructive self and peer

assessment skills 1048708 Professional ethics and behavior

PBL Case (contd)

bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session

What is problem based learning

bull In PBL students use triggers from the problem case or scenario to define their own learning objectives

bull Subsequently they do independent self directed study before returning to the group to discuss and refine their acquired knowledge

bull Thus PBL is not about problem solving per se but rather it uses appropriate problems to increase knowledge and understanding

bull The process is clearly defined

PBL

bull PBL uses clinical cases as the context for students to study basic and clinical sciences

bull Its possible advantages over traditional approaches include its greater relevance to the practice of medicine its ability to promote retention and application of knowledge and its encouragement of self-directed life-long learning

bull Possible disadvantages include higher costs both in resources and staff time

PBL

bull An educational method characterized by the use of patient problems as a context for students to learn problem-solving skills and acquire knowledge about the basic and clinical sciences

bull Students usually meet in small groups two or three times a week for PBL tutorials

bull They are presented with a clinical problem (eg a patient with chest pain) and in a series of steps they discuss possible mechanisms and causes develop hypotheses and strategies to test the hypotheses are presented with further information and use this new information to refine their hypotheses finally reaching a conclusion

bull A tutor usually acts as a facilitator guiding students in this group-learning process

bull In the course of this exercise students identify both their existing levels and gaps in their knowledge These gaps form the basis for independent learning outside the PBL tutorials The identification and pursuit of these so-called learning goals is a key element of the PBL process

Rationale for using PBL bull The PBL approach is based on principles of adult

education20 and cognitive psychology21 It differs fundamentally from traditional curricula in which students acquire background knowledge of the basic sciences in the early years of the course and in the later years apply this knowledge to the diagnosis and management of clinical problems This traditional approach has been criticised for a number of reasons42223

bull It creates an artificial divide between the basic and clinical sciences

bull Time is wasted in acquiring knowledge that is subsequently forgotten or found to be irrelevant

bull Application of the acquired knowledge can be difficult bull The acquisition and retention of information that has no

apparent relevance can be boring and even demoralising for students

The group learning process acquiring

desirable learning skills

Generic Skills amp attitudes

bull Teamwork bull Critical evaluation of literature bull Chairing a group bull Self directed learning and use of

resources bull Listening Presentation skills

Recording bull Cooperation bull Respect for colleagues views

bull Group learning facilitates not only the acquisition of knowledge but also several other desirable attributes such as communication skills teamwork problem solving independent responsibility for learning sharing information and respect for others PBL can therefore be thought of as a small group teaching method that combines the acquisition of knowledge with the development of generic skills and attitudes Presentation of clinical material as the stimulus for learning enables students to understand the relevance of underlying scientific knowledge and principles in clinical practice

bull when PBL is introduced into a curriculum several other issues for curriculum design and implementation need to be tackled PBL is generally introduced in the context of a defined core curriculum and integration of basic and clinical sciences It has implications for staffing and learning resources and demands a different approach to timetabling workload and assessment PBL is often used to deliver core material in non-clinical parts of the curriculum Paper based PBL scenarios form the basis of the core curriculum and ensure that all students are exposed to the same problems Recently modified PBL techniques have been introduced into clinical education with real patients being used as the stimulus for learning Despite the essential ad hoc nature of learning clinical medicine a key cases approach can enable PBL to be used to deliver the core clinical curriculum

Copyright copy2003 BMJ Publishing Group Ltd

Wood D F BMJ 2003326328-330

No CRoles of participants in a PBL tutorial aption Found

What happens in a PBL tutorial bull PBL tutorials are conducted in several ways In

this article the examples are modelled on the Maastricht seven jump process but its format of seven steps may be shortened

bull A typical PBL tutorial consists of a group of students (usually eight to 10) and a tutor who facilitates the session The length of time (number of sessions) that a group stays together with each other and with individual tutors varies between institutions A group needs to be together long enough to allow good group dynamics to develop but may need to be changed occasionally if personality clashes or other dysfunctional behaviour emerges

bull Students elect a chair for each PBL scenario and a scribe to record the discussion The roles are rotated for each scenario Suitable flip charts or a whiteboard should be used for recording the proceedings At the start of the session depending on the trigger material either the student chair reads out the scenario or all students study the material If the trigger is a real patient in a ward clinic or surgery then a student may be asked to take a clinical history or identify an abnormal physical sign before the group moves to a tutorial room For each module students may be given a handbook containing the problem scenarios and suggested learning resources or learning materials may be handed out at appropriate times as the tutorials progress

Examples of trigger material for PBL scenarios bull Paper based clinical scenarios bull Experimental or clinical laboratory data bull Photographs bull Video clips bull Newspaper articles bull All or part of an article from a scientific

journal bull A real or simulated patient bull A family tree showing an inherited

disorder

PBL tutorial process ndash Step 1 Identify and clarify unfamiliar terms presented in the scenario

scribe lists those that remain unexplained after discussion ndash Step 2 Define the problem or problems to be discussed students may

have different views on the issues but all should be considered scribe records a list of agreed problems

ndash Step 3 Brainstorming session to discuss the problem(s) suggestingpossible explanations on basis of prior knowledge students draw on each others knowledge and identify areas of incomplete knowledge scribe records all discussion

ndash Step 4 Review steps 2 and 3 and arrange explanations into tentativesolutions scribe organises the explanations and restructures if necessary

ndash Step 5 Formulate learning objectives group reaches consensus onthe learning objectives tutor ensures learning objectives are focused achievable comprehensive and appropriate

ndash Step 6 Private study (all students gather information related to eachlearning objective)

ndash Step 7 Group shares results of private study (students identify theirlearning resources and share their results) tutor checks learning and may assess the group

bull The role of the tutor is to facilitate the proceedings (helping the chair to maintain group dynamics and moving the group through the task) and to ensure that the group achieves appropriate learning objectives in line with those set by the curriculum design team The tutor may need to take a more active role in step 7 of the process to ensure that all the students have done the appropriate work and to help the chair to suggest a suitable format for group members to use to present the results of their private study The tutor should encourage students to check their understanding of the material He or she can do this by encouraging the students to ask open questions and ask each other to explain topics in their own words or by the use of drawings and diagrams

PBL in curriculum design bull PBL may be used either as the mainstay of an entire

curriculum or for the delivery of individual courses In practice PBL is usually part of an integrated curriculum using a systems based approach with non-clinical material delivered in the context of clinical practice A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge skills and attitudes A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios Sufficient time should be allowed each week for students to do the self directed learning required for PBL

bull

Copyright copy2003 BMJ Publishing Group Ltd

Wood D F BMJ 2003326328-330

No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found

Writing PBL scenarios

bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives

bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after

studying the scenario should be consistent with the faculty learning objectives

bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding

bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice

bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge

bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented

bull The problem should be sufficiently open so that discussion is not curtailed too early in the process

bull Scenarios should promote participation by the students in seeking information from various learning resources

bull Adapted from Dolmans et al Med Teacher 199719185-9

Staff development

bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)

A dysfunctional group a dominant character may

make it difficult for other students to be heard

A dysfunctional group a dominant character may make it difficult for other students to be heard

bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties

Advantages of PBL bull Student centred PBLIt fostersactive learning improved

understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks

Disadvantagesbull Tutors who cant teachTutorsenjoy passing on

their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful

Assessment of PBL

bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods

bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL

Conclusion

bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning

bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL

PBL 5 Easy Steps

bull Read the problem

Mrs Paula Embledon

Mrs Paula Embledon is a 78 year old woman who has come to the emergency room complaining of shortness of breath and pain in her chest She had been in relatively good health until three weeks previously when she sprained

2 Brain storm

bull Brainstorm

bull ndash hypotheses

bull - what do we know in support of the hypothesis

bull - what do we need to know to test the hypothesis

ndash learning issues

Brainstorm

bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)

ndash specific issues (for individuals to look up)

ndash overlapping issues

bull 4 Individual Reading - Research - Preparation

bull 5 Return

bull ndash review case so far ndash report and discuss

ndash assess progress - continue pagenext pagecomplete

ndash self-evaluation - How did things go Any suggestions for next time

ndash next problem

bull 5 Return

THE FIRST GROUP SESSION

bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day

bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session

bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr

bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine

bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise

bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator

bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues

bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know

bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)

bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)

bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)

  • PROBLEM BASED LEARNING
  • New Horizons in Medical Education
  • Slide 3
  • Domains of essential Global Requirements of ME
  • What was the response to these challenges
  • New Educational Strategies
  • New Tools amp Aids
  • PBL
  • PBL
  • Advantages
  • Slide 11
  • Slide 12
  • Slide 13
  • Slide 14
  • Framework for PBL
  • Framework for PBL - II
  • Characteristics of an effective PBL Group
  • Staff Development
  • Tutorrsquos Role in Assessment
  • Slide 20
  • Evaluating PBL Tutorials-II
  • PBL
  • Slide 23
  • PBL Starting the case
  • PBL Case (contd)
  • PBL Case contd
  • The Process of PBL
  • The Process of PBL contd
  • Learn from each other
  • Determine priorities for learning
  • Slide 31
  • Slide 32
  • Learning Issues
  • Learning Issues in PBL First Session
  • PBL Second Session
  • PBL Third Session
  • Slide 37
  • Slide 38
  • During Tutorial Session students will
  • Tutorial Session contd
  • Between Tutorial Session
  • Slide 42
  • Slide 43
  • Problem-based learning is designed to develop
  • Slide 45
  • What is problem based learning
  • Slide 47
  • Slide 48
  • Slide 49
  • Rationale for using PBL
  • Slide 51
  • Slide 52
  • The group learning process acquiring desirable learning skills
  • Generic Skills amp attitudes
  • Slide 55
  • Slide 56
  • Slide 57
  • What happens in a PBL tutorial
  • Slide 59
  • Examples of trigger material for PBL scenarios
  • PBL tutorial process
  • Slide 62
  • PBL in curriculum design
  • Slide 64
  • Writing PBL scenarios
  • Slide 66
  • Staff development
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • Slide 70
  • Advantages of PBL
  • Slide 72
  • Slide 73
  • Disadvantages
  • Assessment of PBL
  • Slide 76
  • Conclusion
  • Slide 78
  • PBL 5 Easy Steps
  • 2 Brain storm
  • Brainstorm
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • THE FIRST GROUP SESSION
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
Page 16: Problem based learning

Framework for PBL - II

bull In Breaks between Tutorials students identfy Learning Issues to be pursued

bull They are encouraged to adot an evidence-based approach

bull When they reconvene they share and review the learning

Characteristics of an effective PBL Group

An Effective Group is Cohesive motivated mutually supportive amp actively engaged in learning

bull The Group understands the process amp energetically pursues its task

bull Members respect each otherrsquos contribution but examine them critically

bull Discussions flow as students cooperate rather than compete

bull The atmosphere is friendly amp good humouredbull Roles are shared all take turns in scribing

leading discussion taking responsibility for acquiring information

Staff Development

bull Basic training is mandatorybull Further development may be a requirementbull Initial training may involve observation amp

practice with a group from the programbull Effective training ensures that necessary

background goals amp local strategies are considered together with info on assessment amp evaluation

bull In addition to materials supplied to students tutors are usually issued with handbooks highlighting issues for each problem

Tutorrsquos Role in Assessment

bull Individual StudentsGroups may be assessed Summatively (determining progression) or formatively (for feedback)

The GROUP

bull At the end of each problem groups review their processes to encourage self-reflection ampenhance their collective performance

Tutorrsquos Role in Assessment

Individual students

bull Tutors should provide formative feedback to each member

bull Ask students to complete a simple self-assessment questionnaire reviewing appropriate behaviors the tutor returns them with comments

bull Students will be a writtenoralclinical tests that will determine their progression amp ultimate graduation

Evaluating PBL Tutorials-II

bull At the end of each problem time is allocated for evaluation

bull Both the process amp learning in PBL can be evaluated against explicit goals

bull The tutorrsquos review of effectiveness of group processes offers insight for the members

bull Students normally evaluate their tutor helpfulness support for clinical reasoning encouragement for independent learning appropriate intervention provision for effective feedback

PBLbull 1048708 Enabling students to learn in the context in which the

information will be used which increases the ability to retrieve and apply information

bull 1048708 Focusing on important concepts which helps learners organize and store new information in a way that facilitates retrieval and application

bull 1048708 Exploring prior knowledge formulating inquiries derived from and defined by the learnersrsquo need to know and actively constructing meaning through dialogue and reflection

bull 1048708 Utilizing problems designed to simulate studentsrsquo perception of their future profession which serves as a powerful stimulus for studentsrsquo intrinsic motivation to learn

bull 1048708 Actively involving students in monitoring their own progress and reflecting on what works and what needs improvement frequently assessing student performance and providing feedback

PBL Starting the casebull After the introductions and discussion

are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it

bull Reading the case aloud keeps the group focused

bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here

PBL Case (contd)

bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session

PBL Case contdbull SECOND deciding which issues everyone will

tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)

bull THIRD deciding what SPECIFIC questions individuals will try to answer

bull FOURTH deciding how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet or consulting an expert)

The Process of PBL

bullWhat are the issues Identify the important issues in the problem

bull How well do you understand the issues

bull Are there any words or terms about which you are unclear

The Process of PBL contd

bull Consider the basic mechanisms that might explain each important aspect of each problem

bull Assess your current understanding of the basic structural andor functional mechanisms that may contribute to the presentation of the problem

bull Use the collective skills and experiences of group members to explore or explain these phenomena Identify current gaps in knowledge or understanding

Learn from each other

bullShare your own knowledge expertise or ability to reason and synthesize information Be receptive and appreciative of the contribution of your small group members

Determine priorities for learning

bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue

bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan

bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge

bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career

PBL

bull The problem comes first without advance readings lectures or preparation

bull The problem serves as a stimulus for the need to know

Learning Issues

bull Learning issues are questions that cannot be answered with studentsrsquo current knowledge and that can be explored and answered through systematic self-directed inquiry

bull The use of learning issues in tutorials prepares students to handle similar challenges in clinical practice and life-long learning

Learning Issues in PBL First Session1 Getting Started (Introductions Ground

Rules Expectations)2 Identifying Problem3 Exploring Pre-Existing Knowledge4 Generating Hypotheses and Explaining

Mechanisms5 Unfolding the Case Incrementally6 Re-EvaluatingReprioritizing Hypotheses

Based on New Information7 AssessmentReflection

PBL Second Session

8 Independent Self-Directed Study of Learning Issues

PBL Third Session

bull 9 Discussion of Learning Issues and Application of New Knowledge to the Case

bull 10 Continued Unfolding of the Case Incrementally

bull 11 AssessmentReflection

During Tutorial Session students will

1048708 Come prepared to discuss the case and learning issues researched since the last tutorial

1048708 Actively participate in group discussions and contribute to the learning process in a manner that allows for the balanced participation of everyone in the group

1048708 Develop learning issues at each session phrase them as full-sentence questions write them on the board and post them on the course web page

1048708 Consider biological population behaviormental health issuesexplanations and questions of professional attitudes values and ethics related to the patientrsquos problem(s) described in the case

Tutorial Session contd1048708 Go to the board to diagram outline draw etc in

explanation of mechanisms relatedto hypotheses1048708 Debate evidence related to the case and avoid

personal attacks on others1048708 Comply with ground rules with regard to how

the group will function and how itsmembers treat one another1048708 Participate in end-of-session reflection and

assessment by giving and receivingconstructive criticism regarding self tutor

student and group performance

Between Tutorial Session

1048708 Research key learning issues using a variety of resources

1048708 Critically evaluate the credibility of sources and the validity of the information they have obtained in their research

1048708 Integrate what they have learned through research lectures labs clinical skills Perspectives in Medicine (PIM) etc into what is discussed in tutorials

1048708 Synthesize what they have learned and be prepared to discuss it without reading directly from their materials as much as possible and apply it to the case at the next tutorial session

Determine priorities for learning

bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue

bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan

bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge

bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career

PBL Starting the casebull After the introductions and discussion

are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it

bull Reading the case aloud keeps the group focused

bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here

Problem-based learning is designed to develop

1048708 Integrated context-specific knowledge base

1048708 Decision-makingcritical thinking process and skills

1048708 Self-directed life-long learning skills 1048708 Interpersonal collaboration and

communication skills 1048708 Constructive self and peer

assessment skills 1048708 Professional ethics and behavior

PBL Case (contd)

bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session

What is problem based learning

bull In PBL students use triggers from the problem case or scenario to define their own learning objectives

bull Subsequently they do independent self directed study before returning to the group to discuss and refine their acquired knowledge

bull Thus PBL is not about problem solving per se but rather it uses appropriate problems to increase knowledge and understanding

bull The process is clearly defined

PBL

bull PBL uses clinical cases as the context for students to study basic and clinical sciences

bull Its possible advantages over traditional approaches include its greater relevance to the practice of medicine its ability to promote retention and application of knowledge and its encouragement of self-directed life-long learning

bull Possible disadvantages include higher costs both in resources and staff time

PBL

bull An educational method characterized by the use of patient problems as a context for students to learn problem-solving skills and acquire knowledge about the basic and clinical sciences

bull Students usually meet in small groups two or three times a week for PBL tutorials

bull They are presented with a clinical problem (eg a patient with chest pain) and in a series of steps they discuss possible mechanisms and causes develop hypotheses and strategies to test the hypotheses are presented with further information and use this new information to refine their hypotheses finally reaching a conclusion

bull A tutor usually acts as a facilitator guiding students in this group-learning process

bull In the course of this exercise students identify both their existing levels and gaps in their knowledge These gaps form the basis for independent learning outside the PBL tutorials The identification and pursuit of these so-called learning goals is a key element of the PBL process

Rationale for using PBL bull The PBL approach is based on principles of adult

education20 and cognitive psychology21 It differs fundamentally from traditional curricula in which students acquire background knowledge of the basic sciences in the early years of the course and in the later years apply this knowledge to the diagnosis and management of clinical problems This traditional approach has been criticised for a number of reasons42223

bull It creates an artificial divide between the basic and clinical sciences

bull Time is wasted in acquiring knowledge that is subsequently forgotten or found to be irrelevant

bull Application of the acquired knowledge can be difficult bull The acquisition and retention of information that has no

apparent relevance can be boring and even demoralising for students

The group learning process acquiring

desirable learning skills

Generic Skills amp attitudes

bull Teamwork bull Critical evaluation of literature bull Chairing a group bull Self directed learning and use of

resources bull Listening Presentation skills

Recording bull Cooperation bull Respect for colleagues views

bull Group learning facilitates not only the acquisition of knowledge but also several other desirable attributes such as communication skills teamwork problem solving independent responsibility for learning sharing information and respect for others PBL can therefore be thought of as a small group teaching method that combines the acquisition of knowledge with the development of generic skills and attitudes Presentation of clinical material as the stimulus for learning enables students to understand the relevance of underlying scientific knowledge and principles in clinical practice

bull when PBL is introduced into a curriculum several other issues for curriculum design and implementation need to be tackled PBL is generally introduced in the context of a defined core curriculum and integration of basic and clinical sciences It has implications for staffing and learning resources and demands a different approach to timetabling workload and assessment PBL is often used to deliver core material in non-clinical parts of the curriculum Paper based PBL scenarios form the basis of the core curriculum and ensure that all students are exposed to the same problems Recently modified PBL techniques have been introduced into clinical education with real patients being used as the stimulus for learning Despite the essential ad hoc nature of learning clinical medicine a key cases approach can enable PBL to be used to deliver the core clinical curriculum

Copyright copy2003 BMJ Publishing Group Ltd

Wood D F BMJ 2003326328-330

No CRoles of participants in a PBL tutorial aption Found

What happens in a PBL tutorial bull PBL tutorials are conducted in several ways In

this article the examples are modelled on the Maastricht seven jump process but its format of seven steps may be shortened

bull A typical PBL tutorial consists of a group of students (usually eight to 10) and a tutor who facilitates the session The length of time (number of sessions) that a group stays together with each other and with individual tutors varies between institutions A group needs to be together long enough to allow good group dynamics to develop but may need to be changed occasionally if personality clashes or other dysfunctional behaviour emerges

bull Students elect a chair for each PBL scenario and a scribe to record the discussion The roles are rotated for each scenario Suitable flip charts or a whiteboard should be used for recording the proceedings At the start of the session depending on the trigger material either the student chair reads out the scenario or all students study the material If the trigger is a real patient in a ward clinic or surgery then a student may be asked to take a clinical history or identify an abnormal physical sign before the group moves to a tutorial room For each module students may be given a handbook containing the problem scenarios and suggested learning resources or learning materials may be handed out at appropriate times as the tutorials progress

Examples of trigger material for PBL scenarios bull Paper based clinical scenarios bull Experimental or clinical laboratory data bull Photographs bull Video clips bull Newspaper articles bull All or part of an article from a scientific

journal bull A real or simulated patient bull A family tree showing an inherited

disorder

PBL tutorial process ndash Step 1 Identify and clarify unfamiliar terms presented in the scenario

scribe lists those that remain unexplained after discussion ndash Step 2 Define the problem or problems to be discussed students may

have different views on the issues but all should be considered scribe records a list of agreed problems

ndash Step 3 Brainstorming session to discuss the problem(s) suggestingpossible explanations on basis of prior knowledge students draw on each others knowledge and identify areas of incomplete knowledge scribe records all discussion

ndash Step 4 Review steps 2 and 3 and arrange explanations into tentativesolutions scribe organises the explanations and restructures if necessary

ndash Step 5 Formulate learning objectives group reaches consensus onthe learning objectives tutor ensures learning objectives are focused achievable comprehensive and appropriate

ndash Step 6 Private study (all students gather information related to eachlearning objective)

ndash Step 7 Group shares results of private study (students identify theirlearning resources and share their results) tutor checks learning and may assess the group

bull The role of the tutor is to facilitate the proceedings (helping the chair to maintain group dynamics and moving the group through the task) and to ensure that the group achieves appropriate learning objectives in line with those set by the curriculum design team The tutor may need to take a more active role in step 7 of the process to ensure that all the students have done the appropriate work and to help the chair to suggest a suitable format for group members to use to present the results of their private study The tutor should encourage students to check their understanding of the material He or she can do this by encouraging the students to ask open questions and ask each other to explain topics in their own words or by the use of drawings and diagrams

PBL in curriculum design bull PBL may be used either as the mainstay of an entire

curriculum or for the delivery of individual courses In practice PBL is usually part of an integrated curriculum using a systems based approach with non-clinical material delivered in the context of clinical practice A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge skills and attitudes A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios Sufficient time should be allowed each week for students to do the self directed learning required for PBL

bull

Copyright copy2003 BMJ Publishing Group Ltd

Wood D F BMJ 2003326328-330

No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found

Writing PBL scenarios

bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives

bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after

studying the scenario should be consistent with the faculty learning objectives

bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding

bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice

bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge

bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented

bull The problem should be sufficiently open so that discussion is not curtailed too early in the process

bull Scenarios should promote participation by the students in seeking information from various learning resources

bull Adapted from Dolmans et al Med Teacher 199719185-9

Staff development

bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)

A dysfunctional group a dominant character may

make it difficult for other students to be heard

A dysfunctional group a dominant character may make it difficult for other students to be heard

bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties

Advantages of PBL bull Student centred PBLIt fostersactive learning improved

understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks

Disadvantagesbull Tutors who cant teachTutorsenjoy passing on

their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful

Assessment of PBL

bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods

bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL

Conclusion

bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning

bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL

PBL 5 Easy Steps

bull Read the problem

Mrs Paula Embledon

Mrs Paula Embledon is a 78 year old woman who has come to the emergency room complaining of shortness of breath and pain in her chest She had been in relatively good health until three weeks previously when she sprained

2 Brain storm

bull Brainstorm

bull ndash hypotheses

bull - what do we know in support of the hypothesis

bull - what do we need to know to test the hypothesis

ndash learning issues

Brainstorm

bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)

ndash specific issues (for individuals to look up)

ndash overlapping issues

bull 4 Individual Reading - Research - Preparation

bull 5 Return

bull ndash review case so far ndash report and discuss

ndash assess progress - continue pagenext pagecomplete

ndash self-evaluation - How did things go Any suggestions for next time

ndash next problem

bull 5 Return

THE FIRST GROUP SESSION

bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day

bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session

bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr

bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine

bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise

bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator

bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues

bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know

bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)

bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)

bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)

  • PROBLEM BASED LEARNING
  • New Horizons in Medical Education
  • Slide 3
  • Domains of essential Global Requirements of ME
  • What was the response to these challenges
  • New Educational Strategies
  • New Tools amp Aids
  • PBL
  • PBL
  • Advantages
  • Slide 11
  • Slide 12
  • Slide 13
  • Slide 14
  • Framework for PBL
  • Framework for PBL - II
  • Characteristics of an effective PBL Group
  • Staff Development
  • Tutorrsquos Role in Assessment
  • Slide 20
  • Evaluating PBL Tutorials-II
  • PBL
  • Slide 23
  • PBL Starting the case
  • PBL Case (contd)
  • PBL Case contd
  • The Process of PBL
  • The Process of PBL contd
  • Learn from each other
  • Determine priorities for learning
  • Slide 31
  • Slide 32
  • Learning Issues
  • Learning Issues in PBL First Session
  • PBL Second Session
  • PBL Third Session
  • Slide 37
  • Slide 38
  • During Tutorial Session students will
  • Tutorial Session contd
  • Between Tutorial Session
  • Slide 42
  • Slide 43
  • Problem-based learning is designed to develop
  • Slide 45
  • What is problem based learning
  • Slide 47
  • Slide 48
  • Slide 49
  • Rationale for using PBL
  • Slide 51
  • Slide 52
  • The group learning process acquiring desirable learning skills
  • Generic Skills amp attitudes
  • Slide 55
  • Slide 56
  • Slide 57
  • What happens in a PBL tutorial
  • Slide 59
  • Examples of trigger material for PBL scenarios
  • PBL tutorial process
  • Slide 62
  • PBL in curriculum design
  • Slide 64
  • Writing PBL scenarios
  • Slide 66
  • Staff development
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • Slide 70
  • Advantages of PBL
  • Slide 72
  • Slide 73
  • Disadvantages
  • Assessment of PBL
  • Slide 76
  • Conclusion
  • Slide 78
  • PBL 5 Easy Steps
  • 2 Brain storm
  • Brainstorm
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • THE FIRST GROUP SESSION
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
Page 17: Problem based learning

Characteristics of an effective PBL Group

An Effective Group is Cohesive motivated mutually supportive amp actively engaged in learning

bull The Group understands the process amp energetically pursues its task

bull Members respect each otherrsquos contribution but examine them critically

bull Discussions flow as students cooperate rather than compete

bull The atmosphere is friendly amp good humouredbull Roles are shared all take turns in scribing

leading discussion taking responsibility for acquiring information

Staff Development

bull Basic training is mandatorybull Further development may be a requirementbull Initial training may involve observation amp

practice with a group from the programbull Effective training ensures that necessary

background goals amp local strategies are considered together with info on assessment amp evaluation

bull In addition to materials supplied to students tutors are usually issued with handbooks highlighting issues for each problem

Tutorrsquos Role in Assessment

bull Individual StudentsGroups may be assessed Summatively (determining progression) or formatively (for feedback)

The GROUP

bull At the end of each problem groups review their processes to encourage self-reflection ampenhance their collective performance

Tutorrsquos Role in Assessment

Individual students

bull Tutors should provide formative feedback to each member

bull Ask students to complete a simple self-assessment questionnaire reviewing appropriate behaviors the tutor returns them with comments

bull Students will be a writtenoralclinical tests that will determine their progression amp ultimate graduation

Evaluating PBL Tutorials-II

bull At the end of each problem time is allocated for evaluation

bull Both the process amp learning in PBL can be evaluated against explicit goals

bull The tutorrsquos review of effectiveness of group processes offers insight for the members

bull Students normally evaluate their tutor helpfulness support for clinical reasoning encouragement for independent learning appropriate intervention provision for effective feedback

PBLbull 1048708 Enabling students to learn in the context in which the

information will be used which increases the ability to retrieve and apply information

bull 1048708 Focusing on important concepts which helps learners organize and store new information in a way that facilitates retrieval and application

bull 1048708 Exploring prior knowledge formulating inquiries derived from and defined by the learnersrsquo need to know and actively constructing meaning through dialogue and reflection

bull 1048708 Utilizing problems designed to simulate studentsrsquo perception of their future profession which serves as a powerful stimulus for studentsrsquo intrinsic motivation to learn

bull 1048708 Actively involving students in monitoring their own progress and reflecting on what works and what needs improvement frequently assessing student performance and providing feedback

PBL Starting the casebull After the introductions and discussion

are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it

bull Reading the case aloud keeps the group focused

bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here

PBL Case (contd)

bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session

PBL Case contdbull SECOND deciding which issues everyone will

tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)

bull THIRD deciding what SPECIFIC questions individuals will try to answer

bull FOURTH deciding how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet or consulting an expert)

The Process of PBL

bullWhat are the issues Identify the important issues in the problem

bull How well do you understand the issues

bull Are there any words or terms about which you are unclear

The Process of PBL contd

bull Consider the basic mechanisms that might explain each important aspect of each problem

bull Assess your current understanding of the basic structural andor functional mechanisms that may contribute to the presentation of the problem

bull Use the collective skills and experiences of group members to explore or explain these phenomena Identify current gaps in knowledge or understanding

Learn from each other

bullShare your own knowledge expertise or ability to reason and synthesize information Be receptive and appreciative of the contribution of your small group members

Determine priorities for learning

bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue

bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan

bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge

bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career

PBL

bull The problem comes first without advance readings lectures or preparation

bull The problem serves as a stimulus for the need to know

Learning Issues

bull Learning issues are questions that cannot be answered with studentsrsquo current knowledge and that can be explored and answered through systematic self-directed inquiry

bull The use of learning issues in tutorials prepares students to handle similar challenges in clinical practice and life-long learning

Learning Issues in PBL First Session1 Getting Started (Introductions Ground

Rules Expectations)2 Identifying Problem3 Exploring Pre-Existing Knowledge4 Generating Hypotheses and Explaining

Mechanisms5 Unfolding the Case Incrementally6 Re-EvaluatingReprioritizing Hypotheses

Based on New Information7 AssessmentReflection

PBL Second Session

8 Independent Self-Directed Study of Learning Issues

PBL Third Session

bull 9 Discussion of Learning Issues and Application of New Knowledge to the Case

bull 10 Continued Unfolding of the Case Incrementally

bull 11 AssessmentReflection

During Tutorial Session students will

1048708 Come prepared to discuss the case and learning issues researched since the last tutorial

1048708 Actively participate in group discussions and contribute to the learning process in a manner that allows for the balanced participation of everyone in the group

1048708 Develop learning issues at each session phrase them as full-sentence questions write them on the board and post them on the course web page

1048708 Consider biological population behaviormental health issuesexplanations and questions of professional attitudes values and ethics related to the patientrsquos problem(s) described in the case

Tutorial Session contd1048708 Go to the board to diagram outline draw etc in

explanation of mechanisms relatedto hypotheses1048708 Debate evidence related to the case and avoid

personal attacks on others1048708 Comply with ground rules with regard to how

the group will function and how itsmembers treat one another1048708 Participate in end-of-session reflection and

assessment by giving and receivingconstructive criticism regarding self tutor

student and group performance

Between Tutorial Session

1048708 Research key learning issues using a variety of resources

1048708 Critically evaluate the credibility of sources and the validity of the information they have obtained in their research

1048708 Integrate what they have learned through research lectures labs clinical skills Perspectives in Medicine (PIM) etc into what is discussed in tutorials

1048708 Synthesize what they have learned and be prepared to discuss it without reading directly from their materials as much as possible and apply it to the case at the next tutorial session

Determine priorities for learning

bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue

bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan

bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge

bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career

PBL Starting the casebull After the introductions and discussion

are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it

bull Reading the case aloud keeps the group focused

bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here

Problem-based learning is designed to develop

1048708 Integrated context-specific knowledge base

1048708 Decision-makingcritical thinking process and skills

1048708 Self-directed life-long learning skills 1048708 Interpersonal collaboration and

communication skills 1048708 Constructive self and peer

assessment skills 1048708 Professional ethics and behavior

PBL Case (contd)

bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session

What is problem based learning

bull In PBL students use triggers from the problem case or scenario to define their own learning objectives

bull Subsequently they do independent self directed study before returning to the group to discuss and refine their acquired knowledge

bull Thus PBL is not about problem solving per se but rather it uses appropriate problems to increase knowledge and understanding

bull The process is clearly defined

PBL

bull PBL uses clinical cases as the context for students to study basic and clinical sciences

bull Its possible advantages over traditional approaches include its greater relevance to the practice of medicine its ability to promote retention and application of knowledge and its encouragement of self-directed life-long learning

bull Possible disadvantages include higher costs both in resources and staff time

PBL

bull An educational method characterized by the use of patient problems as a context for students to learn problem-solving skills and acquire knowledge about the basic and clinical sciences

bull Students usually meet in small groups two or three times a week for PBL tutorials

bull They are presented with a clinical problem (eg a patient with chest pain) and in a series of steps they discuss possible mechanisms and causes develop hypotheses and strategies to test the hypotheses are presented with further information and use this new information to refine their hypotheses finally reaching a conclusion

bull A tutor usually acts as a facilitator guiding students in this group-learning process

bull In the course of this exercise students identify both their existing levels and gaps in their knowledge These gaps form the basis for independent learning outside the PBL tutorials The identification and pursuit of these so-called learning goals is a key element of the PBL process

Rationale for using PBL bull The PBL approach is based on principles of adult

education20 and cognitive psychology21 It differs fundamentally from traditional curricula in which students acquire background knowledge of the basic sciences in the early years of the course and in the later years apply this knowledge to the diagnosis and management of clinical problems This traditional approach has been criticised for a number of reasons42223

bull It creates an artificial divide between the basic and clinical sciences

bull Time is wasted in acquiring knowledge that is subsequently forgotten or found to be irrelevant

bull Application of the acquired knowledge can be difficult bull The acquisition and retention of information that has no

apparent relevance can be boring and even demoralising for students

The group learning process acquiring

desirable learning skills

Generic Skills amp attitudes

bull Teamwork bull Critical evaluation of literature bull Chairing a group bull Self directed learning and use of

resources bull Listening Presentation skills

Recording bull Cooperation bull Respect for colleagues views

bull Group learning facilitates not only the acquisition of knowledge but also several other desirable attributes such as communication skills teamwork problem solving independent responsibility for learning sharing information and respect for others PBL can therefore be thought of as a small group teaching method that combines the acquisition of knowledge with the development of generic skills and attitudes Presentation of clinical material as the stimulus for learning enables students to understand the relevance of underlying scientific knowledge and principles in clinical practice

bull when PBL is introduced into a curriculum several other issues for curriculum design and implementation need to be tackled PBL is generally introduced in the context of a defined core curriculum and integration of basic and clinical sciences It has implications for staffing and learning resources and demands a different approach to timetabling workload and assessment PBL is often used to deliver core material in non-clinical parts of the curriculum Paper based PBL scenarios form the basis of the core curriculum and ensure that all students are exposed to the same problems Recently modified PBL techniques have been introduced into clinical education with real patients being used as the stimulus for learning Despite the essential ad hoc nature of learning clinical medicine a key cases approach can enable PBL to be used to deliver the core clinical curriculum

Copyright copy2003 BMJ Publishing Group Ltd

Wood D F BMJ 2003326328-330

No CRoles of participants in a PBL tutorial aption Found

What happens in a PBL tutorial bull PBL tutorials are conducted in several ways In

this article the examples are modelled on the Maastricht seven jump process but its format of seven steps may be shortened

bull A typical PBL tutorial consists of a group of students (usually eight to 10) and a tutor who facilitates the session The length of time (number of sessions) that a group stays together with each other and with individual tutors varies between institutions A group needs to be together long enough to allow good group dynamics to develop but may need to be changed occasionally if personality clashes or other dysfunctional behaviour emerges

bull Students elect a chair for each PBL scenario and a scribe to record the discussion The roles are rotated for each scenario Suitable flip charts or a whiteboard should be used for recording the proceedings At the start of the session depending on the trigger material either the student chair reads out the scenario or all students study the material If the trigger is a real patient in a ward clinic or surgery then a student may be asked to take a clinical history or identify an abnormal physical sign before the group moves to a tutorial room For each module students may be given a handbook containing the problem scenarios and suggested learning resources or learning materials may be handed out at appropriate times as the tutorials progress

Examples of trigger material for PBL scenarios bull Paper based clinical scenarios bull Experimental or clinical laboratory data bull Photographs bull Video clips bull Newspaper articles bull All or part of an article from a scientific

journal bull A real or simulated patient bull A family tree showing an inherited

disorder

PBL tutorial process ndash Step 1 Identify and clarify unfamiliar terms presented in the scenario

scribe lists those that remain unexplained after discussion ndash Step 2 Define the problem or problems to be discussed students may

have different views on the issues but all should be considered scribe records a list of agreed problems

ndash Step 3 Brainstorming session to discuss the problem(s) suggestingpossible explanations on basis of prior knowledge students draw on each others knowledge and identify areas of incomplete knowledge scribe records all discussion

ndash Step 4 Review steps 2 and 3 and arrange explanations into tentativesolutions scribe organises the explanations and restructures if necessary

ndash Step 5 Formulate learning objectives group reaches consensus onthe learning objectives tutor ensures learning objectives are focused achievable comprehensive and appropriate

ndash Step 6 Private study (all students gather information related to eachlearning objective)

ndash Step 7 Group shares results of private study (students identify theirlearning resources and share their results) tutor checks learning and may assess the group

bull The role of the tutor is to facilitate the proceedings (helping the chair to maintain group dynamics and moving the group through the task) and to ensure that the group achieves appropriate learning objectives in line with those set by the curriculum design team The tutor may need to take a more active role in step 7 of the process to ensure that all the students have done the appropriate work and to help the chair to suggest a suitable format for group members to use to present the results of their private study The tutor should encourage students to check their understanding of the material He or she can do this by encouraging the students to ask open questions and ask each other to explain topics in their own words or by the use of drawings and diagrams

PBL in curriculum design bull PBL may be used either as the mainstay of an entire

curriculum or for the delivery of individual courses In practice PBL is usually part of an integrated curriculum using a systems based approach with non-clinical material delivered in the context of clinical practice A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge skills and attitudes A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios Sufficient time should be allowed each week for students to do the self directed learning required for PBL

bull

Copyright copy2003 BMJ Publishing Group Ltd

Wood D F BMJ 2003326328-330

No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found

Writing PBL scenarios

bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives

bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after

studying the scenario should be consistent with the faculty learning objectives

bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding

bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice

bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge

bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented

bull The problem should be sufficiently open so that discussion is not curtailed too early in the process

bull Scenarios should promote participation by the students in seeking information from various learning resources

bull Adapted from Dolmans et al Med Teacher 199719185-9

Staff development

bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)

A dysfunctional group a dominant character may

make it difficult for other students to be heard

A dysfunctional group a dominant character may make it difficult for other students to be heard

bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties

Advantages of PBL bull Student centred PBLIt fostersactive learning improved

understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks

Disadvantagesbull Tutors who cant teachTutorsenjoy passing on

their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful

Assessment of PBL

bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods

bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL

Conclusion

bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning

bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL

PBL 5 Easy Steps

bull Read the problem

Mrs Paula Embledon

Mrs Paula Embledon is a 78 year old woman who has come to the emergency room complaining of shortness of breath and pain in her chest She had been in relatively good health until three weeks previously when she sprained

2 Brain storm

bull Brainstorm

bull ndash hypotheses

bull - what do we know in support of the hypothesis

bull - what do we need to know to test the hypothesis

ndash learning issues

Brainstorm

bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)

ndash specific issues (for individuals to look up)

ndash overlapping issues

bull 4 Individual Reading - Research - Preparation

bull 5 Return

bull ndash review case so far ndash report and discuss

ndash assess progress - continue pagenext pagecomplete

ndash self-evaluation - How did things go Any suggestions for next time

ndash next problem

bull 5 Return

THE FIRST GROUP SESSION

bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day

bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session

bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr

bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine

bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise

bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator

bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues

bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know

bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)

bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)

bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)

  • PROBLEM BASED LEARNING
  • New Horizons in Medical Education
  • Slide 3
  • Domains of essential Global Requirements of ME
  • What was the response to these challenges
  • New Educational Strategies
  • New Tools amp Aids
  • PBL
  • PBL
  • Advantages
  • Slide 11
  • Slide 12
  • Slide 13
  • Slide 14
  • Framework for PBL
  • Framework for PBL - II
  • Characteristics of an effective PBL Group
  • Staff Development
  • Tutorrsquos Role in Assessment
  • Slide 20
  • Evaluating PBL Tutorials-II
  • PBL
  • Slide 23
  • PBL Starting the case
  • PBL Case (contd)
  • PBL Case contd
  • The Process of PBL
  • The Process of PBL contd
  • Learn from each other
  • Determine priorities for learning
  • Slide 31
  • Slide 32
  • Learning Issues
  • Learning Issues in PBL First Session
  • PBL Second Session
  • PBL Third Session
  • Slide 37
  • Slide 38
  • During Tutorial Session students will
  • Tutorial Session contd
  • Between Tutorial Session
  • Slide 42
  • Slide 43
  • Problem-based learning is designed to develop
  • Slide 45
  • What is problem based learning
  • Slide 47
  • Slide 48
  • Slide 49
  • Rationale for using PBL
  • Slide 51
  • Slide 52
  • The group learning process acquiring desirable learning skills
  • Generic Skills amp attitudes
  • Slide 55
  • Slide 56
  • Slide 57
  • What happens in a PBL tutorial
  • Slide 59
  • Examples of trigger material for PBL scenarios
  • PBL tutorial process
  • Slide 62
  • PBL in curriculum design
  • Slide 64
  • Writing PBL scenarios
  • Slide 66
  • Staff development
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • Slide 70
  • Advantages of PBL
  • Slide 72
  • Slide 73
  • Disadvantages
  • Assessment of PBL
  • Slide 76
  • Conclusion
  • Slide 78
  • PBL 5 Easy Steps
  • 2 Brain storm
  • Brainstorm
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • THE FIRST GROUP SESSION
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
Page 18: Problem based learning

Staff Development

bull Basic training is mandatorybull Further development may be a requirementbull Initial training may involve observation amp

practice with a group from the programbull Effective training ensures that necessary

background goals amp local strategies are considered together with info on assessment amp evaluation

bull In addition to materials supplied to students tutors are usually issued with handbooks highlighting issues for each problem

Tutorrsquos Role in Assessment

bull Individual StudentsGroups may be assessed Summatively (determining progression) or formatively (for feedback)

The GROUP

bull At the end of each problem groups review their processes to encourage self-reflection ampenhance their collective performance

Tutorrsquos Role in Assessment

Individual students

bull Tutors should provide formative feedback to each member

bull Ask students to complete a simple self-assessment questionnaire reviewing appropriate behaviors the tutor returns them with comments

bull Students will be a writtenoralclinical tests that will determine their progression amp ultimate graduation

Evaluating PBL Tutorials-II

bull At the end of each problem time is allocated for evaluation

bull Both the process amp learning in PBL can be evaluated against explicit goals

bull The tutorrsquos review of effectiveness of group processes offers insight for the members

bull Students normally evaluate their tutor helpfulness support for clinical reasoning encouragement for independent learning appropriate intervention provision for effective feedback

PBLbull 1048708 Enabling students to learn in the context in which the

information will be used which increases the ability to retrieve and apply information

bull 1048708 Focusing on important concepts which helps learners organize and store new information in a way that facilitates retrieval and application

bull 1048708 Exploring prior knowledge formulating inquiries derived from and defined by the learnersrsquo need to know and actively constructing meaning through dialogue and reflection

bull 1048708 Utilizing problems designed to simulate studentsrsquo perception of their future profession which serves as a powerful stimulus for studentsrsquo intrinsic motivation to learn

bull 1048708 Actively involving students in monitoring their own progress and reflecting on what works and what needs improvement frequently assessing student performance and providing feedback

PBL Starting the casebull After the introductions and discussion

are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it

bull Reading the case aloud keeps the group focused

bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here

PBL Case (contd)

bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session

PBL Case contdbull SECOND deciding which issues everyone will

tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)

bull THIRD deciding what SPECIFIC questions individuals will try to answer

bull FOURTH deciding how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet or consulting an expert)

The Process of PBL

bullWhat are the issues Identify the important issues in the problem

bull How well do you understand the issues

bull Are there any words or terms about which you are unclear

The Process of PBL contd

bull Consider the basic mechanisms that might explain each important aspect of each problem

bull Assess your current understanding of the basic structural andor functional mechanisms that may contribute to the presentation of the problem

bull Use the collective skills and experiences of group members to explore or explain these phenomena Identify current gaps in knowledge or understanding

Learn from each other

bullShare your own knowledge expertise or ability to reason and synthesize information Be receptive and appreciative of the contribution of your small group members

Determine priorities for learning

bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue

bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan

bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge

bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career

PBL

bull The problem comes first without advance readings lectures or preparation

bull The problem serves as a stimulus for the need to know

Learning Issues

bull Learning issues are questions that cannot be answered with studentsrsquo current knowledge and that can be explored and answered through systematic self-directed inquiry

bull The use of learning issues in tutorials prepares students to handle similar challenges in clinical practice and life-long learning

Learning Issues in PBL First Session1 Getting Started (Introductions Ground

Rules Expectations)2 Identifying Problem3 Exploring Pre-Existing Knowledge4 Generating Hypotheses and Explaining

Mechanisms5 Unfolding the Case Incrementally6 Re-EvaluatingReprioritizing Hypotheses

Based on New Information7 AssessmentReflection

PBL Second Session

8 Independent Self-Directed Study of Learning Issues

PBL Third Session

bull 9 Discussion of Learning Issues and Application of New Knowledge to the Case

bull 10 Continued Unfolding of the Case Incrementally

bull 11 AssessmentReflection

During Tutorial Session students will

1048708 Come prepared to discuss the case and learning issues researched since the last tutorial

1048708 Actively participate in group discussions and contribute to the learning process in a manner that allows for the balanced participation of everyone in the group

1048708 Develop learning issues at each session phrase them as full-sentence questions write them on the board and post them on the course web page

1048708 Consider biological population behaviormental health issuesexplanations and questions of professional attitudes values and ethics related to the patientrsquos problem(s) described in the case

Tutorial Session contd1048708 Go to the board to diagram outline draw etc in

explanation of mechanisms relatedto hypotheses1048708 Debate evidence related to the case and avoid

personal attacks on others1048708 Comply with ground rules with regard to how

the group will function and how itsmembers treat one another1048708 Participate in end-of-session reflection and

assessment by giving and receivingconstructive criticism regarding self tutor

student and group performance

Between Tutorial Session

1048708 Research key learning issues using a variety of resources

1048708 Critically evaluate the credibility of sources and the validity of the information they have obtained in their research

1048708 Integrate what they have learned through research lectures labs clinical skills Perspectives in Medicine (PIM) etc into what is discussed in tutorials

1048708 Synthesize what they have learned and be prepared to discuss it without reading directly from their materials as much as possible and apply it to the case at the next tutorial session

Determine priorities for learning

bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue

bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan

bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge

bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career

PBL Starting the casebull After the introductions and discussion

are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it

bull Reading the case aloud keeps the group focused

bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here

Problem-based learning is designed to develop

1048708 Integrated context-specific knowledge base

1048708 Decision-makingcritical thinking process and skills

1048708 Self-directed life-long learning skills 1048708 Interpersonal collaboration and

communication skills 1048708 Constructive self and peer

assessment skills 1048708 Professional ethics and behavior

PBL Case (contd)

bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session

What is problem based learning

bull In PBL students use triggers from the problem case or scenario to define their own learning objectives

bull Subsequently they do independent self directed study before returning to the group to discuss and refine their acquired knowledge

bull Thus PBL is not about problem solving per se but rather it uses appropriate problems to increase knowledge and understanding

bull The process is clearly defined

PBL

bull PBL uses clinical cases as the context for students to study basic and clinical sciences

bull Its possible advantages over traditional approaches include its greater relevance to the practice of medicine its ability to promote retention and application of knowledge and its encouragement of self-directed life-long learning

bull Possible disadvantages include higher costs both in resources and staff time

PBL

bull An educational method characterized by the use of patient problems as a context for students to learn problem-solving skills and acquire knowledge about the basic and clinical sciences

bull Students usually meet in small groups two or three times a week for PBL tutorials

bull They are presented with a clinical problem (eg a patient with chest pain) and in a series of steps they discuss possible mechanisms and causes develop hypotheses and strategies to test the hypotheses are presented with further information and use this new information to refine their hypotheses finally reaching a conclusion

bull A tutor usually acts as a facilitator guiding students in this group-learning process

bull In the course of this exercise students identify both their existing levels and gaps in their knowledge These gaps form the basis for independent learning outside the PBL tutorials The identification and pursuit of these so-called learning goals is a key element of the PBL process

Rationale for using PBL bull The PBL approach is based on principles of adult

education20 and cognitive psychology21 It differs fundamentally from traditional curricula in which students acquire background knowledge of the basic sciences in the early years of the course and in the later years apply this knowledge to the diagnosis and management of clinical problems This traditional approach has been criticised for a number of reasons42223

bull It creates an artificial divide between the basic and clinical sciences

bull Time is wasted in acquiring knowledge that is subsequently forgotten or found to be irrelevant

bull Application of the acquired knowledge can be difficult bull The acquisition and retention of information that has no

apparent relevance can be boring and even demoralising for students

The group learning process acquiring

desirable learning skills

Generic Skills amp attitudes

bull Teamwork bull Critical evaluation of literature bull Chairing a group bull Self directed learning and use of

resources bull Listening Presentation skills

Recording bull Cooperation bull Respect for colleagues views

bull Group learning facilitates not only the acquisition of knowledge but also several other desirable attributes such as communication skills teamwork problem solving independent responsibility for learning sharing information and respect for others PBL can therefore be thought of as a small group teaching method that combines the acquisition of knowledge with the development of generic skills and attitudes Presentation of clinical material as the stimulus for learning enables students to understand the relevance of underlying scientific knowledge and principles in clinical practice

bull when PBL is introduced into a curriculum several other issues for curriculum design and implementation need to be tackled PBL is generally introduced in the context of a defined core curriculum and integration of basic and clinical sciences It has implications for staffing and learning resources and demands a different approach to timetabling workload and assessment PBL is often used to deliver core material in non-clinical parts of the curriculum Paper based PBL scenarios form the basis of the core curriculum and ensure that all students are exposed to the same problems Recently modified PBL techniques have been introduced into clinical education with real patients being used as the stimulus for learning Despite the essential ad hoc nature of learning clinical medicine a key cases approach can enable PBL to be used to deliver the core clinical curriculum

Copyright copy2003 BMJ Publishing Group Ltd

Wood D F BMJ 2003326328-330

No CRoles of participants in a PBL tutorial aption Found

What happens in a PBL tutorial bull PBL tutorials are conducted in several ways In

this article the examples are modelled on the Maastricht seven jump process but its format of seven steps may be shortened

bull A typical PBL tutorial consists of a group of students (usually eight to 10) and a tutor who facilitates the session The length of time (number of sessions) that a group stays together with each other and with individual tutors varies between institutions A group needs to be together long enough to allow good group dynamics to develop but may need to be changed occasionally if personality clashes or other dysfunctional behaviour emerges

bull Students elect a chair for each PBL scenario and a scribe to record the discussion The roles are rotated for each scenario Suitable flip charts or a whiteboard should be used for recording the proceedings At the start of the session depending on the trigger material either the student chair reads out the scenario or all students study the material If the trigger is a real patient in a ward clinic or surgery then a student may be asked to take a clinical history or identify an abnormal physical sign before the group moves to a tutorial room For each module students may be given a handbook containing the problem scenarios and suggested learning resources or learning materials may be handed out at appropriate times as the tutorials progress

Examples of trigger material for PBL scenarios bull Paper based clinical scenarios bull Experimental or clinical laboratory data bull Photographs bull Video clips bull Newspaper articles bull All or part of an article from a scientific

journal bull A real or simulated patient bull A family tree showing an inherited

disorder

PBL tutorial process ndash Step 1 Identify and clarify unfamiliar terms presented in the scenario

scribe lists those that remain unexplained after discussion ndash Step 2 Define the problem or problems to be discussed students may

have different views on the issues but all should be considered scribe records a list of agreed problems

ndash Step 3 Brainstorming session to discuss the problem(s) suggestingpossible explanations on basis of prior knowledge students draw on each others knowledge and identify areas of incomplete knowledge scribe records all discussion

ndash Step 4 Review steps 2 and 3 and arrange explanations into tentativesolutions scribe organises the explanations and restructures if necessary

ndash Step 5 Formulate learning objectives group reaches consensus onthe learning objectives tutor ensures learning objectives are focused achievable comprehensive and appropriate

ndash Step 6 Private study (all students gather information related to eachlearning objective)

ndash Step 7 Group shares results of private study (students identify theirlearning resources and share their results) tutor checks learning and may assess the group

bull The role of the tutor is to facilitate the proceedings (helping the chair to maintain group dynamics and moving the group through the task) and to ensure that the group achieves appropriate learning objectives in line with those set by the curriculum design team The tutor may need to take a more active role in step 7 of the process to ensure that all the students have done the appropriate work and to help the chair to suggest a suitable format for group members to use to present the results of their private study The tutor should encourage students to check their understanding of the material He or she can do this by encouraging the students to ask open questions and ask each other to explain topics in their own words or by the use of drawings and diagrams

PBL in curriculum design bull PBL may be used either as the mainstay of an entire

curriculum or for the delivery of individual courses In practice PBL is usually part of an integrated curriculum using a systems based approach with non-clinical material delivered in the context of clinical practice A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge skills and attitudes A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios Sufficient time should be allowed each week for students to do the self directed learning required for PBL

bull

Copyright copy2003 BMJ Publishing Group Ltd

Wood D F BMJ 2003326328-330

No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found

Writing PBL scenarios

bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives

bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after

studying the scenario should be consistent with the faculty learning objectives

bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding

bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice

bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge

bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented

bull The problem should be sufficiently open so that discussion is not curtailed too early in the process

bull Scenarios should promote participation by the students in seeking information from various learning resources

bull Adapted from Dolmans et al Med Teacher 199719185-9

Staff development

bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)

A dysfunctional group a dominant character may

make it difficult for other students to be heard

A dysfunctional group a dominant character may make it difficult for other students to be heard

bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties

Advantages of PBL bull Student centred PBLIt fostersactive learning improved

understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks

Disadvantagesbull Tutors who cant teachTutorsenjoy passing on

their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful

Assessment of PBL

bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods

bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL

Conclusion

bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning

bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL

PBL 5 Easy Steps

bull Read the problem

Mrs Paula Embledon

Mrs Paula Embledon is a 78 year old woman who has come to the emergency room complaining of shortness of breath and pain in her chest She had been in relatively good health until three weeks previously when she sprained

2 Brain storm

bull Brainstorm

bull ndash hypotheses

bull - what do we know in support of the hypothesis

bull - what do we need to know to test the hypothesis

ndash learning issues

Brainstorm

bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)

ndash specific issues (for individuals to look up)

ndash overlapping issues

bull 4 Individual Reading - Research - Preparation

bull 5 Return

bull ndash review case so far ndash report and discuss

ndash assess progress - continue pagenext pagecomplete

ndash self-evaluation - How did things go Any suggestions for next time

ndash next problem

bull 5 Return

THE FIRST GROUP SESSION

bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day

bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session

bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr

bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine

bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise

bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator

bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues

bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know

bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)

bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)

bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)

  • PROBLEM BASED LEARNING
  • New Horizons in Medical Education
  • Slide 3
  • Domains of essential Global Requirements of ME
  • What was the response to these challenges
  • New Educational Strategies
  • New Tools amp Aids
  • PBL
  • PBL
  • Advantages
  • Slide 11
  • Slide 12
  • Slide 13
  • Slide 14
  • Framework for PBL
  • Framework for PBL - II
  • Characteristics of an effective PBL Group
  • Staff Development
  • Tutorrsquos Role in Assessment
  • Slide 20
  • Evaluating PBL Tutorials-II
  • PBL
  • Slide 23
  • PBL Starting the case
  • PBL Case (contd)
  • PBL Case contd
  • The Process of PBL
  • The Process of PBL contd
  • Learn from each other
  • Determine priorities for learning
  • Slide 31
  • Slide 32
  • Learning Issues
  • Learning Issues in PBL First Session
  • PBL Second Session
  • PBL Third Session
  • Slide 37
  • Slide 38
  • During Tutorial Session students will
  • Tutorial Session contd
  • Between Tutorial Session
  • Slide 42
  • Slide 43
  • Problem-based learning is designed to develop
  • Slide 45
  • What is problem based learning
  • Slide 47
  • Slide 48
  • Slide 49
  • Rationale for using PBL
  • Slide 51
  • Slide 52
  • The group learning process acquiring desirable learning skills
  • Generic Skills amp attitudes
  • Slide 55
  • Slide 56
  • Slide 57
  • What happens in a PBL tutorial
  • Slide 59
  • Examples of trigger material for PBL scenarios
  • PBL tutorial process
  • Slide 62
  • PBL in curriculum design
  • Slide 64
  • Writing PBL scenarios
  • Slide 66
  • Staff development
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • Slide 70
  • Advantages of PBL
  • Slide 72
  • Slide 73
  • Disadvantages
  • Assessment of PBL
  • Slide 76
  • Conclusion
  • Slide 78
  • PBL 5 Easy Steps
  • 2 Brain storm
  • Brainstorm
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • THE FIRST GROUP SESSION
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
Page 19: Problem based learning

Tutorrsquos Role in Assessment

bull Individual StudentsGroups may be assessed Summatively (determining progression) or formatively (for feedback)

The GROUP

bull At the end of each problem groups review their processes to encourage self-reflection ampenhance their collective performance

Tutorrsquos Role in Assessment

Individual students

bull Tutors should provide formative feedback to each member

bull Ask students to complete a simple self-assessment questionnaire reviewing appropriate behaviors the tutor returns them with comments

bull Students will be a writtenoralclinical tests that will determine their progression amp ultimate graduation

Evaluating PBL Tutorials-II

bull At the end of each problem time is allocated for evaluation

bull Both the process amp learning in PBL can be evaluated against explicit goals

bull The tutorrsquos review of effectiveness of group processes offers insight for the members

bull Students normally evaluate their tutor helpfulness support for clinical reasoning encouragement for independent learning appropriate intervention provision for effective feedback

PBLbull 1048708 Enabling students to learn in the context in which the

information will be used which increases the ability to retrieve and apply information

bull 1048708 Focusing on important concepts which helps learners organize and store new information in a way that facilitates retrieval and application

bull 1048708 Exploring prior knowledge formulating inquiries derived from and defined by the learnersrsquo need to know and actively constructing meaning through dialogue and reflection

bull 1048708 Utilizing problems designed to simulate studentsrsquo perception of their future profession which serves as a powerful stimulus for studentsrsquo intrinsic motivation to learn

bull 1048708 Actively involving students in monitoring their own progress and reflecting on what works and what needs improvement frequently assessing student performance and providing feedback

PBL Starting the casebull After the introductions and discussion

are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it

bull Reading the case aloud keeps the group focused

bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here

PBL Case (contd)

bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session

PBL Case contdbull SECOND deciding which issues everyone will

tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)

bull THIRD deciding what SPECIFIC questions individuals will try to answer

bull FOURTH deciding how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet or consulting an expert)

The Process of PBL

bullWhat are the issues Identify the important issues in the problem

bull How well do you understand the issues

bull Are there any words or terms about which you are unclear

The Process of PBL contd

bull Consider the basic mechanisms that might explain each important aspect of each problem

bull Assess your current understanding of the basic structural andor functional mechanisms that may contribute to the presentation of the problem

bull Use the collective skills and experiences of group members to explore or explain these phenomena Identify current gaps in knowledge or understanding

Learn from each other

bullShare your own knowledge expertise or ability to reason and synthesize information Be receptive and appreciative of the contribution of your small group members

Determine priorities for learning

bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue

bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan

bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge

bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career

PBL

bull The problem comes first without advance readings lectures or preparation

bull The problem serves as a stimulus for the need to know

Learning Issues

bull Learning issues are questions that cannot be answered with studentsrsquo current knowledge and that can be explored and answered through systematic self-directed inquiry

bull The use of learning issues in tutorials prepares students to handle similar challenges in clinical practice and life-long learning

Learning Issues in PBL First Session1 Getting Started (Introductions Ground

Rules Expectations)2 Identifying Problem3 Exploring Pre-Existing Knowledge4 Generating Hypotheses and Explaining

Mechanisms5 Unfolding the Case Incrementally6 Re-EvaluatingReprioritizing Hypotheses

Based on New Information7 AssessmentReflection

PBL Second Session

8 Independent Self-Directed Study of Learning Issues

PBL Third Session

bull 9 Discussion of Learning Issues and Application of New Knowledge to the Case

bull 10 Continued Unfolding of the Case Incrementally

bull 11 AssessmentReflection

During Tutorial Session students will

1048708 Come prepared to discuss the case and learning issues researched since the last tutorial

1048708 Actively participate in group discussions and contribute to the learning process in a manner that allows for the balanced participation of everyone in the group

1048708 Develop learning issues at each session phrase them as full-sentence questions write them on the board and post them on the course web page

1048708 Consider biological population behaviormental health issuesexplanations and questions of professional attitudes values and ethics related to the patientrsquos problem(s) described in the case

Tutorial Session contd1048708 Go to the board to diagram outline draw etc in

explanation of mechanisms relatedto hypotheses1048708 Debate evidence related to the case and avoid

personal attacks on others1048708 Comply with ground rules with regard to how

the group will function and how itsmembers treat one another1048708 Participate in end-of-session reflection and

assessment by giving and receivingconstructive criticism regarding self tutor

student and group performance

Between Tutorial Session

1048708 Research key learning issues using a variety of resources

1048708 Critically evaluate the credibility of sources and the validity of the information they have obtained in their research

1048708 Integrate what they have learned through research lectures labs clinical skills Perspectives in Medicine (PIM) etc into what is discussed in tutorials

1048708 Synthesize what they have learned and be prepared to discuss it without reading directly from their materials as much as possible and apply it to the case at the next tutorial session

Determine priorities for learning

bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue

bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan

bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge

bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career

PBL Starting the casebull After the introductions and discussion

are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it

bull Reading the case aloud keeps the group focused

bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here

Problem-based learning is designed to develop

1048708 Integrated context-specific knowledge base

1048708 Decision-makingcritical thinking process and skills

1048708 Self-directed life-long learning skills 1048708 Interpersonal collaboration and

communication skills 1048708 Constructive self and peer

assessment skills 1048708 Professional ethics and behavior

PBL Case (contd)

bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session

What is problem based learning

bull In PBL students use triggers from the problem case or scenario to define their own learning objectives

bull Subsequently they do independent self directed study before returning to the group to discuss and refine their acquired knowledge

bull Thus PBL is not about problem solving per se but rather it uses appropriate problems to increase knowledge and understanding

bull The process is clearly defined

PBL

bull PBL uses clinical cases as the context for students to study basic and clinical sciences

bull Its possible advantages over traditional approaches include its greater relevance to the practice of medicine its ability to promote retention and application of knowledge and its encouragement of self-directed life-long learning

bull Possible disadvantages include higher costs both in resources and staff time

PBL

bull An educational method characterized by the use of patient problems as a context for students to learn problem-solving skills and acquire knowledge about the basic and clinical sciences

bull Students usually meet in small groups two or three times a week for PBL tutorials

bull They are presented with a clinical problem (eg a patient with chest pain) and in a series of steps they discuss possible mechanisms and causes develop hypotheses and strategies to test the hypotheses are presented with further information and use this new information to refine their hypotheses finally reaching a conclusion

bull A tutor usually acts as a facilitator guiding students in this group-learning process

bull In the course of this exercise students identify both their existing levels and gaps in their knowledge These gaps form the basis for independent learning outside the PBL tutorials The identification and pursuit of these so-called learning goals is a key element of the PBL process

Rationale for using PBL bull The PBL approach is based on principles of adult

education20 and cognitive psychology21 It differs fundamentally from traditional curricula in which students acquire background knowledge of the basic sciences in the early years of the course and in the later years apply this knowledge to the diagnosis and management of clinical problems This traditional approach has been criticised for a number of reasons42223

bull It creates an artificial divide between the basic and clinical sciences

bull Time is wasted in acquiring knowledge that is subsequently forgotten or found to be irrelevant

bull Application of the acquired knowledge can be difficult bull The acquisition and retention of information that has no

apparent relevance can be boring and even demoralising for students

The group learning process acquiring

desirable learning skills

Generic Skills amp attitudes

bull Teamwork bull Critical evaluation of literature bull Chairing a group bull Self directed learning and use of

resources bull Listening Presentation skills

Recording bull Cooperation bull Respect for colleagues views

bull Group learning facilitates not only the acquisition of knowledge but also several other desirable attributes such as communication skills teamwork problem solving independent responsibility for learning sharing information and respect for others PBL can therefore be thought of as a small group teaching method that combines the acquisition of knowledge with the development of generic skills and attitudes Presentation of clinical material as the stimulus for learning enables students to understand the relevance of underlying scientific knowledge and principles in clinical practice

bull when PBL is introduced into a curriculum several other issues for curriculum design and implementation need to be tackled PBL is generally introduced in the context of a defined core curriculum and integration of basic and clinical sciences It has implications for staffing and learning resources and demands a different approach to timetabling workload and assessment PBL is often used to deliver core material in non-clinical parts of the curriculum Paper based PBL scenarios form the basis of the core curriculum and ensure that all students are exposed to the same problems Recently modified PBL techniques have been introduced into clinical education with real patients being used as the stimulus for learning Despite the essential ad hoc nature of learning clinical medicine a key cases approach can enable PBL to be used to deliver the core clinical curriculum

Copyright copy2003 BMJ Publishing Group Ltd

Wood D F BMJ 2003326328-330

No CRoles of participants in a PBL tutorial aption Found

What happens in a PBL tutorial bull PBL tutorials are conducted in several ways In

this article the examples are modelled on the Maastricht seven jump process but its format of seven steps may be shortened

bull A typical PBL tutorial consists of a group of students (usually eight to 10) and a tutor who facilitates the session The length of time (number of sessions) that a group stays together with each other and with individual tutors varies between institutions A group needs to be together long enough to allow good group dynamics to develop but may need to be changed occasionally if personality clashes or other dysfunctional behaviour emerges

bull Students elect a chair for each PBL scenario and a scribe to record the discussion The roles are rotated for each scenario Suitable flip charts or a whiteboard should be used for recording the proceedings At the start of the session depending on the trigger material either the student chair reads out the scenario or all students study the material If the trigger is a real patient in a ward clinic or surgery then a student may be asked to take a clinical history or identify an abnormal physical sign before the group moves to a tutorial room For each module students may be given a handbook containing the problem scenarios and suggested learning resources or learning materials may be handed out at appropriate times as the tutorials progress

Examples of trigger material for PBL scenarios bull Paper based clinical scenarios bull Experimental or clinical laboratory data bull Photographs bull Video clips bull Newspaper articles bull All or part of an article from a scientific

journal bull A real or simulated patient bull A family tree showing an inherited

disorder

PBL tutorial process ndash Step 1 Identify and clarify unfamiliar terms presented in the scenario

scribe lists those that remain unexplained after discussion ndash Step 2 Define the problem or problems to be discussed students may

have different views on the issues but all should be considered scribe records a list of agreed problems

ndash Step 3 Brainstorming session to discuss the problem(s) suggestingpossible explanations on basis of prior knowledge students draw on each others knowledge and identify areas of incomplete knowledge scribe records all discussion

ndash Step 4 Review steps 2 and 3 and arrange explanations into tentativesolutions scribe organises the explanations and restructures if necessary

ndash Step 5 Formulate learning objectives group reaches consensus onthe learning objectives tutor ensures learning objectives are focused achievable comprehensive and appropriate

ndash Step 6 Private study (all students gather information related to eachlearning objective)

ndash Step 7 Group shares results of private study (students identify theirlearning resources and share their results) tutor checks learning and may assess the group

bull The role of the tutor is to facilitate the proceedings (helping the chair to maintain group dynamics and moving the group through the task) and to ensure that the group achieves appropriate learning objectives in line with those set by the curriculum design team The tutor may need to take a more active role in step 7 of the process to ensure that all the students have done the appropriate work and to help the chair to suggest a suitable format for group members to use to present the results of their private study The tutor should encourage students to check their understanding of the material He or she can do this by encouraging the students to ask open questions and ask each other to explain topics in their own words or by the use of drawings and diagrams

PBL in curriculum design bull PBL may be used either as the mainstay of an entire

curriculum or for the delivery of individual courses In practice PBL is usually part of an integrated curriculum using a systems based approach with non-clinical material delivered in the context of clinical practice A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge skills and attitudes A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios Sufficient time should be allowed each week for students to do the self directed learning required for PBL

bull

Copyright copy2003 BMJ Publishing Group Ltd

Wood D F BMJ 2003326328-330

No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found

Writing PBL scenarios

bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives

bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after

studying the scenario should be consistent with the faculty learning objectives

bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding

bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice

bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge

bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented

bull The problem should be sufficiently open so that discussion is not curtailed too early in the process

bull Scenarios should promote participation by the students in seeking information from various learning resources

bull Adapted from Dolmans et al Med Teacher 199719185-9

Staff development

bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)

A dysfunctional group a dominant character may

make it difficult for other students to be heard

A dysfunctional group a dominant character may make it difficult for other students to be heard

bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties

Advantages of PBL bull Student centred PBLIt fostersactive learning improved

understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks

Disadvantagesbull Tutors who cant teachTutorsenjoy passing on

their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful

Assessment of PBL

bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods

bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL

Conclusion

bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning

bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL

PBL 5 Easy Steps

bull Read the problem

Mrs Paula Embledon

Mrs Paula Embledon is a 78 year old woman who has come to the emergency room complaining of shortness of breath and pain in her chest She had been in relatively good health until three weeks previously when she sprained

2 Brain storm

bull Brainstorm

bull ndash hypotheses

bull - what do we know in support of the hypothesis

bull - what do we need to know to test the hypothesis

ndash learning issues

Brainstorm

bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)

ndash specific issues (for individuals to look up)

ndash overlapping issues

bull 4 Individual Reading - Research - Preparation

bull 5 Return

bull ndash review case so far ndash report and discuss

ndash assess progress - continue pagenext pagecomplete

ndash self-evaluation - How did things go Any suggestions for next time

ndash next problem

bull 5 Return

THE FIRST GROUP SESSION

bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day

bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session

bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr

bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine

bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise

bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator

bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues

bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know

bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)

bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)

bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)

  • PROBLEM BASED LEARNING
  • New Horizons in Medical Education
  • Slide 3
  • Domains of essential Global Requirements of ME
  • What was the response to these challenges
  • New Educational Strategies
  • New Tools amp Aids
  • PBL
  • PBL
  • Advantages
  • Slide 11
  • Slide 12
  • Slide 13
  • Slide 14
  • Framework for PBL
  • Framework for PBL - II
  • Characteristics of an effective PBL Group
  • Staff Development
  • Tutorrsquos Role in Assessment
  • Slide 20
  • Evaluating PBL Tutorials-II
  • PBL
  • Slide 23
  • PBL Starting the case
  • PBL Case (contd)
  • PBL Case contd
  • The Process of PBL
  • The Process of PBL contd
  • Learn from each other
  • Determine priorities for learning
  • Slide 31
  • Slide 32
  • Learning Issues
  • Learning Issues in PBL First Session
  • PBL Second Session
  • PBL Third Session
  • Slide 37
  • Slide 38
  • During Tutorial Session students will
  • Tutorial Session contd
  • Between Tutorial Session
  • Slide 42
  • Slide 43
  • Problem-based learning is designed to develop
  • Slide 45
  • What is problem based learning
  • Slide 47
  • Slide 48
  • Slide 49
  • Rationale for using PBL
  • Slide 51
  • Slide 52
  • The group learning process acquiring desirable learning skills
  • Generic Skills amp attitudes
  • Slide 55
  • Slide 56
  • Slide 57
  • What happens in a PBL tutorial
  • Slide 59
  • Examples of trigger material for PBL scenarios
  • PBL tutorial process
  • Slide 62
  • PBL in curriculum design
  • Slide 64
  • Writing PBL scenarios
  • Slide 66
  • Staff development
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • Slide 70
  • Advantages of PBL
  • Slide 72
  • Slide 73
  • Disadvantages
  • Assessment of PBL
  • Slide 76
  • Conclusion
  • Slide 78
  • PBL 5 Easy Steps
  • 2 Brain storm
  • Brainstorm
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • THE FIRST GROUP SESSION
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
Page 20: Problem based learning

Tutorrsquos Role in Assessment

Individual students

bull Tutors should provide formative feedback to each member

bull Ask students to complete a simple self-assessment questionnaire reviewing appropriate behaviors the tutor returns them with comments

bull Students will be a writtenoralclinical tests that will determine their progression amp ultimate graduation

Evaluating PBL Tutorials-II

bull At the end of each problem time is allocated for evaluation

bull Both the process amp learning in PBL can be evaluated against explicit goals

bull The tutorrsquos review of effectiveness of group processes offers insight for the members

bull Students normally evaluate their tutor helpfulness support for clinical reasoning encouragement for independent learning appropriate intervention provision for effective feedback

PBLbull 1048708 Enabling students to learn in the context in which the

information will be used which increases the ability to retrieve and apply information

bull 1048708 Focusing on important concepts which helps learners organize and store new information in a way that facilitates retrieval and application

bull 1048708 Exploring prior knowledge formulating inquiries derived from and defined by the learnersrsquo need to know and actively constructing meaning through dialogue and reflection

bull 1048708 Utilizing problems designed to simulate studentsrsquo perception of their future profession which serves as a powerful stimulus for studentsrsquo intrinsic motivation to learn

bull 1048708 Actively involving students in monitoring their own progress and reflecting on what works and what needs improvement frequently assessing student performance and providing feedback

PBL Starting the casebull After the introductions and discussion

are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it

bull Reading the case aloud keeps the group focused

bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here

PBL Case (contd)

bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session

PBL Case contdbull SECOND deciding which issues everyone will

tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)

bull THIRD deciding what SPECIFIC questions individuals will try to answer

bull FOURTH deciding how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet or consulting an expert)

The Process of PBL

bullWhat are the issues Identify the important issues in the problem

bull How well do you understand the issues

bull Are there any words or terms about which you are unclear

The Process of PBL contd

bull Consider the basic mechanisms that might explain each important aspect of each problem

bull Assess your current understanding of the basic structural andor functional mechanisms that may contribute to the presentation of the problem

bull Use the collective skills and experiences of group members to explore or explain these phenomena Identify current gaps in knowledge or understanding

Learn from each other

bullShare your own knowledge expertise or ability to reason and synthesize information Be receptive and appreciative of the contribution of your small group members

Determine priorities for learning

bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue

bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan

bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge

bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career

PBL

bull The problem comes first without advance readings lectures or preparation

bull The problem serves as a stimulus for the need to know

Learning Issues

bull Learning issues are questions that cannot be answered with studentsrsquo current knowledge and that can be explored and answered through systematic self-directed inquiry

bull The use of learning issues in tutorials prepares students to handle similar challenges in clinical practice and life-long learning

Learning Issues in PBL First Session1 Getting Started (Introductions Ground

Rules Expectations)2 Identifying Problem3 Exploring Pre-Existing Knowledge4 Generating Hypotheses and Explaining

Mechanisms5 Unfolding the Case Incrementally6 Re-EvaluatingReprioritizing Hypotheses

Based on New Information7 AssessmentReflection

PBL Second Session

8 Independent Self-Directed Study of Learning Issues

PBL Third Session

bull 9 Discussion of Learning Issues and Application of New Knowledge to the Case

bull 10 Continued Unfolding of the Case Incrementally

bull 11 AssessmentReflection

During Tutorial Session students will

1048708 Come prepared to discuss the case and learning issues researched since the last tutorial

1048708 Actively participate in group discussions and contribute to the learning process in a manner that allows for the balanced participation of everyone in the group

1048708 Develop learning issues at each session phrase them as full-sentence questions write them on the board and post them on the course web page

1048708 Consider biological population behaviormental health issuesexplanations and questions of professional attitudes values and ethics related to the patientrsquos problem(s) described in the case

Tutorial Session contd1048708 Go to the board to diagram outline draw etc in

explanation of mechanisms relatedto hypotheses1048708 Debate evidence related to the case and avoid

personal attacks on others1048708 Comply with ground rules with regard to how

the group will function and how itsmembers treat one another1048708 Participate in end-of-session reflection and

assessment by giving and receivingconstructive criticism regarding self tutor

student and group performance

Between Tutorial Session

1048708 Research key learning issues using a variety of resources

1048708 Critically evaluate the credibility of sources and the validity of the information they have obtained in their research

1048708 Integrate what they have learned through research lectures labs clinical skills Perspectives in Medicine (PIM) etc into what is discussed in tutorials

1048708 Synthesize what they have learned and be prepared to discuss it without reading directly from their materials as much as possible and apply it to the case at the next tutorial session

Determine priorities for learning

bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue

bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan

bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge

bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career

PBL Starting the casebull After the introductions and discussion

are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it

bull Reading the case aloud keeps the group focused

bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here

Problem-based learning is designed to develop

1048708 Integrated context-specific knowledge base

1048708 Decision-makingcritical thinking process and skills

1048708 Self-directed life-long learning skills 1048708 Interpersonal collaboration and

communication skills 1048708 Constructive self and peer

assessment skills 1048708 Professional ethics and behavior

PBL Case (contd)

bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session

What is problem based learning

bull In PBL students use triggers from the problem case or scenario to define their own learning objectives

bull Subsequently they do independent self directed study before returning to the group to discuss and refine their acquired knowledge

bull Thus PBL is not about problem solving per se but rather it uses appropriate problems to increase knowledge and understanding

bull The process is clearly defined

PBL

bull PBL uses clinical cases as the context for students to study basic and clinical sciences

bull Its possible advantages over traditional approaches include its greater relevance to the practice of medicine its ability to promote retention and application of knowledge and its encouragement of self-directed life-long learning

bull Possible disadvantages include higher costs both in resources and staff time

PBL

bull An educational method characterized by the use of patient problems as a context for students to learn problem-solving skills and acquire knowledge about the basic and clinical sciences

bull Students usually meet in small groups two or three times a week for PBL tutorials

bull They are presented with a clinical problem (eg a patient with chest pain) and in a series of steps they discuss possible mechanisms and causes develop hypotheses and strategies to test the hypotheses are presented with further information and use this new information to refine their hypotheses finally reaching a conclusion

bull A tutor usually acts as a facilitator guiding students in this group-learning process

bull In the course of this exercise students identify both their existing levels and gaps in their knowledge These gaps form the basis for independent learning outside the PBL tutorials The identification and pursuit of these so-called learning goals is a key element of the PBL process

Rationale for using PBL bull The PBL approach is based on principles of adult

education20 and cognitive psychology21 It differs fundamentally from traditional curricula in which students acquire background knowledge of the basic sciences in the early years of the course and in the later years apply this knowledge to the diagnosis and management of clinical problems This traditional approach has been criticised for a number of reasons42223

bull It creates an artificial divide between the basic and clinical sciences

bull Time is wasted in acquiring knowledge that is subsequently forgotten or found to be irrelevant

bull Application of the acquired knowledge can be difficult bull The acquisition and retention of information that has no

apparent relevance can be boring and even demoralising for students

The group learning process acquiring

desirable learning skills

Generic Skills amp attitudes

bull Teamwork bull Critical evaluation of literature bull Chairing a group bull Self directed learning and use of

resources bull Listening Presentation skills

Recording bull Cooperation bull Respect for colleagues views

bull Group learning facilitates not only the acquisition of knowledge but also several other desirable attributes such as communication skills teamwork problem solving independent responsibility for learning sharing information and respect for others PBL can therefore be thought of as a small group teaching method that combines the acquisition of knowledge with the development of generic skills and attitudes Presentation of clinical material as the stimulus for learning enables students to understand the relevance of underlying scientific knowledge and principles in clinical practice

bull when PBL is introduced into a curriculum several other issues for curriculum design and implementation need to be tackled PBL is generally introduced in the context of a defined core curriculum and integration of basic and clinical sciences It has implications for staffing and learning resources and demands a different approach to timetabling workload and assessment PBL is often used to deliver core material in non-clinical parts of the curriculum Paper based PBL scenarios form the basis of the core curriculum and ensure that all students are exposed to the same problems Recently modified PBL techniques have been introduced into clinical education with real patients being used as the stimulus for learning Despite the essential ad hoc nature of learning clinical medicine a key cases approach can enable PBL to be used to deliver the core clinical curriculum

Copyright copy2003 BMJ Publishing Group Ltd

Wood D F BMJ 2003326328-330

No CRoles of participants in a PBL tutorial aption Found

What happens in a PBL tutorial bull PBL tutorials are conducted in several ways In

this article the examples are modelled on the Maastricht seven jump process but its format of seven steps may be shortened

bull A typical PBL tutorial consists of a group of students (usually eight to 10) and a tutor who facilitates the session The length of time (number of sessions) that a group stays together with each other and with individual tutors varies between institutions A group needs to be together long enough to allow good group dynamics to develop but may need to be changed occasionally if personality clashes or other dysfunctional behaviour emerges

bull Students elect a chair for each PBL scenario and a scribe to record the discussion The roles are rotated for each scenario Suitable flip charts or a whiteboard should be used for recording the proceedings At the start of the session depending on the trigger material either the student chair reads out the scenario or all students study the material If the trigger is a real patient in a ward clinic or surgery then a student may be asked to take a clinical history or identify an abnormal physical sign before the group moves to a tutorial room For each module students may be given a handbook containing the problem scenarios and suggested learning resources or learning materials may be handed out at appropriate times as the tutorials progress

Examples of trigger material for PBL scenarios bull Paper based clinical scenarios bull Experimental or clinical laboratory data bull Photographs bull Video clips bull Newspaper articles bull All or part of an article from a scientific

journal bull A real or simulated patient bull A family tree showing an inherited

disorder

PBL tutorial process ndash Step 1 Identify and clarify unfamiliar terms presented in the scenario

scribe lists those that remain unexplained after discussion ndash Step 2 Define the problem or problems to be discussed students may

have different views on the issues but all should be considered scribe records a list of agreed problems

ndash Step 3 Brainstorming session to discuss the problem(s) suggestingpossible explanations on basis of prior knowledge students draw on each others knowledge and identify areas of incomplete knowledge scribe records all discussion

ndash Step 4 Review steps 2 and 3 and arrange explanations into tentativesolutions scribe organises the explanations and restructures if necessary

ndash Step 5 Formulate learning objectives group reaches consensus onthe learning objectives tutor ensures learning objectives are focused achievable comprehensive and appropriate

ndash Step 6 Private study (all students gather information related to eachlearning objective)

ndash Step 7 Group shares results of private study (students identify theirlearning resources and share their results) tutor checks learning and may assess the group

bull The role of the tutor is to facilitate the proceedings (helping the chair to maintain group dynamics and moving the group through the task) and to ensure that the group achieves appropriate learning objectives in line with those set by the curriculum design team The tutor may need to take a more active role in step 7 of the process to ensure that all the students have done the appropriate work and to help the chair to suggest a suitable format for group members to use to present the results of their private study The tutor should encourage students to check their understanding of the material He or she can do this by encouraging the students to ask open questions and ask each other to explain topics in their own words or by the use of drawings and diagrams

PBL in curriculum design bull PBL may be used either as the mainstay of an entire

curriculum or for the delivery of individual courses In practice PBL is usually part of an integrated curriculum using a systems based approach with non-clinical material delivered in the context of clinical practice A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge skills and attitudes A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios Sufficient time should be allowed each week for students to do the self directed learning required for PBL

bull

Copyright copy2003 BMJ Publishing Group Ltd

Wood D F BMJ 2003326328-330

No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found

Writing PBL scenarios

bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives

bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after

studying the scenario should be consistent with the faculty learning objectives

bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding

bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice

bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge

bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented

bull The problem should be sufficiently open so that discussion is not curtailed too early in the process

bull Scenarios should promote participation by the students in seeking information from various learning resources

bull Adapted from Dolmans et al Med Teacher 199719185-9

Staff development

bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)

A dysfunctional group a dominant character may

make it difficult for other students to be heard

A dysfunctional group a dominant character may make it difficult for other students to be heard

bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties

Advantages of PBL bull Student centred PBLIt fostersactive learning improved

understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks

Disadvantagesbull Tutors who cant teachTutorsenjoy passing on

their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful

Assessment of PBL

bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods

bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL

Conclusion

bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning

bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL

PBL 5 Easy Steps

bull Read the problem

Mrs Paula Embledon

Mrs Paula Embledon is a 78 year old woman who has come to the emergency room complaining of shortness of breath and pain in her chest She had been in relatively good health until three weeks previously when she sprained

2 Brain storm

bull Brainstorm

bull ndash hypotheses

bull - what do we know in support of the hypothesis

bull - what do we need to know to test the hypothesis

ndash learning issues

Brainstorm

bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)

ndash specific issues (for individuals to look up)

ndash overlapping issues

bull 4 Individual Reading - Research - Preparation

bull 5 Return

bull ndash review case so far ndash report and discuss

ndash assess progress - continue pagenext pagecomplete

ndash self-evaluation - How did things go Any suggestions for next time

ndash next problem

bull 5 Return

THE FIRST GROUP SESSION

bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day

bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session

bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr

bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine

bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise

bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator

bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues

bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know

bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)

bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)

bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)

  • PROBLEM BASED LEARNING
  • New Horizons in Medical Education
  • Slide 3
  • Domains of essential Global Requirements of ME
  • What was the response to these challenges
  • New Educational Strategies
  • New Tools amp Aids
  • PBL
  • PBL
  • Advantages
  • Slide 11
  • Slide 12
  • Slide 13
  • Slide 14
  • Framework for PBL
  • Framework for PBL - II
  • Characteristics of an effective PBL Group
  • Staff Development
  • Tutorrsquos Role in Assessment
  • Slide 20
  • Evaluating PBL Tutorials-II
  • PBL
  • Slide 23
  • PBL Starting the case
  • PBL Case (contd)
  • PBL Case contd
  • The Process of PBL
  • The Process of PBL contd
  • Learn from each other
  • Determine priorities for learning
  • Slide 31
  • Slide 32
  • Learning Issues
  • Learning Issues in PBL First Session
  • PBL Second Session
  • PBL Third Session
  • Slide 37
  • Slide 38
  • During Tutorial Session students will
  • Tutorial Session contd
  • Between Tutorial Session
  • Slide 42
  • Slide 43
  • Problem-based learning is designed to develop
  • Slide 45
  • What is problem based learning
  • Slide 47
  • Slide 48
  • Slide 49
  • Rationale for using PBL
  • Slide 51
  • Slide 52
  • The group learning process acquiring desirable learning skills
  • Generic Skills amp attitudes
  • Slide 55
  • Slide 56
  • Slide 57
  • What happens in a PBL tutorial
  • Slide 59
  • Examples of trigger material for PBL scenarios
  • PBL tutorial process
  • Slide 62
  • PBL in curriculum design
  • Slide 64
  • Writing PBL scenarios
  • Slide 66
  • Staff development
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • Slide 70
  • Advantages of PBL
  • Slide 72
  • Slide 73
  • Disadvantages
  • Assessment of PBL
  • Slide 76
  • Conclusion
  • Slide 78
  • PBL 5 Easy Steps
  • 2 Brain storm
  • Brainstorm
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • THE FIRST GROUP SESSION
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
Page 21: Problem based learning

Evaluating PBL Tutorials-II

bull At the end of each problem time is allocated for evaluation

bull Both the process amp learning in PBL can be evaluated against explicit goals

bull The tutorrsquos review of effectiveness of group processes offers insight for the members

bull Students normally evaluate their tutor helpfulness support for clinical reasoning encouragement for independent learning appropriate intervention provision for effective feedback

PBLbull 1048708 Enabling students to learn in the context in which the

information will be used which increases the ability to retrieve and apply information

bull 1048708 Focusing on important concepts which helps learners organize and store new information in a way that facilitates retrieval and application

bull 1048708 Exploring prior knowledge formulating inquiries derived from and defined by the learnersrsquo need to know and actively constructing meaning through dialogue and reflection

bull 1048708 Utilizing problems designed to simulate studentsrsquo perception of their future profession which serves as a powerful stimulus for studentsrsquo intrinsic motivation to learn

bull 1048708 Actively involving students in monitoring their own progress and reflecting on what works and what needs improvement frequently assessing student performance and providing feedback

PBL Starting the casebull After the introductions and discussion

are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it

bull Reading the case aloud keeps the group focused

bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here

PBL Case (contd)

bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session

PBL Case contdbull SECOND deciding which issues everyone will

tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)

bull THIRD deciding what SPECIFIC questions individuals will try to answer

bull FOURTH deciding how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet or consulting an expert)

The Process of PBL

bullWhat are the issues Identify the important issues in the problem

bull How well do you understand the issues

bull Are there any words or terms about which you are unclear

The Process of PBL contd

bull Consider the basic mechanisms that might explain each important aspect of each problem

bull Assess your current understanding of the basic structural andor functional mechanisms that may contribute to the presentation of the problem

bull Use the collective skills and experiences of group members to explore or explain these phenomena Identify current gaps in knowledge or understanding

Learn from each other

bullShare your own knowledge expertise or ability to reason and synthesize information Be receptive and appreciative of the contribution of your small group members

Determine priorities for learning

bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue

bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan

bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge

bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career

PBL

bull The problem comes first without advance readings lectures or preparation

bull The problem serves as a stimulus for the need to know

Learning Issues

bull Learning issues are questions that cannot be answered with studentsrsquo current knowledge and that can be explored and answered through systematic self-directed inquiry

bull The use of learning issues in tutorials prepares students to handle similar challenges in clinical practice and life-long learning

Learning Issues in PBL First Session1 Getting Started (Introductions Ground

Rules Expectations)2 Identifying Problem3 Exploring Pre-Existing Knowledge4 Generating Hypotheses and Explaining

Mechanisms5 Unfolding the Case Incrementally6 Re-EvaluatingReprioritizing Hypotheses

Based on New Information7 AssessmentReflection

PBL Second Session

8 Independent Self-Directed Study of Learning Issues

PBL Third Session

bull 9 Discussion of Learning Issues and Application of New Knowledge to the Case

bull 10 Continued Unfolding of the Case Incrementally

bull 11 AssessmentReflection

During Tutorial Session students will

1048708 Come prepared to discuss the case and learning issues researched since the last tutorial

1048708 Actively participate in group discussions and contribute to the learning process in a manner that allows for the balanced participation of everyone in the group

1048708 Develop learning issues at each session phrase them as full-sentence questions write them on the board and post them on the course web page

1048708 Consider biological population behaviormental health issuesexplanations and questions of professional attitudes values and ethics related to the patientrsquos problem(s) described in the case

Tutorial Session contd1048708 Go to the board to diagram outline draw etc in

explanation of mechanisms relatedto hypotheses1048708 Debate evidence related to the case and avoid

personal attacks on others1048708 Comply with ground rules with regard to how

the group will function and how itsmembers treat one another1048708 Participate in end-of-session reflection and

assessment by giving and receivingconstructive criticism regarding self tutor

student and group performance

Between Tutorial Session

1048708 Research key learning issues using a variety of resources

1048708 Critically evaluate the credibility of sources and the validity of the information they have obtained in their research

1048708 Integrate what they have learned through research lectures labs clinical skills Perspectives in Medicine (PIM) etc into what is discussed in tutorials

1048708 Synthesize what they have learned and be prepared to discuss it without reading directly from their materials as much as possible and apply it to the case at the next tutorial session

Determine priorities for learning

bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue

bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan

bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge

bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career

PBL Starting the casebull After the introductions and discussion

are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it

bull Reading the case aloud keeps the group focused

bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here

Problem-based learning is designed to develop

1048708 Integrated context-specific knowledge base

1048708 Decision-makingcritical thinking process and skills

1048708 Self-directed life-long learning skills 1048708 Interpersonal collaboration and

communication skills 1048708 Constructive self and peer

assessment skills 1048708 Professional ethics and behavior

PBL Case (contd)

bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session

What is problem based learning

bull In PBL students use triggers from the problem case or scenario to define their own learning objectives

bull Subsequently they do independent self directed study before returning to the group to discuss and refine their acquired knowledge

bull Thus PBL is not about problem solving per se but rather it uses appropriate problems to increase knowledge and understanding

bull The process is clearly defined

PBL

bull PBL uses clinical cases as the context for students to study basic and clinical sciences

bull Its possible advantages over traditional approaches include its greater relevance to the practice of medicine its ability to promote retention and application of knowledge and its encouragement of self-directed life-long learning

bull Possible disadvantages include higher costs both in resources and staff time

PBL

bull An educational method characterized by the use of patient problems as a context for students to learn problem-solving skills and acquire knowledge about the basic and clinical sciences

bull Students usually meet in small groups two or three times a week for PBL tutorials

bull They are presented with a clinical problem (eg a patient with chest pain) and in a series of steps they discuss possible mechanisms and causes develop hypotheses and strategies to test the hypotheses are presented with further information and use this new information to refine their hypotheses finally reaching a conclusion

bull A tutor usually acts as a facilitator guiding students in this group-learning process

bull In the course of this exercise students identify both their existing levels and gaps in their knowledge These gaps form the basis for independent learning outside the PBL tutorials The identification and pursuit of these so-called learning goals is a key element of the PBL process

Rationale for using PBL bull The PBL approach is based on principles of adult

education20 and cognitive psychology21 It differs fundamentally from traditional curricula in which students acquire background knowledge of the basic sciences in the early years of the course and in the later years apply this knowledge to the diagnosis and management of clinical problems This traditional approach has been criticised for a number of reasons42223

bull It creates an artificial divide between the basic and clinical sciences

bull Time is wasted in acquiring knowledge that is subsequently forgotten or found to be irrelevant

bull Application of the acquired knowledge can be difficult bull The acquisition and retention of information that has no

apparent relevance can be boring and even demoralising for students

The group learning process acquiring

desirable learning skills

Generic Skills amp attitudes

bull Teamwork bull Critical evaluation of literature bull Chairing a group bull Self directed learning and use of

resources bull Listening Presentation skills

Recording bull Cooperation bull Respect for colleagues views

bull Group learning facilitates not only the acquisition of knowledge but also several other desirable attributes such as communication skills teamwork problem solving independent responsibility for learning sharing information and respect for others PBL can therefore be thought of as a small group teaching method that combines the acquisition of knowledge with the development of generic skills and attitudes Presentation of clinical material as the stimulus for learning enables students to understand the relevance of underlying scientific knowledge and principles in clinical practice

bull when PBL is introduced into a curriculum several other issues for curriculum design and implementation need to be tackled PBL is generally introduced in the context of a defined core curriculum and integration of basic and clinical sciences It has implications for staffing and learning resources and demands a different approach to timetabling workload and assessment PBL is often used to deliver core material in non-clinical parts of the curriculum Paper based PBL scenarios form the basis of the core curriculum and ensure that all students are exposed to the same problems Recently modified PBL techniques have been introduced into clinical education with real patients being used as the stimulus for learning Despite the essential ad hoc nature of learning clinical medicine a key cases approach can enable PBL to be used to deliver the core clinical curriculum

Copyright copy2003 BMJ Publishing Group Ltd

Wood D F BMJ 2003326328-330

No CRoles of participants in a PBL tutorial aption Found

What happens in a PBL tutorial bull PBL tutorials are conducted in several ways In

this article the examples are modelled on the Maastricht seven jump process but its format of seven steps may be shortened

bull A typical PBL tutorial consists of a group of students (usually eight to 10) and a tutor who facilitates the session The length of time (number of sessions) that a group stays together with each other and with individual tutors varies between institutions A group needs to be together long enough to allow good group dynamics to develop but may need to be changed occasionally if personality clashes or other dysfunctional behaviour emerges

bull Students elect a chair for each PBL scenario and a scribe to record the discussion The roles are rotated for each scenario Suitable flip charts or a whiteboard should be used for recording the proceedings At the start of the session depending on the trigger material either the student chair reads out the scenario or all students study the material If the trigger is a real patient in a ward clinic or surgery then a student may be asked to take a clinical history or identify an abnormal physical sign before the group moves to a tutorial room For each module students may be given a handbook containing the problem scenarios and suggested learning resources or learning materials may be handed out at appropriate times as the tutorials progress

Examples of trigger material for PBL scenarios bull Paper based clinical scenarios bull Experimental or clinical laboratory data bull Photographs bull Video clips bull Newspaper articles bull All or part of an article from a scientific

journal bull A real or simulated patient bull A family tree showing an inherited

disorder

PBL tutorial process ndash Step 1 Identify and clarify unfamiliar terms presented in the scenario

scribe lists those that remain unexplained after discussion ndash Step 2 Define the problem or problems to be discussed students may

have different views on the issues but all should be considered scribe records a list of agreed problems

ndash Step 3 Brainstorming session to discuss the problem(s) suggestingpossible explanations on basis of prior knowledge students draw on each others knowledge and identify areas of incomplete knowledge scribe records all discussion

ndash Step 4 Review steps 2 and 3 and arrange explanations into tentativesolutions scribe organises the explanations and restructures if necessary

ndash Step 5 Formulate learning objectives group reaches consensus onthe learning objectives tutor ensures learning objectives are focused achievable comprehensive and appropriate

ndash Step 6 Private study (all students gather information related to eachlearning objective)

ndash Step 7 Group shares results of private study (students identify theirlearning resources and share their results) tutor checks learning and may assess the group

bull The role of the tutor is to facilitate the proceedings (helping the chair to maintain group dynamics and moving the group through the task) and to ensure that the group achieves appropriate learning objectives in line with those set by the curriculum design team The tutor may need to take a more active role in step 7 of the process to ensure that all the students have done the appropriate work and to help the chair to suggest a suitable format for group members to use to present the results of their private study The tutor should encourage students to check their understanding of the material He or she can do this by encouraging the students to ask open questions and ask each other to explain topics in their own words or by the use of drawings and diagrams

PBL in curriculum design bull PBL may be used either as the mainstay of an entire

curriculum or for the delivery of individual courses In practice PBL is usually part of an integrated curriculum using a systems based approach with non-clinical material delivered in the context of clinical practice A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge skills and attitudes A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios Sufficient time should be allowed each week for students to do the self directed learning required for PBL

bull

Copyright copy2003 BMJ Publishing Group Ltd

Wood D F BMJ 2003326328-330

No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found

Writing PBL scenarios

bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives

bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after

studying the scenario should be consistent with the faculty learning objectives

bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding

bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice

bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge

bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented

bull The problem should be sufficiently open so that discussion is not curtailed too early in the process

bull Scenarios should promote participation by the students in seeking information from various learning resources

bull Adapted from Dolmans et al Med Teacher 199719185-9

Staff development

bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)

A dysfunctional group a dominant character may

make it difficult for other students to be heard

A dysfunctional group a dominant character may make it difficult for other students to be heard

bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties

Advantages of PBL bull Student centred PBLIt fostersactive learning improved

understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks

Disadvantagesbull Tutors who cant teachTutorsenjoy passing on

their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful

Assessment of PBL

bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods

bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL

Conclusion

bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning

bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL

PBL 5 Easy Steps

bull Read the problem

Mrs Paula Embledon

Mrs Paula Embledon is a 78 year old woman who has come to the emergency room complaining of shortness of breath and pain in her chest She had been in relatively good health until three weeks previously when she sprained

2 Brain storm

bull Brainstorm

bull ndash hypotheses

bull - what do we know in support of the hypothesis

bull - what do we need to know to test the hypothesis

ndash learning issues

Brainstorm

bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)

ndash specific issues (for individuals to look up)

ndash overlapping issues

bull 4 Individual Reading - Research - Preparation

bull 5 Return

bull ndash review case so far ndash report and discuss

ndash assess progress - continue pagenext pagecomplete

ndash self-evaluation - How did things go Any suggestions for next time

ndash next problem

bull 5 Return

THE FIRST GROUP SESSION

bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day

bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session

bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr

bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine

bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise

bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator

bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues

bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know

bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)

bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)

bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)

  • PROBLEM BASED LEARNING
  • New Horizons in Medical Education
  • Slide 3
  • Domains of essential Global Requirements of ME
  • What was the response to these challenges
  • New Educational Strategies
  • New Tools amp Aids
  • PBL
  • PBL
  • Advantages
  • Slide 11
  • Slide 12
  • Slide 13
  • Slide 14
  • Framework for PBL
  • Framework for PBL - II
  • Characteristics of an effective PBL Group
  • Staff Development
  • Tutorrsquos Role in Assessment
  • Slide 20
  • Evaluating PBL Tutorials-II
  • PBL
  • Slide 23
  • PBL Starting the case
  • PBL Case (contd)
  • PBL Case contd
  • The Process of PBL
  • The Process of PBL contd
  • Learn from each other
  • Determine priorities for learning
  • Slide 31
  • Slide 32
  • Learning Issues
  • Learning Issues in PBL First Session
  • PBL Second Session
  • PBL Third Session
  • Slide 37
  • Slide 38
  • During Tutorial Session students will
  • Tutorial Session contd
  • Between Tutorial Session
  • Slide 42
  • Slide 43
  • Problem-based learning is designed to develop
  • Slide 45
  • What is problem based learning
  • Slide 47
  • Slide 48
  • Slide 49
  • Rationale for using PBL
  • Slide 51
  • Slide 52
  • The group learning process acquiring desirable learning skills
  • Generic Skills amp attitudes
  • Slide 55
  • Slide 56
  • Slide 57
  • What happens in a PBL tutorial
  • Slide 59
  • Examples of trigger material for PBL scenarios
  • PBL tutorial process
  • Slide 62
  • PBL in curriculum design
  • Slide 64
  • Writing PBL scenarios
  • Slide 66
  • Staff development
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • Slide 70
  • Advantages of PBL
  • Slide 72
  • Slide 73
  • Disadvantages
  • Assessment of PBL
  • Slide 76
  • Conclusion
  • Slide 78
  • PBL 5 Easy Steps
  • 2 Brain storm
  • Brainstorm
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • THE FIRST GROUP SESSION
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
Page 22: Problem based learning

PBLbull 1048708 Enabling students to learn in the context in which the

information will be used which increases the ability to retrieve and apply information

bull 1048708 Focusing on important concepts which helps learners organize and store new information in a way that facilitates retrieval and application

bull 1048708 Exploring prior knowledge formulating inquiries derived from and defined by the learnersrsquo need to know and actively constructing meaning through dialogue and reflection

bull 1048708 Utilizing problems designed to simulate studentsrsquo perception of their future profession which serves as a powerful stimulus for studentsrsquo intrinsic motivation to learn

bull 1048708 Actively involving students in monitoring their own progress and reflecting on what works and what needs improvement frequently assessing student performance and providing feedback

PBL Starting the casebull After the introductions and discussion

are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it

bull Reading the case aloud keeps the group focused

bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here

PBL Case (contd)

bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session

PBL Case contdbull SECOND deciding which issues everyone will

tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)

bull THIRD deciding what SPECIFIC questions individuals will try to answer

bull FOURTH deciding how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet or consulting an expert)

The Process of PBL

bullWhat are the issues Identify the important issues in the problem

bull How well do you understand the issues

bull Are there any words or terms about which you are unclear

The Process of PBL contd

bull Consider the basic mechanisms that might explain each important aspect of each problem

bull Assess your current understanding of the basic structural andor functional mechanisms that may contribute to the presentation of the problem

bull Use the collective skills and experiences of group members to explore or explain these phenomena Identify current gaps in knowledge or understanding

Learn from each other

bullShare your own knowledge expertise or ability to reason and synthesize information Be receptive and appreciative of the contribution of your small group members

Determine priorities for learning

bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue

bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan

bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge

bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career

PBL

bull The problem comes first without advance readings lectures or preparation

bull The problem serves as a stimulus for the need to know

Learning Issues

bull Learning issues are questions that cannot be answered with studentsrsquo current knowledge and that can be explored and answered through systematic self-directed inquiry

bull The use of learning issues in tutorials prepares students to handle similar challenges in clinical practice and life-long learning

Learning Issues in PBL First Session1 Getting Started (Introductions Ground

Rules Expectations)2 Identifying Problem3 Exploring Pre-Existing Knowledge4 Generating Hypotheses and Explaining

Mechanisms5 Unfolding the Case Incrementally6 Re-EvaluatingReprioritizing Hypotheses

Based on New Information7 AssessmentReflection

PBL Second Session

8 Independent Self-Directed Study of Learning Issues

PBL Third Session

bull 9 Discussion of Learning Issues and Application of New Knowledge to the Case

bull 10 Continued Unfolding of the Case Incrementally

bull 11 AssessmentReflection

During Tutorial Session students will

1048708 Come prepared to discuss the case and learning issues researched since the last tutorial

1048708 Actively participate in group discussions and contribute to the learning process in a manner that allows for the balanced participation of everyone in the group

1048708 Develop learning issues at each session phrase them as full-sentence questions write them on the board and post them on the course web page

1048708 Consider biological population behaviormental health issuesexplanations and questions of professional attitudes values and ethics related to the patientrsquos problem(s) described in the case

Tutorial Session contd1048708 Go to the board to diagram outline draw etc in

explanation of mechanisms relatedto hypotheses1048708 Debate evidence related to the case and avoid

personal attacks on others1048708 Comply with ground rules with regard to how

the group will function and how itsmembers treat one another1048708 Participate in end-of-session reflection and

assessment by giving and receivingconstructive criticism regarding self tutor

student and group performance

Between Tutorial Session

1048708 Research key learning issues using a variety of resources

1048708 Critically evaluate the credibility of sources and the validity of the information they have obtained in their research

1048708 Integrate what they have learned through research lectures labs clinical skills Perspectives in Medicine (PIM) etc into what is discussed in tutorials

1048708 Synthesize what they have learned and be prepared to discuss it without reading directly from their materials as much as possible and apply it to the case at the next tutorial session

Determine priorities for learning

bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue

bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan

bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge

bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career

PBL Starting the casebull After the introductions and discussion

are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it

bull Reading the case aloud keeps the group focused

bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here

Problem-based learning is designed to develop

1048708 Integrated context-specific knowledge base

1048708 Decision-makingcritical thinking process and skills

1048708 Self-directed life-long learning skills 1048708 Interpersonal collaboration and

communication skills 1048708 Constructive self and peer

assessment skills 1048708 Professional ethics and behavior

PBL Case (contd)

bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session

What is problem based learning

bull In PBL students use triggers from the problem case or scenario to define their own learning objectives

bull Subsequently they do independent self directed study before returning to the group to discuss and refine their acquired knowledge

bull Thus PBL is not about problem solving per se but rather it uses appropriate problems to increase knowledge and understanding

bull The process is clearly defined

PBL

bull PBL uses clinical cases as the context for students to study basic and clinical sciences

bull Its possible advantages over traditional approaches include its greater relevance to the practice of medicine its ability to promote retention and application of knowledge and its encouragement of self-directed life-long learning

bull Possible disadvantages include higher costs both in resources and staff time

PBL

bull An educational method characterized by the use of patient problems as a context for students to learn problem-solving skills and acquire knowledge about the basic and clinical sciences

bull Students usually meet in small groups two or three times a week for PBL tutorials

bull They are presented with a clinical problem (eg a patient with chest pain) and in a series of steps they discuss possible mechanisms and causes develop hypotheses and strategies to test the hypotheses are presented with further information and use this new information to refine their hypotheses finally reaching a conclusion

bull A tutor usually acts as a facilitator guiding students in this group-learning process

bull In the course of this exercise students identify both their existing levels and gaps in their knowledge These gaps form the basis for independent learning outside the PBL tutorials The identification and pursuit of these so-called learning goals is a key element of the PBL process

Rationale for using PBL bull The PBL approach is based on principles of adult

education20 and cognitive psychology21 It differs fundamentally from traditional curricula in which students acquire background knowledge of the basic sciences in the early years of the course and in the later years apply this knowledge to the diagnosis and management of clinical problems This traditional approach has been criticised for a number of reasons42223

bull It creates an artificial divide between the basic and clinical sciences

bull Time is wasted in acquiring knowledge that is subsequently forgotten or found to be irrelevant

bull Application of the acquired knowledge can be difficult bull The acquisition and retention of information that has no

apparent relevance can be boring and even demoralising for students

The group learning process acquiring

desirable learning skills

Generic Skills amp attitudes

bull Teamwork bull Critical evaluation of literature bull Chairing a group bull Self directed learning and use of

resources bull Listening Presentation skills

Recording bull Cooperation bull Respect for colleagues views

bull Group learning facilitates not only the acquisition of knowledge but also several other desirable attributes such as communication skills teamwork problem solving independent responsibility for learning sharing information and respect for others PBL can therefore be thought of as a small group teaching method that combines the acquisition of knowledge with the development of generic skills and attitudes Presentation of clinical material as the stimulus for learning enables students to understand the relevance of underlying scientific knowledge and principles in clinical practice

bull when PBL is introduced into a curriculum several other issues for curriculum design and implementation need to be tackled PBL is generally introduced in the context of a defined core curriculum and integration of basic and clinical sciences It has implications for staffing and learning resources and demands a different approach to timetabling workload and assessment PBL is often used to deliver core material in non-clinical parts of the curriculum Paper based PBL scenarios form the basis of the core curriculum and ensure that all students are exposed to the same problems Recently modified PBL techniques have been introduced into clinical education with real patients being used as the stimulus for learning Despite the essential ad hoc nature of learning clinical medicine a key cases approach can enable PBL to be used to deliver the core clinical curriculum

Copyright copy2003 BMJ Publishing Group Ltd

Wood D F BMJ 2003326328-330

No CRoles of participants in a PBL tutorial aption Found

What happens in a PBL tutorial bull PBL tutorials are conducted in several ways In

this article the examples are modelled on the Maastricht seven jump process but its format of seven steps may be shortened

bull A typical PBL tutorial consists of a group of students (usually eight to 10) and a tutor who facilitates the session The length of time (number of sessions) that a group stays together with each other and with individual tutors varies between institutions A group needs to be together long enough to allow good group dynamics to develop but may need to be changed occasionally if personality clashes or other dysfunctional behaviour emerges

bull Students elect a chair for each PBL scenario and a scribe to record the discussion The roles are rotated for each scenario Suitable flip charts or a whiteboard should be used for recording the proceedings At the start of the session depending on the trigger material either the student chair reads out the scenario or all students study the material If the trigger is a real patient in a ward clinic or surgery then a student may be asked to take a clinical history or identify an abnormal physical sign before the group moves to a tutorial room For each module students may be given a handbook containing the problem scenarios and suggested learning resources or learning materials may be handed out at appropriate times as the tutorials progress

Examples of trigger material for PBL scenarios bull Paper based clinical scenarios bull Experimental or clinical laboratory data bull Photographs bull Video clips bull Newspaper articles bull All or part of an article from a scientific

journal bull A real or simulated patient bull A family tree showing an inherited

disorder

PBL tutorial process ndash Step 1 Identify and clarify unfamiliar terms presented in the scenario

scribe lists those that remain unexplained after discussion ndash Step 2 Define the problem or problems to be discussed students may

have different views on the issues but all should be considered scribe records a list of agreed problems

ndash Step 3 Brainstorming session to discuss the problem(s) suggestingpossible explanations on basis of prior knowledge students draw on each others knowledge and identify areas of incomplete knowledge scribe records all discussion

ndash Step 4 Review steps 2 and 3 and arrange explanations into tentativesolutions scribe organises the explanations and restructures if necessary

ndash Step 5 Formulate learning objectives group reaches consensus onthe learning objectives tutor ensures learning objectives are focused achievable comprehensive and appropriate

ndash Step 6 Private study (all students gather information related to eachlearning objective)

ndash Step 7 Group shares results of private study (students identify theirlearning resources and share their results) tutor checks learning and may assess the group

bull The role of the tutor is to facilitate the proceedings (helping the chair to maintain group dynamics and moving the group through the task) and to ensure that the group achieves appropriate learning objectives in line with those set by the curriculum design team The tutor may need to take a more active role in step 7 of the process to ensure that all the students have done the appropriate work and to help the chair to suggest a suitable format for group members to use to present the results of their private study The tutor should encourage students to check their understanding of the material He or she can do this by encouraging the students to ask open questions and ask each other to explain topics in their own words or by the use of drawings and diagrams

PBL in curriculum design bull PBL may be used either as the mainstay of an entire

curriculum or for the delivery of individual courses In practice PBL is usually part of an integrated curriculum using a systems based approach with non-clinical material delivered in the context of clinical practice A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge skills and attitudes A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios Sufficient time should be allowed each week for students to do the self directed learning required for PBL

bull

Copyright copy2003 BMJ Publishing Group Ltd

Wood D F BMJ 2003326328-330

No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found

Writing PBL scenarios

bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives

bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after

studying the scenario should be consistent with the faculty learning objectives

bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding

bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice

bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge

bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented

bull The problem should be sufficiently open so that discussion is not curtailed too early in the process

bull Scenarios should promote participation by the students in seeking information from various learning resources

bull Adapted from Dolmans et al Med Teacher 199719185-9

Staff development

bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)

A dysfunctional group a dominant character may

make it difficult for other students to be heard

A dysfunctional group a dominant character may make it difficult for other students to be heard

bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties

Advantages of PBL bull Student centred PBLIt fostersactive learning improved

understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks

Disadvantagesbull Tutors who cant teachTutorsenjoy passing on

their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful

Assessment of PBL

bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods

bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL

Conclusion

bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning

bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL

PBL 5 Easy Steps

bull Read the problem

Mrs Paula Embledon

Mrs Paula Embledon is a 78 year old woman who has come to the emergency room complaining of shortness of breath and pain in her chest She had been in relatively good health until three weeks previously when she sprained

2 Brain storm

bull Brainstorm

bull ndash hypotheses

bull - what do we know in support of the hypothesis

bull - what do we need to know to test the hypothesis

ndash learning issues

Brainstorm

bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)

ndash specific issues (for individuals to look up)

ndash overlapping issues

bull 4 Individual Reading - Research - Preparation

bull 5 Return

bull ndash review case so far ndash report and discuss

ndash assess progress - continue pagenext pagecomplete

ndash self-evaluation - How did things go Any suggestions for next time

ndash next problem

bull 5 Return

THE FIRST GROUP SESSION

bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day

bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session

bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr

bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine

bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise

bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator

bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues

bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know

bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)

bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)

bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)

  • PROBLEM BASED LEARNING
  • New Horizons in Medical Education
  • Slide 3
  • Domains of essential Global Requirements of ME
  • What was the response to these challenges
  • New Educational Strategies
  • New Tools amp Aids
  • PBL
  • PBL
  • Advantages
  • Slide 11
  • Slide 12
  • Slide 13
  • Slide 14
  • Framework for PBL
  • Framework for PBL - II
  • Characteristics of an effective PBL Group
  • Staff Development
  • Tutorrsquos Role in Assessment
  • Slide 20
  • Evaluating PBL Tutorials-II
  • PBL
  • Slide 23
  • PBL Starting the case
  • PBL Case (contd)
  • PBL Case contd
  • The Process of PBL
  • The Process of PBL contd
  • Learn from each other
  • Determine priorities for learning
  • Slide 31
  • Slide 32
  • Learning Issues
  • Learning Issues in PBL First Session
  • PBL Second Session
  • PBL Third Session
  • Slide 37
  • Slide 38
  • During Tutorial Session students will
  • Tutorial Session contd
  • Between Tutorial Session
  • Slide 42
  • Slide 43
  • Problem-based learning is designed to develop
  • Slide 45
  • What is problem based learning
  • Slide 47
  • Slide 48
  • Slide 49
  • Rationale for using PBL
  • Slide 51
  • Slide 52
  • The group learning process acquiring desirable learning skills
  • Generic Skills amp attitudes
  • Slide 55
  • Slide 56
  • Slide 57
  • What happens in a PBL tutorial
  • Slide 59
  • Examples of trigger material for PBL scenarios
  • PBL tutorial process
  • Slide 62
  • PBL in curriculum design
  • Slide 64
  • Writing PBL scenarios
  • Slide 66
  • Staff development
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • Slide 70
  • Advantages of PBL
  • Slide 72
  • Slide 73
  • Disadvantages
  • Assessment of PBL
  • Slide 76
  • Conclusion
  • Slide 78
  • PBL 5 Easy Steps
  • 2 Brain storm
  • Brainstorm
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • THE FIRST GROUP SESSION
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
Page 23: Problem based learning

PBL Starting the casebull After the introductions and discussion

are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it

bull Reading the case aloud keeps the group focused

bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here

PBL Case (contd)

bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session

PBL Case contdbull SECOND deciding which issues everyone will

tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)

bull THIRD deciding what SPECIFIC questions individuals will try to answer

bull FOURTH deciding how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet or consulting an expert)

The Process of PBL

bullWhat are the issues Identify the important issues in the problem

bull How well do you understand the issues

bull Are there any words or terms about which you are unclear

The Process of PBL contd

bull Consider the basic mechanisms that might explain each important aspect of each problem

bull Assess your current understanding of the basic structural andor functional mechanisms that may contribute to the presentation of the problem

bull Use the collective skills and experiences of group members to explore or explain these phenomena Identify current gaps in knowledge or understanding

Learn from each other

bullShare your own knowledge expertise or ability to reason and synthesize information Be receptive and appreciative of the contribution of your small group members

Determine priorities for learning

bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue

bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan

bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge

bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career

PBL

bull The problem comes first without advance readings lectures or preparation

bull The problem serves as a stimulus for the need to know

Learning Issues

bull Learning issues are questions that cannot be answered with studentsrsquo current knowledge and that can be explored and answered through systematic self-directed inquiry

bull The use of learning issues in tutorials prepares students to handle similar challenges in clinical practice and life-long learning

Learning Issues in PBL First Session1 Getting Started (Introductions Ground

Rules Expectations)2 Identifying Problem3 Exploring Pre-Existing Knowledge4 Generating Hypotheses and Explaining

Mechanisms5 Unfolding the Case Incrementally6 Re-EvaluatingReprioritizing Hypotheses

Based on New Information7 AssessmentReflection

PBL Second Session

8 Independent Self-Directed Study of Learning Issues

PBL Third Session

bull 9 Discussion of Learning Issues and Application of New Knowledge to the Case

bull 10 Continued Unfolding of the Case Incrementally

bull 11 AssessmentReflection

During Tutorial Session students will

1048708 Come prepared to discuss the case and learning issues researched since the last tutorial

1048708 Actively participate in group discussions and contribute to the learning process in a manner that allows for the balanced participation of everyone in the group

1048708 Develop learning issues at each session phrase them as full-sentence questions write them on the board and post them on the course web page

1048708 Consider biological population behaviormental health issuesexplanations and questions of professional attitudes values and ethics related to the patientrsquos problem(s) described in the case

Tutorial Session contd1048708 Go to the board to diagram outline draw etc in

explanation of mechanisms relatedto hypotheses1048708 Debate evidence related to the case and avoid

personal attacks on others1048708 Comply with ground rules with regard to how

the group will function and how itsmembers treat one another1048708 Participate in end-of-session reflection and

assessment by giving and receivingconstructive criticism regarding self tutor

student and group performance

Between Tutorial Session

1048708 Research key learning issues using a variety of resources

1048708 Critically evaluate the credibility of sources and the validity of the information they have obtained in their research

1048708 Integrate what they have learned through research lectures labs clinical skills Perspectives in Medicine (PIM) etc into what is discussed in tutorials

1048708 Synthesize what they have learned and be prepared to discuss it without reading directly from their materials as much as possible and apply it to the case at the next tutorial session

Determine priorities for learning

bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue

bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan

bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge

bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career

PBL Starting the casebull After the introductions and discussion

are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it

bull Reading the case aloud keeps the group focused

bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here

Problem-based learning is designed to develop

1048708 Integrated context-specific knowledge base

1048708 Decision-makingcritical thinking process and skills

1048708 Self-directed life-long learning skills 1048708 Interpersonal collaboration and

communication skills 1048708 Constructive self and peer

assessment skills 1048708 Professional ethics and behavior

PBL Case (contd)

bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session

What is problem based learning

bull In PBL students use triggers from the problem case or scenario to define their own learning objectives

bull Subsequently they do independent self directed study before returning to the group to discuss and refine their acquired knowledge

bull Thus PBL is not about problem solving per se but rather it uses appropriate problems to increase knowledge and understanding

bull The process is clearly defined

PBL

bull PBL uses clinical cases as the context for students to study basic and clinical sciences

bull Its possible advantages over traditional approaches include its greater relevance to the practice of medicine its ability to promote retention and application of knowledge and its encouragement of self-directed life-long learning

bull Possible disadvantages include higher costs both in resources and staff time

PBL

bull An educational method characterized by the use of patient problems as a context for students to learn problem-solving skills and acquire knowledge about the basic and clinical sciences

bull Students usually meet in small groups two or three times a week for PBL tutorials

bull They are presented with a clinical problem (eg a patient with chest pain) and in a series of steps they discuss possible mechanisms and causes develop hypotheses and strategies to test the hypotheses are presented with further information and use this new information to refine their hypotheses finally reaching a conclusion

bull A tutor usually acts as a facilitator guiding students in this group-learning process

bull In the course of this exercise students identify both their existing levels and gaps in their knowledge These gaps form the basis for independent learning outside the PBL tutorials The identification and pursuit of these so-called learning goals is a key element of the PBL process

Rationale for using PBL bull The PBL approach is based on principles of adult

education20 and cognitive psychology21 It differs fundamentally from traditional curricula in which students acquire background knowledge of the basic sciences in the early years of the course and in the later years apply this knowledge to the diagnosis and management of clinical problems This traditional approach has been criticised for a number of reasons42223

bull It creates an artificial divide between the basic and clinical sciences

bull Time is wasted in acquiring knowledge that is subsequently forgotten or found to be irrelevant

bull Application of the acquired knowledge can be difficult bull The acquisition and retention of information that has no

apparent relevance can be boring and even demoralising for students

The group learning process acquiring

desirable learning skills

Generic Skills amp attitudes

bull Teamwork bull Critical evaluation of literature bull Chairing a group bull Self directed learning and use of

resources bull Listening Presentation skills

Recording bull Cooperation bull Respect for colleagues views

bull Group learning facilitates not only the acquisition of knowledge but also several other desirable attributes such as communication skills teamwork problem solving independent responsibility for learning sharing information and respect for others PBL can therefore be thought of as a small group teaching method that combines the acquisition of knowledge with the development of generic skills and attitudes Presentation of clinical material as the stimulus for learning enables students to understand the relevance of underlying scientific knowledge and principles in clinical practice

bull when PBL is introduced into a curriculum several other issues for curriculum design and implementation need to be tackled PBL is generally introduced in the context of a defined core curriculum and integration of basic and clinical sciences It has implications for staffing and learning resources and demands a different approach to timetabling workload and assessment PBL is often used to deliver core material in non-clinical parts of the curriculum Paper based PBL scenarios form the basis of the core curriculum and ensure that all students are exposed to the same problems Recently modified PBL techniques have been introduced into clinical education with real patients being used as the stimulus for learning Despite the essential ad hoc nature of learning clinical medicine a key cases approach can enable PBL to be used to deliver the core clinical curriculum

Copyright copy2003 BMJ Publishing Group Ltd

Wood D F BMJ 2003326328-330

No CRoles of participants in a PBL tutorial aption Found

What happens in a PBL tutorial bull PBL tutorials are conducted in several ways In

this article the examples are modelled on the Maastricht seven jump process but its format of seven steps may be shortened

bull A typical PBL tutorial consists of a group of students (usually eight to 10) and a tutor who facilitates the session The length of time (number of sessions) that a group stays together with each other and with individual tutors varies between institutions A group needs to be together long enough to allow good group dynamics to develop but may need to be changed occasionally if personality clashes or other dysfunctional behaviour emerges

bull Students elect a chair for each PBL scenario and a scribe to record the discussion The roles are rotated for each scenario Suitable flip charts or a whiteboard should be used for recording the proceedings At the start of the session depending on the trigger material either the student chair reads out the scenario or all students study the material If the trigger is a real patient in a ward clinic or surgery then a student may be asked to take a clinical history or identify an abnormal physical sign before the group moves to a tutorial room For each module students may be given a handbook containing the problem scenarios and suggested learning resources or learning materials may be handed out at appropriate times as the tutorials progress

Examples of trigger material for PBL scenarios bull Paper based clinical scenarios bull Experimental or clinical laboratory data bull Photographs bull Video clips bull Newspaper articles bull All or part of an article from a scientific

journal bull A real or simulated patient bull A family tree showing an inherited

disorder

PBL tutorial process ndash Step 1 Identify and clarify unfamiliar terms presented in the scenario

scribe lists those that remain unexplained after discussion ndash Step 2 Define the problem or problems to be discussed students may

have different views on the issues but all should be considered scribe records a list of agreed problems

ndash Step 3 Brainstorming session to discuss the problem(s) suggestingpossible explanations on basis of prior knowledge students draw on each others knowledge and identify areas of incomplete knowledge scribe records all discussion

ndash Step 4 Review steps 2 and 3 and arrange explanations into tentativesolutions scribe organises the explanations and restructures if necessary

ndash Step 5 Formulate learning objectives group reaches consensus onthe learning objectives tutor ensures learning objectives are focused achievable comprehensive and appropriate

ndash Step 6 Private study (all students gather information related to eachlearning objective)

ndash Step 7 Group shares results of private study (students identify theirlearning resources and share their results) tutor checks learning and may assess the group

bull The role of the tutor is to facilitate the proceedings (helping the chair to maintain group dynamics and moving the group through the task) and to ensure that the group achieves appropriate learning objectives in line with those set by the curriculum design team The tutor may need to take a more active role in step 7 of the process to ensure that all the students have done the appropriate work and to help the chair to suggest a suitable format for group members to use to present the results of their private study The tutor should encourage students to check their understanding of the material He or she can do this by encouraging the students to ask open questions and ask each other to explain topics in their own words or by the use of drawings and diagrams

PBL in curriculum design bull PBL may be used either as the mainstay of an entire

curriculum or for the delivery of individual courses In practice PBL is usually part of an integrated curriculum using a systems based approach with non-clinical material delivered in the context of clinical practice A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge skills and attitudes A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios Sufficient time should be allowed each week for students to do the self directed learning required for PBL

bull

Copyright copy2003 BMJ Publishing Group Ltd

Wood D F BMJ 2003326328-330

No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found

Writing PBL scenarios

bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives

bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after

studying the scenario should be consistent with the faculty learning objectives

bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding

bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice

bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge

bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented

bull The problem should be sufficiently open so that discussion is not curtailed too early in the process

bull Scenarios should promote participation by the students in seeking information from various learning resources

bull Adapted from Dolmans et al Med Teacher 199719185-9

Staff development

bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)

A dysfunctional group a dominant character may

make it difficult for other students to be heard

A dysfunctional group a dominant character may make it difficult for other students to be heard

bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties

Advantages of PBL bull Student centred PBLIt fostersactive learning improved

understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks

Disadvantagesbull Tutors who cant teachTutorsenjoy passing on

their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful

Assessment of PBL

bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods

bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL

Conclusion

bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning

bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL

PBL 5 Easy Steps

bull Read the problem

Mrs Paula Embledon

Mrs Paula Embledon is a 78 year old woman who has come to the emergency room complaining of shortness of breath and pain in her chest She had been in relatively good health until three weeks previously when she sprained

2 Brain storm

bull Brainstorm

bull ndash hypotheses

bull - what do we know in support of the hypothesis

bull - what do we need to know to test the hypothesis

ndash learning issues

Brainstorm

bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)

ndash specific issues (for individuals to look up)

ndash overlapping issues

bull 4 Individual Reading - Research - Preparation

bull 5 Return

bull ndash review case so far ndash report and discuss

ndash assess progress - continue pagenext pagecomplete

ndash self-evaluation - How did things go Any suggestions for next time

ndash next problem

bull 5 Return

THE FIRST GROUP SESSION

bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day

bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session

bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr

bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine

bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise

bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator

bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues

bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know

bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)

bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)

bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)

  • PROBLEM BASED LEARNING
  • New Horizons in Medical Education
  • Slide 3
  • Domains of essential Global Requirements of ME
  • What was the response to these challenges
  • New Educational Strategies
  • New Tools amp Aids
  • PBL
  • PBL
  • Advantages
  • Slide 11
  • Slide 12
  • Slide 13
  • Slide 14
  • Framework for PBL
  • Framework for PBL - II
  • Characteristics of an effective PBL Group
  • Staff Development
  • Tutorrsquos Role in Assessment
  • Slide 20
  • Evaluating PBL Tutorials-II
  • PBL
  • Slide 23
  • PBL Starting the case
  • PBL Case (contd)
  • PBL Case contd
  • The Process of PBL
  • The Process of PBL contd
  • Learn from each other
  • Determine priorities for learning
  • Slide 31
  • Slide 32
  • Learning Issues
  • Learning Issues in PBL First Session
  • PBL Second Session
  • PBL Third Session
  • Slide 37
  • Slide 38
  • During Tutorial Session students will
  • Tutorial Session contd
  • Between Tutorial Session
  • Slide 42
  • Slide 43
  • Problem-based learning is designed to develop
  • Slide 45
  • What is problem based learning
  • Slide 47
  • Slide 48
  • Slide 49
  • Rationale for using PBL
  • Slide 51
  • Slide 52
  • The group learning process acquiring desirable learning skills
  • Generic Skills amp attitudes
  • Slide 55
  • Slide 56
  • Slide 57
  • What happens in a PBL tutorial
  • Slide 59
  • Examples of trigger material for PBL scenarios
  • PBL tutorial process
  • Slide 62
  • PBL in curriculum design
  • Slide 64
  • Writing PBL scenarios
  • Slide 66
  • Staff development
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • Slide 70
  • Advantages of PBL
  • Slide 72
  • Slide 73
  • Disadvantages
  • Assessment of PBL
  • Slide 76
  • Conclusion
  • Slide 78
  • PBL 5 Easy Steps
  • 2 Brain storm
  • Brainstorm
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • THE FIRST GROUP SESSION
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
Page 24: Problem based learning

PBL Case (contd)

bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session

PBL Case contdbull SECOND deciding which issues everyone will

tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)

bull THIRD deciding what SPECIFIC questions individuals will try to answer

bull FOURTH deciding how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet or consulting an expert)

The Process of PBL

bullWhat are the issues Identify the important issues in the problem

bull How well do you understand the issues

bull Are there any words or terms about which you are unclear

The Process of PBL contd

bull Consider the basic mechanisms that might explain each important aspect of each problem

bull Assess your current understanding of the basic structural andor functional mechanisms that may contribute to the presentation of the problem

bull Use the collective skills and experiences of group members to explore or explain these phenomena Identify current gaps in knowledge or understanding

Learn from each other

bullShare your own knowledge expertise or ability to reason and synthesize information Be receptive and appreciative of the contribution of your small group members

Determine priorities for learning

bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue

bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan

bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge

bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career

PBL

bull The problem comes first without advance readings lectures or preparation

bull The problem serves as a stimulus for the need to know

Learning Issues

bull Learning issues are questions that cannot be answered with studentsrsquo current knowledge and that can be explored and answered through systematic self-directed inquiry

bull The use of learning issues in tutorials prepares students to handle similar challenges in clinical practice and life-long learning

Learning Issues in PBL First Session1 Getting Started (Introductions Ground

Rules Expectations)2 Identifying Problem3 Exploring Pre-Existing Knowledge4 Generating Hypotheses and Explaining

Mechanisms5 Unfolding the Case Incrementally6 Re-EvaluatingReprioritizing Hypotheses

Based on New Information7 AssessmentReflection

PBL Second Session

8 Independent Self-Directed Study of Learning Issues

PBL Third Session

bull 9 Discussion of Learning Issues and Application of New Knowledge to the Case

bull 10 Continued Unfolding of the Case Incrementally

bull 11 AssessmentReflection

During Tutorial Session students will

1048708 Come prepared to discuss the case and learning issues researched since the last tutorial

1048708 Actively participate in group discussions and contribute to the learning process in a manner that allows for the balanced participation of everyone in the group

1048708 Develop learning issues at each session phrase them as full-sentence questions write them on the board and post them on the course web page

1048708 Consider biological population behaviormental health issuesexplanations and questions of professional attitudes values and ethics related to the patientrsquos problem(s) described in the case

Tutorial Session contd1048708 Go to the board to diagram outline draw etc in

explanation of mechanisms relatedto hypotheses1048708 Debate evidence related to the case and avoid

personal attacks on others1048708 Comply with ground rules with regard to how

the group will function and how itsmembers treat one another1048708 Participate in end-of-session reflection and

assessment by giving and receivingconstructive criticism regarding self tutor

student and group performance

Between Tutorial Session

1048708 Research key learning issues using a variety of resources

1048708 Critically evaluate the credibility of sources and the validity of the information they have obtained in their research

1048708 Integrate what they have learned through research lectures labs clinical skills Perspectives in Medicine (PIM) etc into what is discussed in tutorials

1048708 Synthesize what they have learned and be prepared to discuss it without reading directly from their materials as much as possible and apply it to the case at the next tutorial session

Determine priorities for learning

bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue

bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan

bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge

bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career

PBL Starting the casebull After the introductions and discussion

are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it

bull Reading the case aloud keeps the group focused

bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here

Problem-based learning is designed to develop

1048708 Integrated context-specific knowledge base

1048708 Decision-makingcritical thinking process and skills

1048708 Self-directed life-long learning skills 1048708 Interpersonal collaboration and

communication skills 1048708 Constructive self and peer

assessment skills 1048708 Professional ethics and behavior

PBL Case (contd)

bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session

What is problem based learning

bull In PBL students use triggers from the problem case or scenario to define their own learning objectives

bull Subsequently they do independent self directed study before returning to the group to discuss and refine their acquired knowledge

bull Thus PBL is not about problem solving per se but rather it uses appropriate problems to increase knowledge and understanding

bull The process is clearly defined

PBL

bull PBL uses clinical cases as the context for students to study basic and clinical sciences

bull Its possible advantages over traditional approaches include its greater relevance to the practice of medicine its ability to promote retention and application of knowledge and its encouragement of self-directed life-long learning

bull Possible disadvantages include higher costs both in resources and staff time

PBL

bull An educational method characterized by the use of patient problems as a context for students to learn problem-solving skills and acquire knowledge about the basic and clinical sciences

bull Students usually meet in small groups two or three times a week for PBL tutorials

bull They are presented with a clinical problem (eg a patient with chest pain) and in a series of steps they discuss possible mechanisms and causes develop hypotheses and strategies to test the hypotheses are presented with further information and use this new information to refine their hypotheses finally reaching a conclusion

bull A tutor usually acts as a facilitator guiding students in this group-learning process

bull In the course of this exercise students identify both their existing levels and gaps in their knowledge These gaps form the basis for independent learning outside the PBL tutorials The identification and pursuit of these so-called learning goals is a key element of the PBL process

Rationale for using PBL bull The PBL approach is based on principles of adult

education20 and cognitive psychology21 It differs fundamentally from traditional curricula in which students acquire background knowledge of the basic sciences in the early years of the course and in the later years apply this knowledge to the diagnosis and management of clinical problems This traditional approach has been criticised for a number of reasons42223

bull It creates an artificial divide between the basic and clinical sciences

bull Time is wasted in acquiring knowledge that is subsequently forgotten or found to be irrelevant

bull Application of the acquired knowledge can be difficult bull The acquisition and retention of information that has no

apparent relevance can be boring and even demoralising for students

The group learning process acquiring

desirable learning skills

Generic Skills amp attitudes

bull Teamwork bull Critical evaluation of literature bull Chairing a group bull Self directed learning and use of

resources bull Listening Presentation skills

Recording bull Cooperation bull Respect for colleagues views

bull Group learning facilitates not only the acquisition of knowledge but also several other desirable attributes such as communication skills teamwork problem solving independent responsibility for learning sharing information and respect for others PBL can therefore be thought of as a small group teaching method that combines the acquisition of knowledge with the development of generic skills and attitudes Presentation of clinical material as the stimulus for learning enables students to understand the relevance of underlying scientific knowledge and principles in clinical practice

bull when PBL is introduced into a curriculum several other issues for curriculum design and implementation need to be tackled PBL is generally introduced in the context of a defined core curriculum and integration of basic and clinical sciences It has implications for staffing and learning resources and demands a different approach to timetabling workload and assessment PBL is often used to deliver core material in non-clinical parts of the curriculum Paper based PBL scenarios form the basis of the core curriculum and ensure that all students are exposed to the same problems Recently modified PBL techniques have been introduced into clinical education with real patients being used as the stimulus for learning Despite the essential ad hoc nature of learning clinical medicine a key cases approach can enable PBL to be used to deliver the core clinical curriculum

Copyright copy2003 BMJ Publishing Group Ltd

Wood D F BMJ 2003326328-330

No CRoles of participants in a PBL tutorial aption Found

What happens in a PBL tutorial bull PBL tutorials are conducted in several ways In

this article the examples are modelled on the Maastricht seven jump process but its format of seven steps may be shortened

bull A typical PBL tutorial consists of a group of students (usually eight to 10) and a tutor who facilitates the session The length of time (number of sessions) that a group stays together with each other and with individual tutors varies between institutions A group needs to be together long enough to allow good group dynamics to develop but may need to be changed occasionally if personality clashes or other dysfunctional behaviour emerges

bull Students elect a chair for each PBL scenario and a scribe to record the discussion The roles are rotated for each scenario Suitable flip charts or a whiteboard should be used for recording the proceedings At the start of the session depending on the trigger material either the student chair reads out the scenario or all students study the material If the trigger is a real patient in a ward clinic or surgery then a student may be asked to take a clinical history or identify an abnormal physical sign before the group moves to a tutorial room For each module students may be given a handbook containing the problem scenarios and suggested learning resources or learning materials may be handed out at appropriate times as the tutorials progress

Examples of trigger material for PBL scenarios bull Paper based clinical scenarios bull Experimental or clinical laboratory data bull Photographs bull Video clips bull Newspaper articles bull All or part of an article from a scientific

journal bull A real or simulated patient bull A family tree showing an inherited

disorder

PBL tutorial process ndash Step 1 Identify and clarify unfamiliar terms presented in the scenario

scribe lists those that remain unexplained after discussion ndash Step 2 Define the problem or problems to be discussed students may

have different views on the issues but all should be considered scribe records a list of agreed problems

ndash Step 3 Brainstorming session to discuss the problem(s) suggestingpossible explanations on basis of prior knowledge students draw on each others knowledge and identify areas of incomplete knowledge scribe records all discussion

ndash Step 4 Review steps 2 and 3 and arrange explanations into tentativesolutions scribe organises the explanations and restructures if necessary

ndash Step 5 Formulate learning objectives group reaches consensus onthe learning objectives tutor ensures learning objectives are focused achievable comprehensive and appropriate

ndash Step 6 Private study (all students gather information related to eachlearning objective)

ndash Step 7 Group shares results of private study (students identify theirlearning resources and share their results) tutor checks learning and may assess the group

bull The role of the tutor is to facilitate the proceedings (helping the chair to maintain group dynamics and moving the group through the task) and to ensure that the group achieves appropriate learning objectives in line with those set by the curriculum design team The tutor may need to take a more active role in step 7 of the process to ensure that all the students have done the appropriate work and to help the chair to suggest a suitable format for group members to use to present the results of their private study The tutor should encourage students to check their understanding of the material He or she can do this by encouraging the students to ask open questions and ask each other to explain topics in their own words or by the use of drawings and diagrams

PBL in curriculum design bull PBL may be used either as the mainstay of an entire

curriculum or for the delivery of individual courses In practice PBL is usually part of an integrated curriculum using a systems based approach with non-clinical material delivered in the context of clinical practice A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge skills and attitudes A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios Sufficient time should be allowed each week for students to do the self directed learning required for PBL

bull

Copyright copy2003 BMJ Publishing Group Ltd

Wood D F BMJ 2003326328-330

No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found

Writing PBL scenarios

bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives

bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after

studying the scenario should be consistent with the faculty learning objectives

bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding

bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice

bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge

bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented

bull The problem should be sufficiently open so that discussion is not curtailed too early in the process

bull Scenarios should promote participation by the students in seeking information from various learning resources

bull Adapted from Dolmans et al Med Teacher 199719185-9

Staff development

bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)

A dysfunctional group a dominant character may

make it difficult for other students to be heard

A dysfunctional group a dominant character may make it difficult for other students to be heard

bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties

Advantages of PBL bull Student centred PBLIt fostersactive learning improved

understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks

Disadvantagesbull Tutors who cant teachTutorsenjoy passing on

their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful

Assessment of PBL

bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods

bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL

Conclusion

bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning

bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL

PBL 5 Easy Steps

bull Read the problem

Mrs Paula Embledon

Mrs Paula Embledon is a 78 year old woman who has come to the emergency room complaining of shortness of breath and pain in her chest She had been in relatively good health until three weeks previously when she sprained

2 Brain storm

bull Brainstorm

bull ndash hypotheses

bull - what do we know in support of the hypothesis

bull - what do we need to know to test the hypothesis

ndash learning issues

Brainstorm

bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)

ndash specific issues (for individuals to look up)

ndash overlapping issues

bull 4 Individual Reading - Research - Preparation

bull 5 Return

bull ndash review case so far ndash report and discuss

ndash assess progress - continue pagenext pagecomplete

ndash self-evaluation - How did things go Any suggestions for next time

ndash next problem

bull 5 Return

THE FIRST GROUP SESSION

bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day

bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session

bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr

bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine

bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise

bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator

bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues

bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know

bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)

bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)

bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)

  • PROBLEM BASED LEARNING
  • New Horizons in Medical Education
  • Slide 3
  • Domains of essential Global Requirements of ME
  • What was the response to these challenges
  • New Educational Strategies
  • New Tools amp Aids
  • PBL
  • PBL
  • Advantages
  • Slide 11
  • Slide 12
  • Slide 13
  • Slide 14
  • Framework for PBL
  • Framework for PBL - II
  • Characteristics of an effective PBL Group
  • Staff Development
  • Tutorrsquos Role in Assessment
  • Slide 20
  • Evaluating PBL Tutorials-II
  • PBL
  • Slide 23
  • PBL Starting the case
  • PBL Case (contd)
  • PBL Case contd
  • The Process of PBL
  • The Process of PBL contd
  • Learn from each other
  • Determine priorities for learning
  • Slide 31
  • Slide 32
  • Learning Issues
  • Learning Issues in PBL First Session
  • PBL Second Session
  • PBL Third Session
  • Slide 37
  • Slide 38
  • During Tutorial Session students will
  • Tutorial Session contd
  • Between Tutorial Session
  • Slide 42
  • Slide 43
  • Problem-based learning is designed to develop
  • Slide 45
  • What is problem based learning
  • Slide 47
  • Slide 48
  • Slide 49
  • Rationale for using PBL
  • Slide 51
  • Slide 52
  • The group learning process acquiring desirable learning skills
  • Generic Skills amp attitudes
  • Slide 55
  • Slide 56
  • Slide 57
  • What happens in a PBL tutorial
  • Slide 59
  • Examples of trigger material for PBL scenarios
  • PBL tutorial process
  • Slide 62
  • PBL in curriculum design
  • Slide 64
  • Writing PBL scenarios
  • Slide 66
  • Staff development
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • Slide 70
  • Advantages of PBL
  • Slide 72
  • Slide 73
  • Disadvantages
  • Assessment of PBL
  • Slide 76
  • Conclusion
  • Slide 78
  • PBL 5 Easy Steps
  • 2 Brain storm
  • Brainstorm
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • THE FIRST GROUP SESSION
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
Page 25: Problem based learning

PBL Case contdbull SECOND deciding which issues everyone will

tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)

bull THIRD deciding what SPECIFIC questions individuals will try to answer

bull FOURTH deciding how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet or consulting an expert)

The Process of PBL

bullWhat are the issues Identify the important issues in the problem

bull How well do you understand the issues

bull Are there any words or terms about which you are unclear

The Process of PBL contd

bull Consider the basic mechanisms that might explain each important aspect of each problem

bull Assess your current understanding of the basic structural andor functional mechanisms that may contribute to the presentation of the problem

bull Use the collective skills and experiences of group members to explore or explain these phenomena Identify current gaps in knowledge or understanding

Learn from each other

bullShare your own knowledge expertise or ability to reason and synthesize information Be receptive and appreciative of the contribution of your small group members

Determine priorities for learning

bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue

bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan

bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge

bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career

PBL

bull The problem comes first without advance readings lectures or preparation

bull The problem serves as a stimulus for the need to know

Learning Issues

bull Learning issues are questions that cannot be answered with studentsrsquo current knowledge and that can be explored and answered through systematic self-directed inquiry

bull The use of learning issues in tutorials prepares students to handle similar challenges in clinical practice and life-long learning

Learning Issues in PBL First Session1 Getting Started (Introductions Ground

Rules Expectations)2 Identifying Problem3 Exploring Pre-Existing Knowledge4 Generating Hypotheses and Explaining

Mechanisms5 Unfolding the Case Incrementally6 Re-EvaluatingReprioritizing Hypotheses

Based on New Information7 AssessmentReflection

PBL Second Session

8 Independent Self-Directed Study of Learning Issues

PBL Third Session

bull 9 Discussion of Learning Issues and Application of New Knowledge to the Case

bull 10 Continued Unfolding of the Case Incrementally

bull 11 AssessmentReflection

During Tutorial Session students will

1048708 Come prepared to discuss the case and learning issues researched since the last tutorial

1048708 Actively participate in group discussions and contribute to the learning process in a manner that allows for the balanced participation of everyone in the group

1048708 Develop learning issues at each session phrase them as full-sentence questions write them on the board and post them on the course web page

1048708 Consider biological population behaviormental health issuesexplanations and questions of professional attitudes values and ethics related to the patientrsquos problem(s) described in the case

Tutorial Session contd1048708 Go to the board to diagram outline draw etc in

explanation of mechanisms relatedto hypotheses1048708 Debate evidence related to the case and avoid

personal attacks on others1048708 Comply with ground rules with regard to how

the group will function and how itsmembers treat one another1048708 Participate in end-of-session reflection and

assessment by giving and receivingconstructive criticism regarding self tutor

student and group performance

Between Tutorial Session

1048708 Research key learning issues using a variety of resources

1048708 Critically evaluate the credibility of sources and the validity of the information they have obtained in their research

1048708 Integrate what they have learned through research lectures labs clinical skills Perspectives in Medicine (PIM) etc into what is discussed in tutorials

1048708 Synthesize what they have learned and be prepared to discuss it without reading directly from their materials as much as possible and apply it to the case at the next tutorial session

Determine priorities for learning

bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue

bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan

bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge

bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career

PBL Starting the casebull After the introductions and discussion

are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it

bull Reading the case aloud keeps the group focused

bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here

Problem-based learning is designed to develop

1048708 Integrated context-specific knowledge base

1048708 Decision-makingcritical thinking process and skills

1048708 Self-directed life-long learning skills 1048708 Interpersonal collaboration and

communication skills 1048708 Constructive self and peer

assessment skills 1048708 Professional ethics and behavior

PBL Case (contd)

bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session

What is problem based learning

bull In PBL students use triggers from the problem case or scenario to define their own learning objectives

bull Subsequently they do independent self directed study before returning to the group to discuss and refine their acquired knowledge

bull Thus PBL is not about problem solving per se but rather it uses appropriate problems to increase knowledge and understanding

bull The process is clearly defined

PBL

bull PBL uses clinical cases as the context for students to study basic and clinical sciences

bull Its possible advantages over traditional approaches include its greater relevance to the practice of medicine its ability to promote retention and application of knowledge and its encouragement of self-directed life-long learning

bull Possible disadvantages include higher costs both in resources and staff time

PBL

bull An educational method characterized by the use of patient problems as a context for students to learn problem-solving skills and acquire knowledge about the basic and clinical sciences

bull Students usually meet in small groups two or three times a week for PBL tutorials

bull They are presented with a clinical problem (eg a patient with chest pain) and in a series of steps they discuss possible mechanisms and causes develop hypotheses and strategies to test the hypotheses are presented with further information and use this new information to refine their hypotheses finally reaching a conclusion

bull A tutor usually acts as a facilitator guiding students in this group-learning process

bull In the course of this exercise students identify both their existing levels and gaps in their knowledge These gaps form the basis for independent learning outside the PBL tutorials The identification and pursuit of these so-called learning goals is a key element of the PBL process

Rationale for using PBL bull The PBL approach is based on principles of adult

education20 and cognitive psychology21 It differs fundamentally from traditional curricula in which students acquire background knowledge of the basic sciences in the early years of the course and in the later years apply this knowledge to the diagnosis and management of clinical problems This traditional approach has been criticised for a number of reasons42223

bull It creates an artificial divide between the basic and clinical sciences

bull Time is wasted in acquiring knowledge that is subsequently forgotten or found to be irrelevant

bull Application of the acquired knowledge can be difficult bull The acquisition and retention of information that has no

apparent relevance can be boring and even demoralising for students

The group learning process acquiring

desirable learning skills

Generic Skills amp attitudes

bull Teamwork bull Critical evaluation of literature bull Chairing a group bull Self directed learning and use of

resources bull Listening Presentation skills

Recording bull Cooperation bull Respect for colleagues views

bull Group learning facilitates not only the acquisition of knowledge but also several other desirable attributes such as communication skills teamwork problem solving independent responsibility for learning sharing information and respect for others PBL can therefore be thought of as a small group teaching method that combines the acquisition of knowledge with the development of generic skills and attitudes Presentation of clinical material as the stimulus for learning enables students to understand the relevance of underlying scientific knowledge and principles in clinical practice

bull when PBL is introduced into a curriculum several other issues for curriculum design and implementation need to be tackled PBL is generally introduced in the context of a defined core curriculum and integration of basic and clinical sciences It has implications for staffing and learning resources and demands a different approach to timetabling workload and assessment PBL is often used to deliver core material in non-clinical parts of the curriculum Paper based PBL scenarios form the basis of the core curriculum and ensure that all students are exposed to the same problems Recently modified PBL techniques have been introduced into clinical education with real patients being used as the stimulus for learning Despite the essential ad hoc nature of learning clinical medicine a key cases approach can enable PBL to be used to deliver the core clinical curriculum

Copyright copy2003 BMJ Publishing Group Ltd

Wood D F BMJ 2003326328-330

No CRoles of participants in a PBL tutorial aption Found

What happens in a PBL tutorial bull PBL tutorials are conducted in several ways In

this article the examples are modelled on the Maastricht seven jump process but its format of seven steps may be shortened

bull A typical PBL tutorial consists of a group of students (usually eight to 10) and a tutor who facilitates the session The length of time (number of sessions) that a group stays together with each other and with individual tutors varies between institutions A group needs to be together long enough to allow good group dynamics to develop but may need to be changed occasionally if personality clashes or other dysfunctional behaviour emerges

bull Students elect a chair for each PBL scenario and a scribe to record the discussion The roles are rotated for each scenario Suitable flip charts or a whiteboard should be used for recording the proceedings At the start of the session depending on the trigger material either the student chair reads out the scenario or all students study the material If the trigger is a real patient in a ward clinic or surgery then a student may be asked to take a clinical history or identify an abnormal physical sign before the group moves to a tutorial room For each module students may be given a handbook containing the problem scenarios and suggested learning resources or learning materials may be handed out at appropriate times as the tutorials progress

Examples of trigger material for PBL scenarios bull Paper based clinical scenarios bull Experimental or clinical laboratory data bull Photographs bull Video clips bull Newspaper articles bull All or part of an article from a scientific

journal bull A real or simulated patient bull A family tree showing an inherited

disorder

PBL tutorial process ndash Step 1 Identify and clarify unfamiliar terms presented in the scenario

scribe lists those that remain unexplained after discussion ndash Step 2 Define the problem or problems to be discussed students may

have different views on the issues but all should be considered scribe records a list of agreed problems

ndash Step 3 Brainstorming session to discuss the problem(s) suggestingpossible explanations on basis of prior knowledge students draw on each others knowledge and identify areas of incomplete knowledge scribe records all discussion

ndash Step 4 Review steps 2 and 3 and arrange explanations into tentativesolutions scribe organises the explanations and restructures if necessary

ndash Step 5 Formulate learning objectives group reaches consensus onthe learning objectives tutor ensures learning objectives are focused achievable comprehensive and appropriate

ndash Step 6 Private study (all students gather information related to eachlearning objective)

ndash Step 7 Group shares results of private study (students identify theirlearning resources and share their results) tutor checks learning and may assess the group

bull The role of the tutor is to facilitate the proceedings (helping the chair to maintain group dynamics and moving the group through the task) and to ensure that the group achieves appropriate learning objectives in line with those set by the curriculum design team The tutor may need to take a more active role in step 7 of the process to ensure that all the students have done the appropriate work and to help the chair to suggest a suitable format for group members to use to present the results of their private study The tutor should encourage students to check their understanding of the material He or she can do this by encouraging the students to ask open questions and ask each other to explain topics in their own words or by the use of drawings and diagrams

PBL in curriculum design bull PBL may be used either as the mainstay of an entire

curriculum or for the delivery of individual courses In practice PBL is usually part of an integrated curriculum using a systems based approach with non-clinical material delivered in the context of clinical practice A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge skills and attitudes A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios Sufficient time should be allowed each week for students to do the self directed learning required for PBL

bull

Copyright copy2003 BMJ Publishing Group Ltd

Wood D F BMJ 2003326328-330

No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found

Writing PBL scenarios

bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives

bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after

studying the scenario should be consistent with the faculty learning objectives

bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding

bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice

bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge

bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented

bull The problem should be sufficiently open so that discussion is not curtailed too early in the process

bull Scenarios should promote participation by the students in seeking information from various learning resources

bull Adapted from Dolmans et al Med Teacher 199719185-9

Staff development

bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)

A dysfunctional group a dominant character may

make it difficult for other students to be heard

A dysfunctional group a dominant character may make it difficult for other students to be heard

bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties

Advantages of PBL bull Student centred PBLIt fostersactive learning improved

understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks

Disadvantagesbull Tutors who cant teachTutorsenjoy passing on

their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful

Assessment of PBL

bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods

bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL

Conclusion

bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning

bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL

PBL 5 Easy Steps

bull Read the problem

Mrs Paula Embledon

Mrs Paula Embledon is a 78 year old woman who has come to the emergency room complaining of shortness of breath and pain in her chest She had been in relatively good health until three weeks previously when she sprained

2 Brain storm

bull Brainstorm

bull ndash hypotheses

bull - what do we know in support of the hypothesis

bull - what do we need to know to test the hypothesis

ndash learning issues

Brainstorm

bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)

ndash specific issues (for individuals to look up)

ndash overlapping issues

bull 4 Individual Reading - Research - Preparation

bull 5 Return

bull ndash review case so far ndash report and discuss

ndash assess progress - continue pagenext pagecomplete

ndash self-evaluation - How did things go Any suggestions for next time

ndash next problem

bull 5 Return

THE FIRST GROUP SESSION

bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day

bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session

bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr

bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine

bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise

bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator

bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues

bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know

bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)

bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)

bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)

  • PROBLEM BASED LEARNING
  • New Horizons in Medical Education
  • Slide 3
  • Domains of essential Global Requirements of ME
  • What was the response to these challenges
  • New Educational Strategies
  • New Tools amp Aids
  • PBL
  • PBL
  • Advantages
  • Slide 11
  • Slide 12
  • Slide 13
  • Slide 14
  • Framework for PBL
  • Framework for PBL - II
  • Characteristics of an effective PBL Group
  • Staff Development
  • Tutorrsquos Role in Assessment
  • Slide 20
  • Evaluating PBL Tutorials-II
  • PBL
  • Slide 23
  • PBL Starting the case
  • PBL Case (contd)
  • PBL Case contd
  • The Process of PBL
  • The Process of PBL contd
  • Learn from each other
  • Determine priorities for learning
  • Slide 31
  • Slide 32
  • Learning Issues
  • Learning Issues in PBL First Session
  • PBL Second Session
  • PBL Third Session
  • Slide 37
  • Slide 38
  • During Tutorial Session students will
  • Tutorial Session contd
  • Between Tutorial Session
  • Slide 42
  • Slide 43
  • Problem-based learning is designed to develop
  • Slide 45
  • What is problem based learning
  • Slide 47
  • Slide 48
  • Slide 49
  • Rationale for using PBL
  • Slide 51
  • Slide 52
  • The group learning process acquiring desirable learning skills
  • Generic Skills amp attitudes
  • Slide 55
  • Slide 56
  • Slide 57
  • What happens in a PBL tutorial
  • Slide 59
  • Examples of trigger material for PBL scenarios
  • PBL tutorial process
  • Slide 62
  • PBL in curriculum design
  • Slide 64
  • Writing PBL scenarios
  • Slide 66
  • Staff development
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • Slide 70
  • Advantages of PBL
  • Slide 72
  • Slide 73
  • Disadvantages
  • Assessment of PBL
  • Slide 76
  • Conclusion
  • Slide 78
  • PBL 5 Easy Steps
  • 2 Brain storm
  • Brainstorm
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • THE FIRST GROUP SESSION
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
Page 26: Problem based learning

The Process of PBL

bullWhat are the issues Identify the important issues in the problem

bull How well do you understand the issues

bull Are there any words or terms about which you are unclear

The Process of PBL contd

bull Consider the basic mechanisms that might explain each important aspect of each problem

bull Assess your current understanding of the basic structural andor functional mechanisms that may contribute to the presentation of the problem

bull Use the collective skills and experiences of group members to explore or explain these phenomena Identify current gaps in knowledge or understanding

Learn from each other

bullShare your own knowledge expertise or ability to reason and synthesize information Be receptive and appreciative of the contribution of your small group members

Determine priorities for learning

bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue

bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan

bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge

bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career

PBL

bull The problem comes first without advance readings lectures or preparation

bull The problem serves as a stimulus for the need to know

Learning Issues

bull Learning issues are questions that cannot be answered with studentsrsquo current knowledge and that can be explored and answered through systematic self-directed inquiry

bull The use of learning issues in tutorials prepares students to handle similar challenges in clinical practice and life-long learning

Learning Issues in PBL First Session1 Getting Started (Introductions Ground

Rules Expectations)2 Identifying Problem3 Exploring Pre-Existing Knowledge4 Generating Hypotheses and Explaining

Mechanisms5 Unfolding the Case Incrementally6 Re-EvaluatingReprioritizing Hypotheses

Based on New Information7 AssessmentReflection

PBL Second Session

8 Independent Self-Directed Study of Learning Issues

PBL Third Session

bull 9 Discussion of Learning Issues and Application of New Knowledge to the Case

bull 10 Continued Unfolding of the Case Incrementally

bull 11 AssessmentReflection

During Tutorial Session students will

1048708 Come prepared to discuss the case and learning issues researched since the last tutorial

1048708 Actively participate in group discussions and contribute to the learning process in a manner that allows for the balanced participation of everyone in the group

1048708 Develop learning issues at each session phrase them as full-sentence questions write them on the board and post them on the course web page

1048708 Consider biological population behaviormental health issuesexplanations and questions of professional attitudes values and ethics related to the patientrsquos problem(s) described in the case

Tutorial Session contd1048708 Go to the board to diagram outline draw etc in

explanation of mechanisms relatedto hypotheses1048708 Debate evidence related to the case and avoid

personal attacks on others1048708 Comply with ground rules with regard to how

the group will function and how itsmembers treat one another1048708 Participate in end-of-session reflection and

assessment by giving and receivingconstructive criticism regarding self tutor

student and group performance

Between Tutorial Session

1048708 Research key learning issues using a variety of resources

1048708 Critically evaluate the credibility of sources and the validity of the information they have obtained in their research

1048708 Integrate what they have learned through research lectures labs clinical skills Perspectives in Medicine (PIM) etc into what is discussed in tutorials

1048708 Synthesize what they have learned and be prepared to discuss it without reading directly from their materials as much as possible and apply it to the case at the next tutorial session

Determine priorities for learning

bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue

bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan

bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge

bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career

PBL Starting the casebull After the introductions and discussion

are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it

bull Reading the case aloud keeps the group focused

bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here

Problem-based learning is designed to develop

1048708 Integrated context-specific knowledge base

1048708 Decision-makingcritical thinking process and skills

1048708 Self-directed life-long learning skills 1048708 Interpersonal collaboration and

communication skills 1048708 Constructive self and peer

assessment skills 1048708 Professional ethics and behavior

PBL Case (contd)

bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session

What is problem based learning

bull In PBL students use triggers from the problem case or scenario to define their own learning objectives

bull Subsequently they do independent self directed study before returning to the group to discuss and refine their acquired knowledge

bull Thus PBL is not about problem solving per se but rather it uses appropriate problems to increase knowledge and understanding

bull The process is clearly defined

PBL

bull PBL uses clinical cases as the context for students to study basic and clinical sciences

bull Its possible advantages over traditional approaches include its greater relevance to the practice of medicine its ability to promote retention and application of knowledge and its encouragement of self-directed life-long learning

bull Possible disadvantages include higher costs both in resources and staff time

PBL

bull An educational method characterized by the use of patient problems as a context for students to learn problem-solving skills and acquire knowledge about the basic and clinical sciences

bull Students usually meet in small groups two or three times a week for PBL tutorials

bull They are presented with a clinical problem (eg a patient with chest pain) and in a series of steps they discuss possible mechanisms and causes develop hypotheses and strategies to test the hypotheses are presented with further information and use this new information to refine their hypotheses finally reaching a conclusion

bull A tutor usually acts as a facilitator guiding students in this group-learning process

bull In the course of this exercise students identify both their existing levels and gaps in their knowledge These gaps form the basis for independent learning outside the PBL tutorials The identification and pursuit of these so-called learning goals is a key element of the PBL process

Rationale for using PBL bull The PBL approach is based on principles of adult

education20 and cognitive psychology21 It differs fundamentally from traditional curricula in which students acquire background knowledge of the basic sciences in the early years of the course and in the later years apply this knowledge to the diagnosis and management of clinical problems This traditional approach has been criticised for a number of reasons42223

bull It creates an artificial divide between the basic and clinical sciences

bull Time is wasted in acquiring knowledge that is subsequently forgotten or found to be irrelevant

bull Application of the acquired knowledge can be difficult bull The acquisition and retention of information that has no

apparent relevance can be boring and even demoralising for students

The group learning process acquiring

desirable learning skills

Generic Skills amp attitudes

bull Teamwork bull Critical evaluation of literature bull Chairing a group bull Self directed learning and use of

resources bull Listening Presentation skills

Recording bull Cooperation bull Respect for colleagues views

bull Group learning facilitates not only the acquisition of knowledge but also several other desirable attributes such as communication skills teamwork problem solving independent responsibility for learning sharing information and respect for others PBL can therefore be thought of as a small group teaching method that combines the acquisition of knowledge with the development of generic skills and attitudes Presentation of clinical material as the stimulus for learning enables students to understand the relevance of underlying scientific knowledge and principles in clinical practice

bull when PBL is introduced into a curriculum several other issues for curriculum design and implementation need to be tackled PBL is generally introduced in the context of a defined core curriculum and integration of basic and clinical sciences It has implications for staffing and learning resources and demands a different approach to timetabling workload and assessment PBL is often used to deliver core material in non-clinical parts of the curriculum Paper based PBL scenarios form the basis of the core curriculum and ensure that all students are exposed to the same problems Recently modified PBL techniques have been introduced into clinical education with real patients being used as the stimulus for learning Despite the essential ad hoc nature of learning clinical medicine a key cases approach can enable PBL to be used to deliver the core clinical curriculum

Copyright copy2003 BMJ Publishing Group Ltd

Wood D F BMJ 2003326328-330

No CRoles of participants in a PBL tutorial aption Found

What happens in a PBL tutorial bull PBL tutorials are conducted in several ways In

this article the examples are modelled on the Maastricht seven jump process but its format of seven steps may be shortened

bull A typical PBL tutorial consists of a group of students (usually eight to 10) and a tutor who facilitates the session The length of time (number of sessions) that a group stays together with each other and with individual tutors varies between institutions A group needs to be together long enough to allow good group dynamics to develop but may need to be changed occasionally if personality clashes or other dysfunctional behaviour emerges

bull Students elect a chair for each PBL scenario and a scribe to record the discussion The roles are rotated for each scenario Suitable flip charts or a whiteboard should be used for recording the proceedings At the start of the session depending on the trigger material either the student chair reads out the scenario or all students study the material If the trigger is a real patient in a ward clinic or surgery then a student may be asked to take a clinical history or identify an abnormal physical sign before the group moves to a tutorial room For each module students may be given a handbook containing the problem scenarios and suggested learning resources or learning materials may be handed out at appropriate times as the tutorials progress

Examples of trigger material for PBL scenarios bull Paper based clinical scenarios bull Experimental or clinical laboratory data bull Photographs bull Video clips bull Newspaper articles bull All or part of an article from a scientific

journal bull A real or simulated patient bull A family tree showing an inherited

disorder

PBL tutorial process ndash Step 1 Identify and clarify unfamiliar terms presented in the scenario

scribe lists those that remain unexplained after discussion ndash Step 2 Define the problem or problems to be discussed students may

have different views on the issues but all should be considered scribe records a list of agreed problems

ndash Step 3 Brainstorming session to discuss the problem(s) suggestingpossible explanations on basis of prior knowledge students draw on each others knowledge and identify areas of incomplete knowledge scribe records all discussion

ndash Step 4 Review steps 2 and 3 and arrange explanations into tentativesolutions scribe organises the explanations and restructures if necessary

ndash Step 5 Formulate learning objectives group reaches consensus onthe learning objectives tutor ensures learning objectives are focused achievable comprehensive and appropriate

ndash Step 6 Private study (all students gather information related to eachlearning objective)

ndash Step 7 Group shares results of private study (students identify theirlearning resources and share their results) tutor checks learning and may assess the group

bull The role of the tutor is to facilitate the proceedings (helping the chair to maintain group dynamics and moving the group through the task) and to ensure that the group achieves appropriate learning objectives in line with those set by the curriculum design team The tutor may need to take a more active role in step 7 of the process to ensure that all the students have done the appropriate work and to help the chair to suggest a suitable format for group members to use to present the results of their private study The tutor should encourage students to check their understanding of the material He or she can do this by encouraging the students to ask open questions and ask each other to explain topics in their own words or by the use of drawings and diagrams

PBL in curriculum design bull PBL may be used either as the mainstay of an entire

curriculum or for the delivery of individual courses In practice PBL is usually part of an integrated curriculum using a systems based approach with non-clinical material delivered in the context of clinical practice A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge skills and attitudes A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios Sufficient time should be allowed each week for students to do the self directed learning required for PBL

bull

Copyright copy2003 BMJ Publishing Group Ltd

Wood D F BMJ 2003326328-330

No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found

Writing PBL scenarios

bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives

bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after

studying the scenario should be consistent with the faculty learning objectives

bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding

bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice

bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge

bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented

bull The problem should be sufficiently open so that discussion is not curtailed too early in the process

bull Scenarios should promote participation by the students in seeking information from various learning resources

bull Adapted from Dolmans et al Med Teacher 199719185-9

Staff development

bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)

A dysfunctional group a dominant character may

make it difficult for other students to be heard

A dysfunctional group a dominant character may make it difficult for other students to be heard

bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties

Advantages of PBL bull Student centred PBLIt fostersactive learning improved

understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks

Disadvantagesbull Tutors who cant teachTutorsenjoy passing on

their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful

Assessment of PBL

bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods

bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL

Conclusion

bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning

bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL

PBL 5 Easy Steps

bull Read the problem

Mrs Paula Embledon

Mrs Paula Embledon is a 78 year old woman who has come to the emergency room complaining of shortness of breath and pain in her chest She had been in relatively good health until three weeks previously when she sprained

2 Brain storm

bull Brainstorm

bull ndash hypotheses

bull - what do we know in support of the hypothesis

bull - what do we need to know to test the hypothesis

ndash learning issues

Brainstorm

bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)

ndash specific issues (for individuals to look up)

ndash overlapping issues

bull 4 Individual Reading - Research - Preparation

bull 5 Return

bull ndash review case so far ndash report and discuss

ndash assess progress - continue pagenext pagecomplete

ndash self-evaluation - How did things go Any suggestions for next time

ndash next problem

bull 5 Return

THE FIRST GROUP SESSION

bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day

bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session

bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr

bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine

bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise

bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator

bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues

bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know

bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)

bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)

bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)

  • PROBLEM BASED LEARNING
  • New Horizons in Medical Education
  • Slide 3
  • Domains of essential Global Requirements of ME
  • What was the response to these challenges
  • New Educational Strategies
  • New Tools amp Aids
  • PBL
  • PBL
  • Advantages
  • Slide 11
  • Slide 12
  • Slide 13
  • Slide 14
  • Framework for PBL
  • Framework for PBL - II
  • Characteristics of an effective PBL Group
  • Staff Development
  • Tutorrsquos Role in Assessment
  • Slide 20
  • Evaluating PBL Tutorials-II
  • PBL
  • Slide 23
  • PBL Starting the case
  • PBL Case (contd)
  • PBL Case contd
  • The Process of PBL
  • The Process of PBL contd
  • Learn from each other
  • Determine priorities for learning
  • Slide 31
  • Slide 32
  • Learning Issues
  • Learning Issues in PBL First Session
  • PBL Second Session
  • PBL Third Session
  • Slide 37
  • Slide 38
  • During Tutorial Session students will
  • Tutorial Session contd
  • Between Tutorial Session
  • Slide 42
  • Slide 43
  • Problem-based learning is designed to develop
  • Slide 45
  • What is problem based learning
  • Slide 47
  • Slide 48
  • Slide 49
  • Rationale for using PBL
  • Slide 51
  • Slide 52
  • The group learning process acquiring desirable learning skills
  • Generic Skills amp attitudes
  • Slide 55
  • Slide 56
  • Slide 57
  • What happens in a PBL tutorial
  • Slide 59
  • Examples of trigger material for PBL scenarios
  • PBL tutorial process
  • Slide 62
  • PBL in curriculum design
  • Slide 64
  • Writing PBL scenarios
  • Slide 66
  • Staff development
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • Slide 70
  • Advantages of PBL
  • Slide 72
  • Slide 73
  • Disadvantages
  • Assessment of PBL
  • Slide 76
  • Conclusion
  • Slide 78
  • PBL 5 Easy Steps
  • 2 Brain storm
  • Brainstorm
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • THE FIRST GROUP SESSION
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
Page 27: Problem based learning

The Process of PBL contd

bull Consider the basic mechanisms that might explain each important aspect of each problem

bull Assess your current understanding of the basic structural andor functional mechanisms that may contribute to the presentation of the problem

bull Use the collective skills and experiences of group members to explore or explain these phenomena Identify current gaps in knowledge or understanding

Learn from each other

bullShare your own knowledge expertise or ability to reason and synthesize information Be receptive and appreciative of the contribution of your small group members

Determine priorities for learning

bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue

bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan

bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge

bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career

PBL

bull The problem comes first without advance readings lectures or preparation

bull The problem serves as a stimulus for the need to know

Learning Issues

bull Learning issues are questions that cannot be answered with studentsrsquo current knowledge and that can be explored and answered through systematic self-directed inquiry

bull The use of learning issues in tutorials prepares students to handle similar challenges in clinical practice and life-long learning

Learning Issues in PBL First Session1 Getting Started (Introductions Ground

Rules Expectations)2 Identifying Problem3 Exploring Pre-Existing Knowledge4 Generating Hypotheses and Explaining

Mechanisms5 Unfolding the Case Incrementally6 Re-EvaluatingReprioritizing Hypotheses

Based on New Information7 AssessmentReflection

PBL Second Session

8 Independent Self-Directed Study of Learning Issues

PBL Third Session

bull 9 Discussion of Learning Issues and Application of New Knowledge to the Case

bull 10 Continued Unfolding of the Case Incrementally

bull 11 AssessmentReflection

During Tutorial Session students will

1048708 Come prepared to discuss the case and learning issues researched since the last tutorial

1048708 Actively participate in group discussions and contribute to the learning process in a manner that allows for the balanced participation of everyone in the group

1048708 Develop learning issues at each session phrase them as full-sentence questions write them on the board and post them on the course web page

1048708 Consider biological population behaviormental health issuesexplanations and questions of professional attitudes values and ethics related to the patientrsquos problem(s) described in the case

Tutorial Session contd1048708 Go to the board to diagram outline draw etc in

explanation of mechanisms relatedto hypotheses1048708 Debate evidence related to the case and avoid

personal attacks on others1048708 Comply with ground rules with regard to how

the group will function and how itsmembers treat one another1048708 Participate in end-of-session reflection and

assessment by giving and receivingconstructive criticism regarding self tutor

student and group performance

Between Tutorial Session

1048708 Research key learning issues using a variety of resources

1048708 Critically evaluate the credibility of sources and the validity of the information they have obtained in their research

1048708 Integrate what they have learned through research lectures labs clinical skills Perspectives in Medicine (PIM) etc into what is discussed in tutorials

1048708 Synthesize what they have learned and be prepared to discuss it without reading directly from their materials as much as possible and apply it to the case at the next tutorial session

Determine priorities for learning

bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue

bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan

bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge

bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career

PBL Starting the casebull After the introductions and discussion

are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it

bull Reading the case aloud keeps the group focused

bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here

Problem-based learning is designed to develop

1048708 Integrated context-specific knowledge base

1048708 Decision-makingcritical thinking process and skills

1048708 Self-directed life-long learning skills 1048708 Interpersonal collaboration and

communication skills 1048708 Constructive self and peer

assessment skills 1048708 Professional ethics and behavior

PBL Case (contd)

bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session

What is problem based learning

bull In PBL students use triggers from the problem case or scenario to define their own learning objectives

bull Subsequently they do independent self directed study before returning to the group to discuss and refine their acquired knowledge

bull Thus PBL is not about problem solving per se but rather it uses appropriate problems to increase knowledge and understanding

bull The process is clearly defined

PBL

bull PBL uses clinical cases as the context for students to study basic and clinical sciences

bull Its possible advantages over traditional approaches include its greater relevance to the practice of medicine its ability to promote retention and application of knowledge and its encouragement of self-directed life-long learning

bull Possible disadvantages include higher costs both in resources and staff time

PBL

bull An educational method characterized by the use of patient problems as a context for students to learn problem-solving skills and acquire knowledge about the basic and clinical sciences

bull Students usually meet in small groups two or three times a week for PBL tutorials

bull They are presented with a clinical problem (eg a patient with chest pain) and in a series of steps they discuss possible mechanisms and causes develop hypotheses and strategies to test the hypotheses are presented with further information and use this new information to refine their hypotheses finally reaching a conclusion

bull A tutor usually acts as a facilitator guiding students in this group-learning process

bull In the course of this exercise students identify both their existing levels and gaps in their knowledge These gaps form the basis for independent learning outside the PBL tutorials The identification and pursuit of these so-called learning goals is a key element of the PBL process

Rationale for using PBL bull The PBL approach is based on principles of adult

education20 and cognitive psychology21 It differs fundamentally from traditional curricula in which students acquire background knowledge of the basic sciences in the early years of the course and in the later years apply this knowledge to the diagnosis and management of clinical problems This traditional approach has been criticised for a number of reasons42223

bull It creates an artificial divide between the basic and clinical sciences

bull Time is wasted in acquiring knowledge that is subsequently forgotten or found to be irrelevant

bull Application of the acquired knowledge can be difficult bull The acquisition and retention of information that has no

apparent relevance can be boring and even demoralising for students

The group learning process acquiring

desirable learning skills

Generic Skills amp attitudes

bull Teamwork bull Critical evaluation of literature bull Chairing a group bull Self directed learning and use of

resources bull Listening Presentation skills

Recording bull Cooperation bull Respect for colleagues views

bull Group learning facilitates not only the acquisition of knowledge but also several other desirable attributes such as communication skills teamwork problem solving independent responsibility for learning sharing information and respect for others PBL can therefore be thought of as a small group teaching method that combines the acquisition of knowledge with the development of generic skills and attitudes Presentation of clinical material as the stimulus for learning enables students to understand the relevance of underlying scientific knowledge and principles in clinical practice

bull when PBL is introduced into a curriculum several other issues for curriculum design and implementation need to be tackled PBL is generally introduced in the context of a defined core curriculum and integration of basic and clinical sciences It has implications for staffing and learning resources and demands a different approach to timetabling workload and assessment PBL is often used to deliver core material in non-clinical parts of the curriculum Paper based PBL scenarios form the basis of the core curriculum and ensure that all students are exposed to the same problems Recently modified PBL techniques have been introduced into clinical education with real patients being used as the stimulus for learning Despite the essential ad hoc nature of learning clinical medicine a key cases approach can enable PBL to be used to deliver the core clinical curriculum

Copyright copy2003 BMJ Publishing Group Ltd

Wood D F BMJ 2003326328-330

No CRoles of participants in a PBL tutorial aption Found

What happens in a PBL tutorial bull PBL tutorials are conducted in several ways In

this article the examples are modelled on the Maastricht seven jump process but its format of seven steps may be shortened

bull A typical PBL tutorial consists of a group of students (usually eight to 10) and a tutor who facilitates the session The length of time (number of sessions) that a group stays together with each other and with individual tutors varies between institutions A group needs to be together long enough to allow good group dynamics to develop but may need to be changed occasionally if personality clashes or other dysfunctional behaviour emerges

bull Students elect a chair for each PBL scenario and a scribe to record the discussion The roles are rotated for each scenario Suitable flip charts or a whiteboard should be used for recording the proceedings At the start of the session depending on the trigger material either the student chair reads out the scenario or all students study the material If the trigger is a real patient in a ward clinic or surgery then a student may be asked to take a clinical history or identify an abnormal physical sign before the group moves to a tutorial room For each module students may be given a handbook containing the problem scenarios and suggested learning resources or learning materials may be handed out at appropriate times as the tutorials progress

Examples of trigger material for PBL scenarios bull Paper based clinical scenarios bull Experimental or clinical laboratory data bull Photographs bull Video clips bull Newspaper articles bull All or part of an article from a scientific

journal bull A real or simulated patient bull A family tree showing an inherited

disorder

PBL tutorial process ndash Step 1 Identify and clarify unfamiliar terms presented in the scenario

scribe lists those that remain unexplained after discussion ndash Step 2 Define the problem or problems to be discussed students may

have different views on the issues but all should be considered scribe records a list of agreed problems

ndash Step 3 Brainstorming session to discuss the problem(s) suggestingpossible explanations on basis of prior knowledge students draw on each others knowledge and identify areas of incomplete knowledge scribe records all discussion

ndash Step 4 Review steps 2 and 3 and arrange explanations into tentativesolutions scribe organises the explanations and restructures if necessary

ndash Step 5 Formulate learning objectives group reaches consensus onthe learning objectives tutor ensures learning objectives are focused achievable comprehensive and appropriate

ndash Step 6 Private study (all students gather information related to eachlearning objective)

ndash Step 7 Group shares results of private study (students identify theirlearning resources and share their results) tutor checks learning and may assess the group

bull The role of the tutor is to facilitate the proceedings (helping the chair to maintain group dynamics and moving the group through the task) and to ensure that the group achieves appropriate learning objectives in line with those set by the curriculum design team The tutor may need to take a more active role in step 7 of the process to ensure that all the students have done the appropriate work and to help the chair to suggest a suitable format for group members to use to present the results of their private study The tutor should encourage students to check their understanding of the material He or she can do this by encouraging the students to ask open questions and ask each other to explain topics in their own words or by the use of drawings and diagrams

PBL in curriculum design bull PBL may be used either as the mainstay of an entire

curriculum or for the delivery of individual courses In practice PBL is usually part of an integrated curriculum using a systems based approach with non-clinical material delivered in the context of clinical practice A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge skills and attitudes A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios Sufficient time should be allowed each week for students to do the self directed learning required for PBL

bull

Copyright copy2003 BMJ Publishing Group Ltd

Wood D F BMJ 2003326328-330

No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found

Writing PBL scenarios

bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives

bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after

studying the scenario should be consistent with the faculty learning objectives

bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding

bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice

bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge

bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented

bull The problem should be sufficiently open so that discussion is not curtailed too early in the process

bull Scenarios should promote participation by the students in seeking information from various learning resources

bull Adapted from Dolmans et al Med Teacher 199719185-9

Staff development

bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)

A dysfunctional group a dominant character may

make it difficult for other students to be heard

A dysfunctional group a dominant character may make it difficult for other students to be heard

bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties

Advantages of PBL bull Student centred PBLIt fostersactive learning improved

understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks

Disadvantagesbull Tutors who cant teachTutorsenjoy passing on

their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful

Assessment of PBL

bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods

bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL

Conclusion

bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning

bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL

PBL 5 Easy Steps

bull Read the problem

Mrs Paula Embledon

Mrs Paula Embledon is a 78 year old woman who has come to the emergency room complaining of shortness of breath and pain in her chest She had been in relatively good health until three weeks previously when she sprained

2 Brain storm

bull Brainstorm

bull ndash hypotheses

bull - what do we know in support of the hypothesis

bull - what do we need to know to test the hypothesis

ndash learning issues

Brainstorm

bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)

ndash specific issues (for individuals to look up)

ndash overlapping issues

bull 4 Individual Reading - Research - Preparation

bull 5 Return

bull ndash review case so far ndash report and discuss

ndash assess progress - continue pagenext pagecomplete

ndash self-evaluation - How did things go Any suggestions for next time

ndash next problem

bull 5 Return

THE FIRST GROUP SESSION

bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day

bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session

bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr

bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine

bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise

bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator

bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues

bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know

bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)

bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)

bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)

  • PROBLEM BASED LEARNING
  • New Horizons in Medical Education
  • Slide 3
  • Domains of essential Global Requirements of ME
  • What was the response to these challenges
  • New Educational Strategies
  • New Tools amp Aids
  • PBL
  • PBL
  • Advantages
  • Slide 11
  • Slide 12
  • Slide 13
  • Slide 14
  • Framework for PBL
  • Framework for PBL - II
  • Characteristics of an effective PBL Group
  • Staff Development
  • Tutorrsquos Role in Assessment
  • Slide 20
  • Evaluating PBL Tutorials-II
  • PBL
  • Slide 23
  • PBL Starting the case
  • PBL Case (contd)
  • PBL Case contd
  • The Process of PBL
  • The Process of PBL contd
  • Learn from each other
  • Determine priorities for learning
  • Slide 31
  • Slide 32
  • Learning Issues
  • Learning Issues in PBL First Session
  • PBL Second Session
  • PBL Third Session
  • Slide 37
  • Slide 38
  • During Tutorial Session students will
  • Tutorial Session contd
  • Between Tutorial Session
  • Slide 42
  • Slide 43
  • Problem-based learning is designed to develop
  • Slide 45
  • What is problem based learning
  • Slide 47
  • Slide 48
  • Slide 49
  • Rationale for using PBL
  • Slide 51
  • Slide 52
  • The group learning process acquiring desirable learning skills
  • Generic Skills amp attitudes
  • Slide 55
  • Slide 56
  • Slide 57
  • What happens in a PBL tutorial
  • Slide 59
  • Examples of trigger material for PBL scenarios
  • PBL tutorial process
  • Slide 62
  • PBL in curriculum design
  • Slide 64
  • Writing PBL scenarios
  • Slide 66
  • Staff development
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • Slide 70
  • Advantages of PBL
  • Slide 72
  • Slide 73
  • Disadvantages
  • Assessment of PBL
  • Slide 76
  • Conclusion
  • Slide 78
  • PBL 5 Easy Steps
  • 2 Brain storm
  • Brainstorm
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • THE FIRST GROUP SESSION
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
Page 28: Problem based learning

Learn from each other

bullShare your own knowledge expertise or ability to reason and synthesize information Be receptive and appreciative of the contribution of your small group members

Determine priorities for learning

bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue

bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan

bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge

bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career

PBL

bull The problem comes first without advance readings lectures or preparation

bull The problem serves as a stimulus for the need to know

Learning Issues

bull Learning issues are questions that cannot be answered with studentsrsquo current knowledge and that can be explored and answered through systematic self-directed inquiry

bull The use of learning issues in tutorials prepares students to handle similar challenges in clinical practice and life-long learning

Learning Issues in PBL First Session1 Getting Started (Introductions Ground

Rules Expectations)2 Identifying Problem3 Exploring Pre-Existing Knowledge4 Generating Hypotheses and Explaining

Mechanisms5 Unfolding the Case Incrementally6 Re-EvaluatingReprioritizing Hypotheses

Based on New Information7 AssessmentReflection

PBL Second Session

8 Independent Self-Directed Study of Learning Issues

PBL Third Session

bull 9 Discussion of Learning Issues and Application of New Knowledge to the Case

bull 10 Continued Unfolding of the Case Incrementally

bull 11 AssessmentReflection

During Tutorial Session students will

1048708 Come prepared to discuss the case and learning issues researched since the last tutorial

1048708 Actively participate in group discussions and contribute to the learning process in a manner that allows for the balanced participation of everyone in the group

1048708 Develop learning issues at each session phrase them as full-sentence questions write them on the board and post them on the course web page

1048708 Consider biological population behaviormental health issuesexplanations and questions of professional attitudes values and ethics related to the patientrsquos problem(s) described in the case

Tutorial Session contd1048708 Go to the board to diagram outline draw etc in

explanation of mechanisms relatedto hypotheses1048708 Debate evidence related to the case and avoid

personal attacks on others1048708 Comply with ground rules with regard to how

the group will function and how itsmembers treat one another1048708 Participate in end-of-session reflection and

assessment by giving and receivingconstructive criticism regarding self tutor

student and group performance

Between Tutorial Session

1048708 Research key learning issues using a variety of resources

1048708 Critically evaluate the credibility of sources and the validity of the information they have obtained in their research

1048708 Integrate what they have learned through research lectures labs clinical skills Perspectives in Medicine (PIM) etc into what is discussed in tutorials

1048708 Synthesize what they have learned and be prepared to discuss it without reading directly from their materials as much as possible and apply it to the case at the next tutorial session

Determine priorities for learning

bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue

bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan

bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge

bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career

PBL Starting the casebull After the introductions and discussion

are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it

bull Reading the case aloud keeps the group focused

bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here

Problem-based learning is designed to develop

1048708 Integrated context-specific knowledge base

1048708 Decision-makingcritical thinking process and skills

1048708 Self-directed life-long learning skills 1048708 Interpersonal collaboration and

communication skills 1048708 Constructive self and peer

assessment skills 1048708 Professional ethics and behavior

PBL Case (contd)

bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session

What is problem based learning

bull In PBL students use triggers from the problem case or scenario to define their own learning objectives

bull Subsequently they do independent self directed study before returning to the group to discuss and refine their acquired knowledge

bull Thus PBL is not about problem solving per se but rather it uses appropriate problems to increase knowledge and understanding

bull The process is clearly defined

PBL

bull PBL uses clinical cases as the context for students to study basic and clinical sciences

bull Its possible advantages over traditional approaches include its greater relevance to the practice of medicine its ability to promote retention and application of knowledge and its encouragement of self-directed life-long learning

bull Possible disadvantages include higher costs both in resources and staff time

PBL

bull An educational method characterized by the use of patient problems as a context for students to learn problem-solving skills and acquire knowledge about the basic and clinical sciences

bull Students usually meet in small groups two or three times a week for PBL tutorials

bull They are presented with a clinical problem (eg a patient with chest pain) and in a series of steps they discuss possible mechanisms and causes develop hypotheses and strategies to test the hypotheses are presented with further information and use this new information to refine their hypotheses finally reaching a conclusion

bull A tutor usually acts as a facilitator guiding students in this group-learning process

bull In the course of this exercise students identify both their existing levels and gaps in their knowledge These gaps form the basis for independent learning outside the PBL tutorials The identification and pursuit of these so-called learning goals is a key element of the PBL process

Rationale for using PBL bull The PBL approach is based on principles of adult

education20 and cognitive psychology21 It differs fundamentally from traditional curricula in which students acquire background knowledge of the basic sciences in the early years of the course and in the later years apply this knowledge to the diagnosis and management of clinical problems This traditional approach has been criticised for a number of reasons42223

bull It creates an artificial divide between the basic and clinical sciences

bull Time is wasted in acquiring knowledge that is subsequently forgotten or found to be irrelevant

bull Application of the acquired knowledge can be difficult bull The acquisition and retention of information that has no

apparent relevance can be boring and even demoralising for students

The group learning process acquiring

desirable learning skills

Generic Skills amp attitudes

bull Teamwork bull Critical evaluation of literature bull Chairing a group bull Self directed learning and use of

resources bull Listening Presentation skills

Recording bull Cooperation bull Respect for colleagues views

bull Group learning facilitates not only the acquisition of knowledge but also several other desirable attributes such as communication skills teamwork problem solving independent responsibility for learning sharing information and respect for others PBL can therefore be thought of as a small group teaching method that combines the acquisition of knowledge with the development of generic skills and attitudes Presentation of clinical material as the stimulus for learning enables students to understand the relevance of underlying scientific knowledge and principles in clinical practice

bull when PBL is introduced into a curriculum several other issues for curriculum design and implementation need to be tackled PBL is generally introduced in the context of a defined core curriculum and integration of basic and clinical sciences It has implications for staffing and learning resources and demands a different approach to timetabling workload and assessment PBL is often used to deliver core material in non-clinical parts of the curriculum Paper based PBL scenarios form the basis of the core curriculum and ensure that all students are exposed to the same problems Recently modified PBL techniques have been introduced into clinical education with real patients being used as the stimulus for learning Despite the essential ad hoc nature of learning clinical medicine a key cases approach can enable PBL to be used to deliver the core clinical curriculum

Copyright copy2003 BMJ Publishing Group Ltd

Wood D F BMJ 2003326328-330

No CRoles of participants in a PBL tutorial aption Found

What happens in a PBL tutorial bull PBL tutorials are conducted in several ways In

this article the examples are modelled on the Maastricht seven jump process but its format of seven steps may be shortened

bull A typical PBL tutorial consists of a group of students (usually eight to 10) and a tutor who facilitates the session The length of time (number of sessions) that a group stays together with each other and with individual tutors varies between institutions A group needs to be together long enough to allow good group dynamics to develop but may need to be changed occasionally if personality clashes or other dysfunctional behaviour emerges

bull Students elect a chair for each PBL scenario and a scribe to record the discussion The roles are rotated for each scenario Suitable flip charts or a whiteboard should be used for recording the proceedings At the start of the session depending on the trigger material either the student chair reads out the scenario or all students study the material If the trigger is a real patient in a ward clinic or surgery then a student may be asked to take a clinical history or identify an abnormal physical sign before the group moves to a tutorial room For each module students may be given a handbook containing the problem scenarios and suggested learning resources or learning materials may be handed out at appropriate times as the tutorials progress

Examples of trigger material for PBL scenarios bull Paper based clinical scenarios bull Experimental or clinical laboratory data bull Photographs bull Video clips bull Newspaper articles bull All or part of an article from a scientific

journal bull A real or simulated patient bull A family tree showing an inherited

disorder

PBL tutorial process ndash Step 1 Identify and clarify unfamiliar terms presented in the scenario

scribe lists those that remain unexplained after discussion ndash Step 2 Define the problem or problems to be discussed students may

have different views on the issues but all should be considered scribe records a list of agreed problems

ndash Step 3 Brainstorming session to discuss the problem(s) suggestingpossible explanations on basis of prior knowledge students draw on each others knowledge and identify areas of incomplete knowledge scribe records all discussion

ndash Step 4 Review steps 2 and 3 and arrange explanations into tentativesolutions scribe organises the explanations and restructures if necessary

ndash Step 5 Formulate learning objectives group reaches consensus onthe learning objectives tutor ensures learning objectives are focused achievable comprehensive and appropriate

ndash Step 6 Private study (all students gather information related to eachlearning objective)

ndash Step 7 Group shares results of private study (students identify theirlearning resources and share their results) tutor checks learning and may assess the group

bull The role of the tutor is to facilitate the proceedings (helping the chair to maintain group dynamics and moving the group through the task) and to ensure that the group achieves appropriate learning objectives in line with those set by the curriculum design team The tutor may need to take a more active role in step 7 of the process to ensure that all the students have done the appropriate work and to help the chair to suggest a suitable format for group members to use to present the results of their private study The tutor should encourage students to check their understanding of the material He or she can do this by encouraging the students to ask open questions and ask each other to explain topics in their own words or by the use of drawings and diagrams

PBL in curriculum design bull PBL may be used either as the mainstay of an entire

curriculum or for the delivery of individual courses In practice PBL is usually part of an integrated curriculum using a systems based approach with non-clinical material delivered in the context of clinical practice A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge skills and attitudes A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios Sufficient time should be allowed each week for students to do the self directed learning required for PBL

bull

Copyright copy2003 BMJ Publishing Group Ltd

Wood D F BMJ 2003326328-330

No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found

Writing PBL scenarios

bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives

bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after

studying the scenario should be consistent with the faculty learning objectives

bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding

bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice

bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge

bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented

bull The problem should be sufficiently open so that discussion is not curtailed too early in the process

bull Scenarios should promote participation by the students in seeking information from various learning resources

bull Adapted from Dolmans et al Med Teacher 199719185-9

Staff development

bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)

A dysfunctional group a dominant character may

make it difficult for other students to be heard

A dysfunctional group a dominant character may make it difficult for other students to be heard

bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties

Advantages of PBL bull Student centred PBLIt fostersactive learning improved

understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks

Disadvantagesbull Tutors who cant teachTutorsenjoy passing on

their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful

Assessment of PBL

bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods

bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL

Conclusion

bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning

bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL

PBL 5 Easy Steps

bull Read the problem

Mrs Paula Embledon

Mrs Paula Embledon is a 78 year old woman who has come to the emergency room complaining of shortness of breath and pain in her chest She had been in relatively good health until three weeks previously when she sprained

2 Brain storm

bull Brainstorm

bull ndash hypotheses

bull - what do we know in support of the hypothesis

bull - what do we need to know to test the hypothesis

ndash learning issues

Brainstorm

bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)

ndash specific issues (for individuals to look up)

ndash overlapping issues

bull 4 Individual Reading - Research - Preparation

bull 5 Return

bull ndash review case so far ndash report and discuss

ndash assess progress - continue pagenext pagecomplete

ndash self-evaluation - How did things go Any suggestions for next time

ndash next problem

bull 5 Return

THE FIRST GROUP SESSION

bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day

bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session

bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr

bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine

bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise

bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator

bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues

bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know

bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)

bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)

bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)

  • PROBLEM BASED LEARNING
  • New Horizons in Medical Education
  • Slide 3
  • Domains of essential Global Requirements of ME
  • What was the response to these challenges
  • New Educational Strategies
  • New Tools amp Aids
  • PBL
  • PBL
  • Advantages
  • Slide 11
  • Slide 12
  • Slide 13
  • Slide 14
  • Framework for PBL
  • Framework for PBL - II
  • Characteristics of an effective PBL Group
  • Staff Development
  • Tutorrsquos Role in Assessment
  • Slide 20
  • Evaluating PBL Tutorials-II
  • PBL
  • Slide 23
  • PBL Starting the case
  • PBL Case (contd)
  • PBL Case contd
  • The Process of PBL
  • The Process of PBL contd
  • Learn from each other
  • Determine priorities for learning
  • Slide 31
  • Slide 32
  • Learning Issues
  • Learning Issues in PBL First Session
  • PBL Second Session
  • PBL Third Session
  • Slide 37
  • Slide 38
  • During Tutorial Session students will
  • Tutorial Session contd
  • Between Tutorial Session
  • Slide 42
  • Slide 43
  • Problem-based learning is designed to develop
  • Slide 45
  • What is problem based learning
  • Slide 47
  • Slide 48
  • Slide 49
  • Rationale for using PBL
  • Slide 51
  • Slide 52
  • The group learning process acquiring desirable learning skills
  • Generic Skills amp attitudes
  • Slide 55
  • Slide 56
  • Slide 57
  • What happens in a PBL tutorial
  • Slide 59
  • Examples of trigger material for PBL scenarios
  • PBL tutorial process
  • Slide 62
  • PBL in curriculum design
  • Slide 64
  • Writing PBL scenarios
  • Slide 66
  • Staff development
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • Slide 70
  • Advantages of PBL
  • Slide 72
  • Slide 73
  • Disadvantages
  • Assessment of PBL
  • Slide 76
  • Conclusion
  • Slide 78
  • PBL 5 Easy Steps
  • 2 Brain storm
  • Brainstorm
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • THE FIRST GROUP SESSION
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
Page 29: Problem based learning

Determine priorities for learning

bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue

bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan

bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge

bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career

PBL

bull The problem comes first without advance readings lectures or preparation

bull The problem serves as a stimulus for the need to know

Learning Issues

bull Learning issues are questions that cannot be answered with studentsrsquo current knowledge and that can be explored and answered through systematic self-directed inquiry

bull The use of learning issues in tutorials prepares students to handle similar challenges in clinical practice and life-long learning

Learning Issues in PBL First Session1 Getting Started (Introductions Ground

Rules Expectations)2 Identifying Problem3 Exploring Pre-Existing Knowledge4 Generating Hypotheses and Explaining

Mechanisms5 Unfolding the Case Incrementally6 Re-EvaluatingReprioritizing Hypotheses

Based on New Information7 AssessmentReflection

PBL Second Session

8 Independent Self-Directed Study of Learning Issues

PBL Third Session

bull 9 Discussion of Learning Issues and Application of New Knowledge to the Case

bull 10 Continued Unfolding of the Case Incrementally

bull 11 AssessmentReflection

During Tutorial Session students will

1048708 Come prepared to discuss the case and learning issues researched since the last tutorial

1048708 Actively participate in group discussions and contribute to the learning process in a manner that allows for the balanced participation of everyone in the group

1048708 Develop learning issues at each session phrase them as full-sentence questions write them on the board and post them on the course web page

1048708 Consider biological population behaviormental health issuesexplanations and questions of professional attitudes values and ethics related to the patientrsquos problem(s) described in the case

Tutorial Session contd1048708 Go to the board to diagram outline draw etc in

explanation of mechanisms relatedto hypotheses1048708 Debate evidence related to the case and avoid

personal attacks on others1048708 Comply with ground rules with regard to how

the group will function and how itsmembers treat one another1048708 Participate in end-of-session reflection and

assessment by giving and receivingconstructive criticism regarding self tutor

student and group performance

Between Tutorial Session

1048708 Research key learning issues using a variety of resources

1048708 Critically evaluate the credibility of sources and the validity of the information they have obtained in their research

1048708 Integrate what they have learned through research lectures labs clinical skills Perspectives in Medicine (PIM) etc into what is discussed in tutorials

1048708 Synthesize what they have learned and be prepared to discuss it without reading directly from their materials as much as possible and apply it to the case at the next tutorial session

Determine priorities for learning

bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue

bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan

bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge

bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career

PBL Starting the casebull After the introductions and discussion

are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it

bull Reading the case aloud keeps the group focused

bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here

Problem-based learning is designed to develop

1048708 Integrated context-specific knowledge base

1048708 Decision-makingcritical thinking process and skills

1048708 Self-directed life-long learning skills 1048708 Interpersonal collaboration and

communication skills 1048708 Constructive self and peer

assessment skills 1048708 Professional ethics and behavior

PBL Case (contd)

bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session

What is problem based learning

bull In PBL students use triggers from the problem case or scenario to define their own learning objectives

bull Subsequently they do independent self directed study before returning to the group to discuss and refine their acquired knowledge

bull Thus PBL is not about problem solving per se but rather it uses appropriate problems to increase knowledge and understanding

bull The process is clearly defined

PBL

bull PBL uses clinical cases as the context for students to study basic and clinical sciences

bull Its possible advantages over traditional approaches include its greater relevance to the practice of medicine its ability to promote retention and application of knowledge and its encouragement of self-directed life-long learning

bull Possible disadvantages include higher costs both in resources and staff time

PBL

bull An educational method characterized by the use of patient problems as a context for students to learn problem-solving skills and acquire knowledge about the basic and clinical sciences

bull Students usually meet in small groups two or three times a week for PBL tutorials

bull They are presented with a clinical problem (eg a patient with chest pain) and in a series of steps they discuss possible mechanisms and causes develop hypotheses and strategies to test the hypotheses are presented with further information and use this new information to refine their hypotheses finally reaching a conclusion

bull A tutor usually acts as a facilitator guiding students in this group-learning process

bull In the course of this exercise students identify both their existing levels and gaps in their knowledge These gaps form the basis for independent learning outside the PBL tutorials The identification and pursuit of these so-called learning goals is a key element of the PBL process

Rationale for using PBL bull The PBL approach is based on principles of adult

education20 and cognitive psychology21 It differs fundamentally from traditional curricula in which students acquire background knowledge of the basic sciences in the early years of the course and in the later years apply this knowledge to the diagnosis and management of clinical problems This traditional approach has been criticised for a number of reasons42223

bull It creates an artificial divide between the basic and clinical sciences

bull Time is wasted in acquiring knowledge that is subsequently forgotten or found to be irrelevant

bull Application of the acquired knowledge can be difficult bull The acquisition and retention of information that has no

apparent relevance can be boring and even demoralising for students

The group learning process acquiring

desirable learning skills

Generic Skills amp attitudes

bull Teamwork bull Critical evaluation of literature bull Chairing a group bull Self directed learning and use of

resources bull Listening Presentation skills

Recording bull Cooperation bull Respect for colleagues views

bull Group learning facilitates not only the acquisition of knowledge but also several other desirable attributes such as communication skills teamwork problem solving independent responsibility for learning sharing information and respect for others PBL can therefore be thought of as a small group teaching method that combines the acquisition of knowledge with the development of generic skills and attitudes Presentation of clinical material as the stimulus for learning enables students to understand the relevance of underlying scientific knowledge and principles in clinical practice

bull when PBL is introduced into a curriculum several other issues for curriculum design and implementation need to be tackled PBL is generally introduced in the context of a defined core curriculum and integration of basic and clinical sciences It has implications for staffing and learning resources and demands a different approach to timetabling workload and assessment PBL is often used to deliver core material in non-clinical parts of the curriculum Paper based PBL scenarios form the basis of the core curriculum and ensure that all students are exposed to the same problems Recently modified PBL techniques have been introduced into clinical education with real patients being used as the stimulus for learning Despite the essential ad hoc nature of learning clinical medicine a key cases approach can enable PBL to be used to deliver the core clinical curriculum

Copyright copy2003 BMJ Publishing Group Ltd

Wood D F BMJ 2003326328-330

No CRoles of participants in a PBL tutorial aption Found

What happens in a PBL tutorial bull PBL tutorials are conducted in several ways In

this article the examples are modelled on the Maastricht seven jump process but its format of seven steps may be shortened

bull A typical PBL tutorial consists of a group of students (usually eight to 10) and a tutor who facilitates the session The length of time (number of sessions) that a group stays together with each other and with individual tutors varies between institutions A group needs to be together long enough to allow good group dynamics to develop but may need to be changed occasionally if personality clashes or other dysfunctional behaviour emerges

bull Students elect a chair for each PBL scenario and a scribe to record the discussion The roles are rotated for each scenario Suitable flip charts or a whiteboard should be used for recording the proceedings At the start of the session depending on the trigger material either the student chair reads out the scenario or all students study the material If the trigger is a real patient in a ward clinic or surgery then a student may be asked to take a clinical history or identify an abnormal physical sign before the group moves to a tutorial room For each module students may be given a handbook containing the problem scenarios and suggested learning resources or learning materials may be handed out at appropriate times as the tutorials progress

Examples of trigger material for PBL scenarios bull Paper based clinical scenarios bull Experimental or clinical laboratory data bull Photographs bull Video clips bull Newspaper articles bull All or part of an article from a scientific

journal bull A real or simulated patient bull A family tree showing an inherited

disorder

PBL tutorial process ndash Step 1 Identify and clarify unfamiliar terms presented in the scenario

scribe lists those that remain unexplained after discussion ndash Step 2 Define the problem or problems to be discussed students may

have different views on the issues but all should be considered scribe records a list of agreed problems

ndash Step 3 Brainstorming session to discuss the problem(s) suggestingpossible explanations on basis of prior knowledge students draw on each others knowledge and identify areas of incomplete knowledge scribe records all discussion

ndash Step 4 Review steps 2 and 3 and arrange explanations into tentativesolutions scribe organises the explanations and restructures if necessary

ndash Step 5 Formulate learning objectives group reaches consensus onthe learning objectives tutor ensures learning objectives are focused achievable comprehensive and appropriate

ndash Step 6 Private study (all students gather information related to eachlearning objective)

ndash Step 7 Group shares results of private study (students identify theirlearning resources and share their results) tutor checks learning and may assess the group

bull The role of the tutor is to facilitate the proceedings (helping the chair to maintain group dynamics and moving the group through the task) and to ensure that the group achieves appropriate learning objectives in line with those set by the curriculum design team The tutor may need to take a more active role in step 7 of the process to ensure that all the students have done the appropriate work and to help the chair to suggest a suitable format for group members to use to present the results of their private study The tutor should encourage students to check their understanding of the material He or she can do this by encouraging the students to ask open questions and ask each other to explain topics in their own words or by the use of drawings and diagrams

PBL in curriculum design bull PBL may be used either as the mainstay of an entire

curriculum or for the delivery of individual courses In practice PBL is usually part of an integrated curriculum using a systems based approach with non-clinical material delivered in the context of clinical practice A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge skills and attitudes A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios Sufficient time should be allowed each week for students to do the self directed learning required for PBL

bull

Copyright copy2003 BMJ Publishing Group Ltd

Wood D F BMJ 2003326328-330

No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found

Writing PBL scenarios

bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives

bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after

studying the scenario should be consistent with the faculty learning objectives

bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding

bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice

bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge

bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented

bull The problem should be sufficiently open so that discussion is not curtailed too early in the process

bull Scenarios should promote participation by the students in seeking information from various learning resources

bull Adapted from Dolmans et al Med Teacher 199719185-9

Staff development

bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)

A dysfunctional group a dominant character may

make it difficult for other students to be heard

A dysfunctional group a dominant character may make it difficult for other students to be heard

bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties

Advantages of PBL bull Student centred PBLIt fostersactive learning improved

understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks

Disadvantagesbull Tutors who cant teachTutorsenjoy passing on

their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful

Assessment of PBL

bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods

bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL

Conclusion

bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning

bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL

PBL 5 Easy Steps

bull Read the problem

Mrs Paula Embledon

Mrs Paula Embledon is a 78 year old woman who has come to the emergency room complaining of shortness of breath and pain in her chest She had been in relatively good health until three weeks previously when she sprained

2 Brain storm

bull Brainstorm

bull ndash hypotheses

bull - what do we know in support of the hypothesis

bull - what do we need to know to test the hypothesis

ndash learning issues

Brainstorm

bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)

ndash specific issues (for individuals to look up)

ndash overlapping issues

bull 4 Individual Reading - Research - Preparation

bull 5 Return

bull ndash review case so far ndash report and discuss

ndash assess progress - continue pagenext pagecomplete

ndash self-evaluation - How did things go Any suggestions for next time

ndash next problem

bull 5 Return

THE FIRST GROUP SESSION

bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day

bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session

bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr

bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine

bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise

bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator

bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues

bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know

bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)

bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)

bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)

  • PROBLEM BASED LEARNING
  • New Horizons in Medical Education
  • Slide 3
  • Domains of essential Global Requirements of ME
  • What was the response to these challenges
  • New Educational Strategies
  • New Tools amp Aids
  • PBL
  • PBL
  • Advantages
  • Slide 11
  • Slide 12
  • Slide 13
  • Slide 14
  • Framework for PBL
  • Framework for PBL - II
  • Characteristics of an effective PBL Group
  • Staff Development
  • Tutorrsquos Role in Assessment
  • Slide 20
  • Evaluating PBL Tutorials-II
  • PBL
  • Slide 23
  • PBL Starting the case
  • PBL Case (contd)
  • PBL Case contd
  • The Process of PBL
  • The Process of PBL contd
  • Learn from each other
  • Determine priorities for learning
  • Slide 31
  • Slide 32
  • Learning Issues
  • Learning Issues in PBL First Session
  • PBL Second Session
  • PBL Third Session
  • Slide 37
  • Slide 38
  • During Tutorial Session students will
  • Tutorial Session contd
  • Between Tutorial Session
  • Slide 42
  • Slide 43
  • Problem-based learning is designed to develop
  • Slide 45
  • What is problem based learning
  • Slide 47
  • Slide 48
  • Slide 49
  • Rationale for using PBL
  • Slide 51
  • Slide 52
  • The group learning process acquiring desirable learning skills
  • Generic Skills amp attitudes
  • Slide 55
  • Slide 56
  • Slide 57
  • What happens in a PBL tutorial
  • Slide 59
  • Examples of trigger material for PBL scenarios
  • PBL tutorial process
  • Slide 62
  • PBL in curriculum design
  • Slide 64
  • Writing PBL scenarios
  • Slide 66
  • Staff development
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • Slide 70
  • Advantages of PBL
  • Slide 72
  • Slide 73
  • Disadvantages
  • Assessment of PBL
  • Slide 76
  • Conclusion
  • Slide 78
  • PBL 5 Easy Steps
  • 2 Brain storm
  • Brainstorm
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • THE FIRST GROUP SESSION
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
Page 30: Problem based learning

bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge

bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career

PBL

bull The problem comes first without advance readings lectures or preparation

bull The problem serves as a stimulus for the need to know

Learning Issues

bull Learning issues are questions that cannot be answered with studentsrsquo current knowledge and that can be explored and answered through systematic self-directed inquiry

bull The use of learning issues in tutorials prepares students to handle similar challenges in clinical practice and life-long learning

Learning Issues in PBL First Session1 Getting Started (Introductions Ground

Rules Expectations)2 Identifying Problem3 Exploring Pre-Existing Knowledge4 Generating Hypotheses and Explaining

Mechanisms5 Unfolding the Case Incrementally6 Re-EvaluatingReprioritizing Hypotheses

Based on New Information7 AssessmentReflection

PBL Second Session

8 Independent Self-Directed Study of Learning Issues

PBL Third Session

bull 9 Discussion of Learning Issues and Application of New Knowledge to the Case

bull 10 Continued Unfolding of the Case Incrementally

bull 11 AssessmentReflection

During Tutorial Session students will

1048708 Come prepared to discuss the case and learning issues researched since the last tutorial

1048708 Actively participate in group discussions and contribute to the learning process in a manner that allows for the balanced participation of everyone in the group

1048708 Develop learning issues at each session phrase them as full-sentence questions write them on the board and post them on the course web page

1048708 Consider biological population behaviormental health issuesexplanations and questions of professional attitudes values and ethics related to the patientrsquos problem(s) described in the case

Tutorial Session contd1048708 Go to the board to diagram outline draw etc in

explanation of mechanisms relatedto hypotheses1048708 Debate evidence related to the case and avoid

personal attacks on others1048708 Comply with ground rules with regard to how

the group will function and how itsmembers treat one another1048708 Participate in end-of-session reflection and

assessment by giving and receivingconstructive criticism regarding self tutor

student and group performance

Between Tutorial Session

1048708 Research key learning issues using a variety of resources

1048708 Critically evaluate the credibility of sources and the validity of the information they have obtained in their research

1048708 Integrate what they have learned through research lectures labs clinical skills Perspectives in Medicine (PIM) etc into what is discussed in tutorials

1048708 Synthesize what they have learned and be prepared to discuss it without reading directly from their materials as much as possible and apply it to the case at the next tutorial session

Determine priorities for learning

bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue

bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan

bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge

bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career

PBL Starting the casebull After the introductions and discussion

are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it

bull Reading the case aloud keeps the group focused

bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here

Problem-based learning is designed to develop

1048708 Integrated context-specific knowledge base

1048708 Decision-makingcritical thinking process and skills

1048708 Self-directed life-long learning skills 1048708 Interpersonal collaboration and

communication skills 1048708 Constructive self and peer

assessment skills 1048708 Professional ethics and behavior

PBL Case (contd)

bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session

What is problem based learning

bull In PBL students use triggers from the problem case or scenario to define their own learning objectives

bull Subsequently they do independent self directed study before returning to the group to discuss and refine their acquired knowledge

bull Thus PBL is not about problem solving per se but rather it uses appropriate problems to increase knowledge and understanding

bull The process is clearly defined

PBL

bull PBL uses clinical cases as the context for students to study basic and clinical sciences

bull Its possible advantages over traditional approaches include its greater relevance to the practice of medicine its ability to promote retention and application of knowledge and its encouragement of self-directed life-long learning

bull Possible disadvantages include higher costs both in resources and staff time

PBL

bull An educational method characterized by the use of patient problems as a context for students to learn problem-solving skills and acquire knowledge about the basic and clinical sciences

bull Students usually meet in small groups two or three times a week for PBL tutorials

bull They are presented with a clinical problem (eg a patient with chest pain) and in a series of steps they discuss possible mechanisms and causes develop hypotheses and strategies to test the hypotheses are presented with further information and use this new information to refine their hypotheses finally reaching a conclusion

bull A tutor usually acts as a facilitator guiding students in this group-learning process

bull In the course of this exercise students identify both their existing levels and gaps in their knowledge These gaps form the basis for independent learning outside the PBL tutorials The identification and pursuit of these so-called learning goals is a key element of the PBL process

Rationale for using PBL bull The PBL approach is based on principles of adult

education20 and cognitive psychology21 It differs fundamentally from traditional curricula in which students acquire background knowledge of the basic sciences in the early years of the course and in the later years apply this knowledge to the diagnosis and management of clinical problems This traditional approach has been criticised for a number of reasons42223

bull It creates an artificial divide between the basic and clinical sciences

bull Time is wasted in acquiring knowledge that is subsequently forgotten or found to be irrelevant

bull Application of the acquired knowledge can be difficult bull The acquisition and retention of information that has no

apparent relevance can be boring and even demoralising for students

The group learning process acquiring

desirable learning skills

Generic Skills amp attitudes

bull Teamwork bull Critical evaluation of literature bull Chairing a group bull Self directed learning and use of

resources bull Listening Presentation skills

Recording bull Cooperation bull Respect for colleagues views

bull Group learning facilitates not only the acquisition of knowledge but also several other desirable attributes such as communication skills teamwork problem solving independent responsibility for learning sharing information and respect for others PBL can therefore be thought of as a small group teaching method that combines the acquisition of knowledge with the development of generic skills and attitudes Presentation of clinical material as the stimulus for learning enables students to understand the relevance of underlying scientific knowledge and principles in clinical practice

bull when PBL is introduced into a curriculum several other issues for curriculum design and implementation need to be tackled PBL is generally introduced in the context of a defined core curriculum and integration of basic and clinical sciences It has implications for staffing and learning resources and demands a different approach to timetabling workload and assessment PBL is often used to deliver core material in non-clinical parts of the curriculum Paper based PBL scenarios form the basis of the core curriculum and ensure that all students are exposed to the same problems Recently modified PBL techniques have been introduced into clinical education with real patients being used as the stimulus for learning Despite the essential ad hoc nature of learning clinical medicine a key cases approach can enable PBL to be used to deliver the core clinical curriculum

Copyright copy2003 BMJ Publishing Group Ltd

Wood D F BMJ 2003326328-330

No CRoles of participants in a PBL tutorial aption Found

What happens in a PBL tutorial bull PBL tutorials are conducted in several ways In

this article the examples are modelled on the Maastricht seven jump process but its format of seven steps may be shortened

bull A typical PBL tutorial consists of a group of students (usually eight to 10) and a tutor who facilitates the session The length of time (number of sessions) that a group stays together with each other and with individual tutors varies between institutions A group needs to be together long enough to allow good group dynamics to develop but may need to be changed occasionally if personality clashes or other dysfunctional behaviour emerges

bull Students elect a chair for each PBL scenario and a scribe to record the discussion The roles are rotated for each scenario Suitable flip charts or a whiteboard should be used for recording the proceedings At the start of the session depending on the trigger material either the student chair reads out the scenario or all students study the material If the trigger is a real patient in a ward clinic or surgery then a student may be asked to take a clinical history or identify an abnormal physical sign before the group moves to a tutorial room For each module students may be given a handbook containing the problem scenarios and suggested learning resources or learning materials may be handed out at appropriate times as the tutorials progress

Examples of trigger material for PBL scenarios bull Paper based clinical scenarios bull Experimental or clinical laboratory data bull Photographs bull Video clips bull Newspaper articles bull All or part of an article from a scientific

journal bull A real or simulated patient bull A family tree showing an inherited

disorder

PBL tutorial process ndash Step 1 Identify and clarify unfamiliar terms presented in the scenario

scribe lists those that remain unexplained after discussion ndash Step 2 Define the problem or problems to be discussed students may

have different views on the issues but all should be considered scribe records a list of agreed problems

ndash Step 3 Brainstorming session to discuss the problem(s) suggestingpossible explanations on basis of prior knowledge students draw on each others knowledge and identify areas of incomplete knowledge scribe records all discussion

ndash Step 4 Review steps 2 and 3 and arrange explanations into tentativesolutions scribe organises the explanations and restructures if necessary

ndash Step 5 Formulate learning objectives group reaches consensus onthe learning objectives tutor ensures learning objectives are focused achievable comprehensive and appropriate

ndash Step 6 Private study (all students gather information related to eachlearning objective)

ndash Step 7 Group shares results of private study (students identify theirlearning resources and share their results) tutor checks learning and may assess the group

bull The role of the tutor is to facilitate the proceedings (helping the chair to maintain group dynamics and moving the group through the task) and to ensure that the group achieves appropriate learning objectives in line with those set by the curriculum design team The tutor may need to take a more active role in step 7 of the process to ensure that all the students have done the appropriate work and to help the chair to suggest a suitable format for group members to use to present the results of their private study The tutor should encourage students to check their understanding of the material He or she can do this by encouraging the students to ask open questions and ask each other to explain topics in their own words or by the use of drawings and diagrams

PBL in curriculum design bull PBL may be used either as the mainstay of an entire

curriculum or for the delivery of individual courses In practice PBL is usually part of an integrated curriculum using a systems based approach with non-clinical material delivered in the context of clinical practice A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge skills and attitudes A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios Sufficient time should be allowed each week for students to do the self directed learning required for PBL

bull

Copyright copy2003 BMJ Publishing Group Ltd

Wood D F BMJ 2003326328-330

No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found

Writing PBL scenarios

bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives

bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after

studying the scenario should be consistent with the faculty learning objectives

bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding

bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice

bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge

bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented

bull The problem should be sufficiently open so that discussion is not curtailed too early in the process

bull Scenarios should promote participation by the students in seeking information from various learning resources

bull Adapted from Dolmans et al Med Teacher 199719185-9

Staff development

bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)

A dysfunctional group a dominant character may

make it difficult for other students to be heard

A dysfunctional group a dominant character may make it difficult for other students to be heard

bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties

Advantages of PBL bull Student centred PBLIt fostersactive learning improved

understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks

Disadvantagesbull Tutors who cant teachTutorsenjoy passing on

their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful

Assessment of PBL

bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods

bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL

Conclusion

bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning

bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL

PBL 5 Easy Steps

bull Read the problem

Mrs Paula Embledon

Mrs Paula Embledon is a 78 year old woman who has come to the emergency room complaining of shortness of breath and pain in her chest She had been in relatively good health until three weeks previously when she sprained

2 Brain storm

bull Brainstorm

bull ndash hypotheses

bull - what do we know in support of the hypothesis

bull - what do we need to know to test the hypothesis

ndash learning issues

Brainstorm

bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)

ndash specific issues (for individuals to look up)

ndash overlapping issues

bull 4 Individual Reading - Research - Preparation

bull 5 Return

bull ndash review case so far ndash report and discuss

ndash assess progress - continue pagenext pagecomplete

ndash self-evaluation - How did things go Any suggestions for next time

ndash next problem

bull 5 Return

THE FIRST GROUP SESSION

bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day

bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session

bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr

bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine

bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise

bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator

bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues

bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know

bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)

bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)

bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)

  • PROBLEM BASED LEARNING
  • New Horizons in Medical Education
  • Slide 3
  • Domains of essential Global Requirements of ME
  • What was the response to these challenges
  • New Educational Strategies
  • New Tools amp Aids
  • PBL
  • PBL
  • Advantages
  • Slide 11
  • Slide 12
  • Slide 13
  • Slide 14
  • Framework for PBL
  • Framework for PBL - II
  • Characteristics of an effective PBL Group
  • Staff Development
  • Tutorrsquos Role in Assessment
  • Slide 20
  • Evaluating PBL Tutorials-II
  • PBL
  • Slide 23
  • PBL Starting the case
  • PBL Case (contd)
  • PBL Case contd
  • The Process of PBL
  • The Process of PBL contd
  • Learn from each other
  • Determine priorities for learning
  • Slide 31
  • Slide 32
  • Learning Issues
  • Learning Issues in PBL First Session
  • PBL Second Session
  • PBL Third Session
  • Slide 37
  • Slide 38
  • During Tutorial Session students will
  • Tutorial Session contd
  • Between Tutorial Session
  • Slide 42
  • Slide 43
  • Problem-based learning is designed to develop
  • Slide 45
  • What is problem based learning
  • Slide 47
  • Slide 48
  • Slide 49
  • Rationale for using PBL
  • Slide 51
  • Slide 52
  • The group learning process acquiring desirable learning skills
  • Generic Skills amp attitudes
  • Slide 55
  • Slide 56
  • Slide 57
  • What happens in a PBL tutorial
  • Slide 59
  • Examples of trigger material for PBL scenarios
  • PBL tutorial process
  • Slide 62
  • PBL in curriculum design
  • Slide 64
  • Writing PBL scenarios
  • Slide 66
  • Staff development
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • Slide 70
  • Advantages of PBL
  • Slide 72
  • Slide 73
  • Disadvantages
  • Assessment of PBL
  • Slide 76
  • Conclusion
  • Slide 78
  • PBL 5 Easy Steps
  • 2 Brain storm
  • Brainstorm
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • THE FIRST GROUP SESSION
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
Page 31: Problem based learning

PBL

bull The problem comes first without advance readings lectures or preparation

bull The problem serves as a stimulus for the need to know

Learning Issues

bull Learning issues are questions that cannot be answered with studentsrsquo current knowledge and that can be explored and answered through systematic self-directed inquiry

bull The use of learning issues in tutorials prepares students to handle similar challenges in clinical practice and life-long learning

Learning Issues in PBL First Session1 Getting Started (Introductions Ground

Rules Expectations)2 Identifying Problem3 Exploring Pre-Existing Knowledge4 Generating Hypotheses and Explaining

Mechanisms5 Unfolding the Case Incrementally6 Re-EvaluatingReprioritizing Hypotheses

Based on New Information7 AssessmentReflection

PBL Second Session

8 Independent Self-Directed Study of Learning Issues

PBL Third Session

bull 9 Discussion of Learning Issues and Application of New Knowledge to the Case

bull 10 Continued Unfolding of the Case Incrementally

bull 11 AssessmentReflection

During Tutorial Session students will

1048708 Come prepared to discuss the case and learning issues researched since the last tutorial

1048708 Actively participate in group discussions and contribute to the learning process in a manner that allows for the balanced participation of everyone in the group

1048708 Develop learning issues at each session phrase them as full-sentence questions write them on the board and post them on the course web page

1048708 Consider biological population behaviormental health issuesexplanations and questions of professional attitudes values and ethics related to the patientrsquos problem(s) described in the case

Tutorial Session contd1048708 Go to the board to diagram outline draw etc in

explanation of mechanisms relatedto hypotheses1048708 Debate evidence related to the case and avoid

personal attacks on others1048708 Comply with ground rules with regard to how

the group will function and how itsmembers treat one another1048708 Participate in end-of-session reflection and

assessment by giving and receivingconstructive criticism regarding self tutor

student and group performance

Between Tutorial Session

1048708 Research key learning issues using a variety of resources

1048708 Critically evaluate the credibility of sources and the validity of the information they have obtained in their research

1048708 Integrate what they have learned through research lectures labs clinical skills Perspectives in Medicine (PIM) etc into what is discussed in tutorials

1048708 Synthesize what they have learned and be prepared to discuss it without reading directly from their materials as much as possible and apply it to the case at the next tutorial session

Determine priorities for learning

bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue

bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan

bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge

bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career

PBL Starting the casebull After the introductions and discussion

are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it

bull Reading the case aloud keeps the group focused

bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here

Problem-based learning is designed to develop

1048708 Integrated context-specific knowledge base

1048708 Decision-makingcritical thinking process and skills

1048708 Self-directed life-long learning skills 1048708 Interpersonal collaboration and

communication skills 1048708 Constructive self and peer

assessment skills 1048708 Professional ethics and behavior

PBL Case (contd)

bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session

What is problem based learning

bull In PBL students use triggers from the problem case or scenario to define their own learning objectives

bull Subsequently they do independent self directed study before returning to the group to discuss and refine their acquired knowledge

bull Thus PBL is not about problem solving per se but rather it uses appropriate problems to increase knowledge and understanding

bull The process is clearly defined

PBL

bull PBL uses clinical cases as the context for students to study basic and clinical sciences

bull Its possible advantages over traditional approaches include its greater relevance to the practice of medicine its ability to promote retention and application of knowledge and its encouragement of self-directed life-long learning

bull Possible disadvantages include higher costs both in resources and staff time

PBL

bull An educational method characterized by the use of patient problems as a context for students to learn problem-solving skills and acquire knowledge about the basic and clinical sciences

bull Students usually meet in small groups two or three times a week for PBL tutorials

bull They are presented with a clinical problem (eg a patient with chest pain) and in a series of steps they discuss possible mechanisms and causes develop hypotheses and strategies to test the hypotheses are presented with further information and use this new information to refine their hypotheses finally reaching a conclusion

bull A tutor usually acts as a facilitator guiding students in this group-learning process

bull In the course of this exercise students identify both their existing levels and gaps in their knowledge These gaps form the basis for independent learning outside the PBL tutorials The identification and pursuit of these so-called learning goals is a key element of the PBL process

Rationale for using PBL bull The PBL approach is based on principles of adult

education20 and cognitive psychology21 It differs fundamentally from traditional curricula in which students acquire background knowledge of the basic sciences in the early years of the course and in the later years apply this knowledge to the diagnosis and management of clinical problems This traditional approach has been criticised for a number of reasons42223

bull It creates an artificial divide between the basic and clinical sciences

bull Time is wasted in acquiring knowledge that is subsequently forgotten or found to be irrelevant

bull Application of the acquired knowledge can be difficult bull The acquisition and retention of information that has no

apparent relevance can be boring and even demoralising for students

The group learning process acquiring

desirable learning skills

Generic Skills amp attitudes

bull Teamwork bull Critical evaluation of literature bull Chairing a group bull Self directed learning and use of

resources bull Listening Presentation skills

Recording bull Cooperation bull Respect for colleagues views

bull Group learning facilitates not only the acquisition of knowledge but also several other desirable attributes such as communication skills teamwork problem solving independent responsibility for learning sharing information and respect for others PBL can therefore be thought of as a small group teaching method that combines the acquisition of knowledge with the development of generic skills and attitudes Presentation of clinical material as the stimulus for learning enables students to understand the relevance of underlying scientific knowledge and principles in clinical practice

bull when PBL is introduced into a curriculum several other issues for curriculum design and implementation need to be tackled PBL is generally introduced in the context of a defined core curriculum and integration of basic and clinical sciences It has implications for staffing and learning resources and demands a different approach to timetabling workload and assessment PBL is often used to deliver core material in non-clinical parts of the curriculum Paper based PBL scenarios form the basis of the core curriculum and ensure that all students are exposed to the same problems Recently modified PBL techniques have been introduced into clinical education with real patients being used as the stimulus for learning Despite the essential ad hoc nature of learning clinical medicine a key cases approach can enable PBL to be used to deliver the core clinical curriculum

Copyright copy2003 BMJ Publishing Group Ltd

Wood D F BMJ 2003326328-330

No CRoles of participants in a PBL tutorial aption Found

What happens in a PBL tutorial bull PBL tutorials are conducted in several ways In

this article the examples are modelled on the Maastricht seven jump process but its format of seven steps may be shortened

bull A typical PBL tutorial consists of a group of students (usually eight to 10) and a tutor who facilitates the session The length of time (number of sessions) that a group stays together with each other and with individual tutors varies between institutions A group needs to be together long enough to allow good group dynamics to develop but may need to be changed occasionally if personality clashes or other dysfunctional behaviour emerges

bull Students elect a chair for each PBL scenario and a scribe to record the discussion The roles are rotated for each scenario Suitable flip charts or a whiteboard should be used for recording the proceedings At the start of the session depending on the trigger material either the student chair reads out the scenario or all students study the material If the trigger is a real patient in a ward clinic or surgery then a student may be asked to take a clinical history or identify an abnormal physical sign before the group moves to a tutorial room For each module students may be given a handbook containing the problem scenarios and suggested learning resources or learning materials may be handed out at appropriate times as the tutorials progress

Examples of trigger material for PBL scenarios bull Paper based clinical scenarios bull Experimental or clinical laboratory data bull Photographs bull Video clips bull Newspaper articles bull All or part of an article from a scientific

journal bull A real or simulated patient bull A family tree showing an inherited

disorder

PBL tutorial process ndash Step 1 Identify and clarify unfamiliar terms presented in the scenario

scribe lists those that remain unexplained after discussion ndash Step 2 Define the problem or problems to be discussed students may

have different views on the issues but all should be considered scribe records a list of agreed problems

ndash Step 3 Brainstorming session to discuss the problem(s) suggestingpossible explanations on basis of prior knowledge students draw on each others knowledge and identify areas of incomplete knowledge scribe records all discussion

ndash Step 4 Review steps 2 and 3 and arrange explanations into tentativesolutions scribe organises the explanations and restructures if necessary

ndash Step 5 Formulate learning objectives group reaches consensus onthe learning objectives tutor ensures learning objectives are focused achievable comprehensive and appropriate

ndash Step 6 Private study (all students gather information related to eachlearning objective)

ndash Step 7 Group shares results of private study (students identify theirlearning resources and share their results) tutor checks learning and may assess the group

bull The role of the tutor is to facilitate the proceedings (helping the chair to maintain group dynamics and moving the group through the task) and to ensure that the group achieves appropriate learning objectives in line with those set by the curriculum design team The tutor may need to take a more active role in step 7 of the process to ensure that all the students have done the appropriate work and to help the chair to suggest a suitable format for group members to use to present the results of their private study The tutor should encourage students to check their understanding of the material He or she can do this by encouraging the students to ask open questions and ask each other to explain topics in their own words or by the use of drawings and diagrams

PBL in curriculum design bull PBL may be used either as the mainstay of an entire

curriculum or for the delivery of individual courses In practice PBL is usually part of an integrated curriculum using a systems based approach with non-clinical material delivered in the context of clinical practice A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge skills and attitudes A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios Sufficient time should be allowed each week for students to do the self directed learning required for PBL

bull

Copyright copy2003 BMJ Publishing Group Ltd

Wood D F BMJ 2003326328-330

No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found

Writing PBL scenarios

bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives

bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after

studying the scenario should be consistent with the faculty learning objectives

bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding

bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice

bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge

bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented

bull The problem should be sufficiently open so that discussion is not curtailed too early in the process

bull Scenarios should promote participation by the students in seeking information from various learning resources

bull Adapted from Dolmans et al Med Teacher 199719185-9

Staff development

bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)

A dysfunctional group a dominant character may

make it difficult for other students to be heard

A dysfunctional group a dominant character may make it difficult for other students to be heard

bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties

Advantages of PBL bull Student centred PBLIt fostersactive learning improved

understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks

Disadvantagesbull Tutors who cant teachTutorsenjoy passing on

their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful

Assessment of PBL

bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods

bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL

Conclusion

bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning

bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL

PBL 5 Easy Steps

bull Read the problem

Mrs Paula Embledon

Mrs Paula Embledon is a 78 year old woman who has come to the emergency room complaining of shortness of breath and pain in her chest She had been in relatively good health until three weeks previously when she sprained

2 Brain storm

bull Brainstorm

bull ndash hypotheses

bull - what do we know in support of the hypothesis

bull - what do we need to know to test the hypothesis

ndash learning issues

Brainstorm

bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)

ndash specific issues (for individuals to look up)

ndash overlapping issues

bull 4 Individual Reading - Research - Preparation

bull 5 Return

bull ndash review case so far ndash report and discuss

ndash assess progress - continue pagenext pagecomplete

ndash self-evaluation - How did things go Any suggestions for next time

ndash next problem

bull 5 Return

THE FIRST GROUP SESSION

bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day

bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session

bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr

bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine

bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise

bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator

bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues

bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know

bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)

bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)

bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)

  • PROBLEM BASED LEARNING
  • New Horizons in Medical Education
  • Slide 3
  • Domains of essential Global Requirements of ME
  • What was the response to these challenges
  • New Educational Strategies
  • New Tools amp Aids
  • PBL
  • PBL
  • Advantages
  • Slide 11
  • Slide 12
  • Slide 13
  • Slide 14
  • Framework for PBL
  • Framework for PBL - II
  • Characteristics of an effective PBL Group
  • Staff Development
  • Tutorrsquos Role in Assessment
  • Slide 20
  • Evaluating PBL Tutorials-II
  • PBL
  • Slide 23
  • PBL Starting the case
  • PBL Case (contd)
  • PBL Case contd
  • The Process of PBL
  • The Process of PBL contd
  • Learn from each other
  • Determine priorities for learning
  • Slide 31
  • Slide 32
  • Learning Issues
  • Learning Issues in PBL First Session
  • PBL Second Session
  • PBL Third Session
  • Slide 37
  • Slide 38
  • During Tutorial Session students will
  • Tutorial Session contd
  • Between Tutorial Session
  • Slide 42
  • Slide 43
  • Problem-based learning is designed to develop
  • Slide 45
  • What is problem based learning
  • Slide 47
  • Slide 48
  • Slide 49
  • Rationale for using PBL
  • Slide 51
  • Slide 52
  • The group learning process acquiring desirable learning skills
  • Generic Skills amp attitudes
  • Slide 55
  • Slide 56
  • Slide 57
  • What happens in a PBL tutorial
  • Slide 59
  • Examples of trigger material for PBL scenarios
  • PBL tutorial process
  • Slide 62
  • PBL in curriculum design
  • Slide 64
  • Writing PBL scenarios
  • Slide 66
  • Staff development
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • Slide 70
  • Advantages of PBL
  • Slide 72
  • Slide 73
  • Disadvantages
  • Assessment of PBL
  • Slide 76
  • Conclusion
  • Slide 78
  • PBL 5 Easy Steps
  • 2 Brain storm
  • Brainstorm
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • THE FIRST GROUP SESSION
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
Page 32: Problem based learning

Learning Issues

bull Learning issues are questions that cannot be answered with studentsrsquo current knowledge and that can be explored and answered through systematic self-directed inquiry

bull The use of learning issues in tutorials prepares students to handle similar challenges in clinical practice and life-long learning

Learning Issues in PBL First Session1 Getting Started (Introductions Ground

Rules Expectations)2 Identifying Problem3 Exploring Pre-Existing Knowledge4 Generating Hypotheses and Explaining

Mechanisms5 Unfolding the Case Incrementally6 Re-EvaluatingReprioritizing Hypotheses

Based on New Information7 AssessmentReflection

PBL Second Session

8 Independent Self-Directed Study of Learning Issues

PBL Third Session

bull 9 Discussion of Learning Issues and Application of New Knowledge to the Case

bull 10 Continued Unfolding of the Case Incrementally

bull 11 AssessmentReflection

During Tutorial Session students will

1048708 Come prepared to discuss the case and learning issues researched since the last tutorial

1048708 Actively participate in group discussions and contribute to the learning process in a manner that allows for the balanced participation of everyone in the group

1048708 Develop learning issues at each session phrase them as full-sentence questions write them on the board and post them on the course web page

1048708 Consider biological population behaviormental health issuesexplanations and questions of professional attitudes values and ethics related to the patientrsquos problem(s) described in the case

Tutorial Session contd1048708 Go to the board to diagram outline draw etc in

explanation of mechanisms relatedto hypotheses1048708 Debate evidence related to the case and avoid

personal attacks on others1048708 Comply with ground rules with regard to how

the group will function and how itsmembers treat one another1048708 Participate in end-of-session reflection and

assessment by giving and receivingconstructive criticism regarding self tutor

student and group performance

Between Tutorial Session

1048708 Research key learning issues using a variety of resources

1048708 Critically evaluate the credibility of sources and the validity of the information they have obtained in their research

1048708 Integrate what they have learned through research lectures labs clinical skills Perspectives in Medicine (PIM) etc into what is discussed in tutorials

1048708 Synthesize what they have learned and be prepared to discuss it without reading directly from their materials as much as possible and apply it to the case at the next tutorial session

Determine priorities for learning

bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue

bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan

bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge

bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career

PBL Starting the casebull After the introductions and discussion

are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it

bull Reading the case aloud keeps the group focused

bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here

Problem-based learning is designed to develop

1048708 Integrated context-specific knowledge base

1048708 Decision-makingcritical thinking process and skills

1048708 Self-directed life-long learning skills 1048708 Interpersonal collaboration and

communication skills 1048708 Constructive self and peer

assessment skills 1048708 Professional ethics and behavior

PBL Case (contd)

bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session

What is problem based learning

bull In PBL students use triggers from the problem case or scenario to define their own learning objectives

bull Subsequently they do independent self directed study before returning to the group to discuss and refine their acquired knowledge

bull Thus PBL is not about problem solving per se but rather it uses appropriate problems to increase knowledge and understanding

bull The process is clearly defined

PBL

bull PBL uses clinical cases as the context for students to study basic and clinical sciences

bull Its possible advantages over traditional approaches include its greater relevance to the practice of medicine its ability to promote retention and application of knowledge and its encouragement of self-directed life-long learning

bull Possible disadvantages include higher costs both in resources and staff time

PBL

bull An educational method characterized by the use of patient problems as a context for students to learn problem-solving skills and acquire knowledge about the basic and clinical sciences

bull Students usually meet in small groups two or three times a week for PBL tutorials

bull They are presented with a clinical problem (eg a patient with chest pain) and in a series of steps they discuss possible mechanisms and causes develop hypotheses and strategies to test the hypotheses are presented with further information and use this new information to refine their hypotheses finally reaching a conclusion

bull A tutor usually acts as a facilitator guiding students in this group-learning process

bull In the course of this exercise students identify both their existing levels and gaps in their knowledge These gaps form the basis for independent learning outside the PBL tutorials The identification and pursuit of these so-called learning goals is a key element of the PBL process

Rationale for using PBL bull The PBL approach is based on principles of adult

education20 and cognitive psychology21 It differs fundamentally from traditional curricula in which students acquire background knowledge of the basic sciences in the early years of the course and in the later years apply this knowledge to the diagnosis and management of clinical problems This traditional approach has been criticised for a number of reasons42223

bull It creates an artificial divide between the basic and clinical sciences

bull Time is wasted in acquiring knowledge that is subsequently forgotten or found to be irrelevant

bull Application of the acquired knowledge can be difficult bull The acquisition and retention of information that has no

apparent relevance can be boring and even demoralising for students

The group learning process acquiring

desirable learning skills

Generic Skills amp attitudes

bull Teamwork bull Critical evaluation of literature bull Chairing a group bull Self directed learning and use of

resources bull Listening Presentation skills

Recording bull Cooperation bull Respect for colleagues views

bull Group learning facilitates not only the acquisition of knowledge but also several other desirable attributes such as communication skills teamwork problem solving independent responsibility for learning sharing information and respect for others PBL can therefore be thought of as a small group teaching method that combines the acquisition of knowledge with the development of generic skills and attitudes Presentation of clinical material as the stimulus for learning enables students to understand the relevance of underlying scientific knowledge and principles in clinical practice

bull when PBL is introduced into a curriculum several other issues for curriculum design and implementation need to be tackled PBL is generally introduced in the context of a defined core curriculum and integration of basic and clinical sciences It has implications for staffing and learning resources and demands a different approach to timetabling workload and assessment PBL is often used to deliver core material in non-clinical parts of the curriculum Paper based PBL scenarios form the basis of the core curriculum and ensure that all students are exposed to the same problems Recently modified PBL techniques have been introduced into clinical education with real patients being used as the stimulus for learning Despite the essential ad hoc nature of learning clinical medicine a key cases approach can enable PBL to be used to deliver the core clinical curriculum

Copyright copy2003 BMJ Publishing Group Ltd

Wood D F BMJ 2003326328-330

No CRoles of participants in a PBL tutorial aption Found

What happens in a PBL tutorial bull PBL tutorials are conducted in several ways In

this article the examples are modelled on the Maastricht seven jump process but its format of seven steps may be shortened

bull A typical PBL tutorial consists of a group of students (usually eight to 10) and a tutor who facilitates the session The length of time (number of sessions) that a group stays together with each other and with individual tutors varies between institutions A group needs to be together long enough to allow good group dynamics to develop but may need to be changed occasionally if personality clashes or other dysfunctional behaviour emerges

bull Students elect a chair for each PBL scenario and a scribe to record the discussion The roles are rotated for each scenario Suitable flip charts or a whiteboard should be used for recording the proceedings At the start of the session depending on the trigger material either the student chair reads out the scenario or all students study the material If the trigger is a real patient in a ward clinic or surgery then a student may be asked to take a clinical history or identify an abnormal physical sign before the group moves to a tutorial room For each module students may be given a handbook containing the problem scenarios and suggested learning resources or learning materials may be handed out at appropriate times as the tutorials progress

Examples of trigger material for PBL scenarios bull Paper based clinical scenarios bull Experimental or clinical laboratory data bull Photographs bull Video clips bull Newspaper articles bull All or part of an article from a scientific

journal bull A real or simulated patient bull A family tree showing an inherited

disorder

PBL tutorial process ndash Step 1 Identify and clarify unfamiliar terms presented in the scenario

scribe lists those that remain unexplained after discussion ndash Step 2 Define the problem or problems to be discussed students may

have different views on the issues but all should be considered scribe records a list of agreed problems

ndash Step 3 Brainstorming session to discuss the problem(s) suggestingpossible explanations on basis of prior knowledge students draw on each others knowledge and identify areas of incomplete knowledge scribe records all discussion

ndash Step 4 Review steps 2 and 3 and arrange explanations into tentativesolutions scribe organises the explanations and restructures if necessary

ndash Step 5 Formulate learning objectives group reaches consensus onthe learning objectives tutor ensures learning objectives are focused achievable comprehensive and appropriate

ndash Step 6 Private study (all students gather information related to eachlearning objective)

ndash Step 7 Group shares results of private study (students identify theirlearning resources and share their results) tutor checks learning and may assess the group

bull The role of the tutor is to facilitate the proceedings (helping the chair to maintain group dynamics and moving the group through the task) and to ensure that the group achieves appropriate learning objectives in line with those set by the curriculum design team The tutor may need to take a more active role in step 7 of the process to ensure that all the students have done the appropriate work and to help the chair to suggest a suitable format for group members to use to present the results of their private study The tutor should encourage students to check their understanding of the material He or she can do this by encouraging the students to ask open questions and ask each other to explain topics in their own words or by the use of drawings and diagrams

PBL in curriculum design bull PBL may be used either as the mainstay of an entire

curriculum or for the delivery of individual courses In practice PBL is usually part of an integrated curriculum using a systems based approach with non-clinical material delivered in the context of clinical practice A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge skills and attitudes A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios Sufficient time should be allowed each week for students to do the self directed learning required for PBL

bull

Copyright copy2003 BMJ Publishing Group Ltd

Wood D F BMJ 2003326328-330

No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found

Writing PBL scenarios

bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives

bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after

studying the scenario should be consistent with the faculty learning objectives

bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding

bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice

bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge

bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented

bull The problem should be sufficiently open so that discussion is not curtailed too early in the process

bull Scenarios should promote participation by the students in seeking information from various learning resources

bull Adapted from Dolmans et al Med Teacher 199719185-9

Staff development

bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)

A dysfunctional group a dominant character may

make it difficult for other students to be heard

A dysfunctional group a dominant character may make it difficult for other students to be heard

bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties

Advantages of PBL bull Student centred PBLIt fostersactive learning improved

understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks

Disadvantagesbull Tutors who cant teachTutorsenjoy passing on

their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful

Assessment of PBL

bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods

bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL

Conclusion

bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning

bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL

PBL 5 Easy Steps

bull Read the problem

Mrs Paula Embledon

Mrs Paula Embledon is a 78 year old woman who has come to the emergency room complaining of shortness of breath and pain in her chest She had been in relatively good health until three weeks previously when she sprained

2 Brain storm

bull Brainstorm

bull ndash hypotheses

bull - what do we know in support of the hypothesis

bull - what do we need to know to test the hypothesis

ndash learning issues

Brainstorm

bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)

ndash specific issues (for individuals to look up)

ndash overlapping issues

bull 4 Individual Reading - Research - Preparation

bull 5 Return

bull ndash review case so far ndash report and discuss

ndash assess progress - continue pagenext pagecomplete

ndash self-evaluation - How did things go Any suggestions for next time

ndash next problem

bull 5 Return

THE FIRST GROUP SESSION

bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day

bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session

bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr

bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine

bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise

bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator

bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues

bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know

bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)

bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)

bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)

  • PROBLEM BASED LEARNING
  • New Horizons in Medical Education
  • Slide 3
  • Domains of essential Global Requirements of ME
  • What was the response to these challenges
  • New Educational Strategies
  • New Tools amp Aids
  • PBL
  • PBL
  • Advantages
  • Slide 11
  • Slide 12
  • Slide 13
  • Slide 14
  • Framework for PBL
  • Framework for PBL - II
  • Characteristics of an effective PBL Group
  • Staff Development
  • Tutorrsquos Role in Assessment
  • Slide 20
  • Evaluating PBL Tutorials-II
  • PBL
  • Slide 23
  • PBL Starting the case
  • PBL Case (contd)
  • PBL Case contd
  • The Process of PBL
  • The Process of PBL contd
  • Learn from each other
  • Determine priorities for learning
  • Slide 31
  • Slide 32
  • Learning Issues
  • Learning Issues in PBL First Session
  • PBL Second Session
  • PBL Third Session
  • Slide 37
  • Slide 38
  • During Tutorial Session students will
  • Tutorial Session contd
  • Between Tutorial Session
  • Slide 42
  • Slide 43
  • Problem-based learning is designed to develop
  • Slide 45
  • What is problem based learning
  • Slide 47
  • Slide 48
  • Slide 49
  • Rationale for using PBL
  • Slide 51
  • Slide 52
  • The group learning process acquiring desirable learning skills
  • Generic Skills amp attitudes
  • Slide 55
  • Slide 56
  • Slide 57
  • What happens in a PBL tutorial
  • Slide 59
  • Examples of trigger material for PBL scenarios
  • PBL tutorial process
  • Slide 62
  • PBL in curriculum design
  • Slide 64
  • Writing PBL scenarios
  • Slide 66
  • Staff development
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • Slide 70
  • Advantages of PBL
  • Slide 72
  • Slide 73
  • Disadvantages
  • Assessment of PBL
  • Slide 76
  • Conclusion
  • Slide 78
  • PBL 5 Easy Steps
  • 2 Brain storm
  • Brainstorm
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • THE FIRST GROUP SESSION
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
Page 33: Problem based learning

Learning Issues in PBL First Session1 Getting Started (Introductions Ground

Rules Expectations)2 Identifying Problem3 Exploring Pre-Existing Knowledge4 Generating Hypotheses and Explaining

Mechanisms5 Unfolding the Case Incrementally6 Re-EvaluatingReprioritizing Hypotheses

Based on New Information7 AssessmentReflection

PBL Second Session

8 Independent Self-Directed Study of Learning Issues

PBL Third Session

bull 9 Discussion of Learning Issues and Application of New Knowledge to the Case

bull 10 Continued Unfolding of the Case Incrementally

bull 11 AssessmentReflection

During Tutorial Session students will

1048708 Come prepared to discuss the case and learning issues researched since the last tutorial

1048708 Actively participate in group discussions and contribute to the learning process in a manner that allows for the balanced participation of everyone in the group

1048708 Develop learning issues at each session phrase them as full-sentence questions write them on the board and post them on the course web page

1048708 Consider biological population behaviormental health issuesexplanations and questions of professional attitudes values and ethics related to the patientrsquos problem(s) described in the case

Tutorial Session contd1048708 Go to the board to diagram outline draw etc in

explanation of mechanisms relatedto hypotheses1048708 Debate evidence related to the case and avoid

personal attacks on others1048708 Comply with ground rules with regard to how

the group will function and how itsmembers treat one another1048708 Participate in end-of-session reflection and

assessment by giving and receivingconstructive criticism regarding self tutor

student and group performance

Between Tutorial Session

1048708 Research key learning issues using a variety of resources

1048708 Critically evaluate the credibility of sources and the validity of the information they have obtained in their research

1048708 Integrate what they have learned through research lectures labs clinical skills Perspectives in Medicine (PIM) etc into what is discussed in tutorials

1048708 Synthesize what they have learned and be prepared to discuss it without reading directly from their materials as much as possible and apply it to the case at the next tutorial session

Determine priorities for learning

bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue

bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan

bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge

bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career

PBL Starting the casebull After the introductions and discussion

are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it

bull Reading the case aloud keeps the group focused

bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here

Problem-based learning is designed to develop

1048708 Integrated context-specific knowledge base

1048708 Decision-makingcritical thinking process and skills

1048708 Self-directed life-long learning skills 1048708 Interpersonal collaboration and

communication skills 1048708 Constructive self and peer

assessment skills 1048708 Professional ethics and behavior

PBL Case (contd)

bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session

What is problem based learning

bull In PBL students use triggers from the problem case or scenario to define their own learning objectives

bull Subsequently they do independent self directed study before returning to the group to discuss and refine their acquired knowledge

bull Thus PBL is not about problem solving per se but rather it uses appropriate problems to increase knowledge and understanding

bull The process is clearly defined

PBL

bull PBL uses clinical cases as the context for students to study basic and clinical sciences

bull Its possible advantages over traditional approaches include its greater relevance to the practice of medicine its ability to promote retention and application of knowledge and its encouragement of self-directed life-long learning

bull Possible disadvantages include higher costs both in resources and staff time

PBL

bull An educational method characterized by the use of patient problems as a context for students to learn problem-solving skills and acquire knowledge about the basic and clinical sciences

bull Students usually meet in small groups two or three times a week for PBL tutorials

bull They are presented with a clinical problem (eg a patient with chest pain) and in a series of steps they discuss possible mechanisms and causes develop hypotheses and strategies to test the hypotheses are presented with further information and use this new information to refine their hypotheses finally reaching a conclusion

bull A tutor usually acts as a facilitator guiding students in this group-learning process

bull In the course of this exercise students identify both their existing levels and gaps in their knowledge These gaps form the basis for independent learning outside the PBL tutorials The identification and pursuit of these so-called learning goals is a key element of the PBL process

Rationale for using PBL bull The PBL approach is based on principles of adult

education20 and cognitive psychology21 It differs fundamentally from traditional curricula in which students acquire background knowledge of the basic sciences in the early years of the course and in the later years apply this knowledge to the diagnosis and management of clinical problems This traditional approach has been criticised for a number of reasons42223

bull It creates an artificial divide between the basic and clinical sciences

bull Time is wasted in acquiring knowledge that is subsequently forgotten or found to be irrelevant

bull Application of the acquired knowledge can be difficult bull The acquisition and retention of information that has no

apparent relevance can be boring and even demoralising for students

The group learning process acquiring

desirable learning skills

Generic Skills amp attitudes

bull Teamwork bull Critical evaluation of literature bull Chairing a group bull Self directed learning and use of

resources bull Listening Presentation skills

Recording bull Cooperation bull Respect for colleagues views

bull Group learning facilitates not only the acquisition of knowledge but also several other desirable attributes such as communication skills teamwork problem solving independent responsibility for learning sharing information and respect for others PBL can therefore be thought of as a small group teaching method that combines the acquisition of knowledge with the development of generic skills and attitudes Presentation of clinical material as the stimulus for learning enables students to understand the relevance of underlying scientific knowledge and principles in clinical practice

bull when PBL is introduced into a curriculum several other issues for curriculum design and implementation need to be tackled PBL is generally introduced in the context of a defined core curriculum and integration of basic and clinical sciences It has implications for staffing and learning resources and demands a different approach to timetabling workload and assessment PBL is often used to deliver core material in non-clinical parts of the curriculum Paper based PBL scenarios form the basis of the core curriculum and ensure that all students are exposed to the same problems Recently modified PBL techniques have been introduced into clinical education with real patients being used as the stimulus for learning Despite the essential ad hoc nature of learning clinical medicine a key cases approach can enable PBL to be used to deliver the core clinical curriculum

Copyright copy2003 BMJ Publishing Group Ltd

Wood D F BMJ 2003326328-330

No CRoles of participants in a PBL tutorial aption Found

What happens in a PBL tutorial bull PBL tutorials are conducted in several ways In

this article the examples are modelled on the Maastricht seven jump process but its format of seven steps may be shortened

bull A typical PBL tutorial consists of a group of students (usually eight to 10) and a tutor who facilitates the session The length of time (number of sessions) that a group stays together with each other and with individual tutors varies between institutions A group needs to be together long enough to allow good group dynamics to develop but may need to be changed occasionally if personality clashes or other dysfunctional behaviour emerges

bull Students elect a chair for each PBL scenario and a scribe to record the discussion The roles are rotated for each scenario Suitable flip charts or a whiteboard should be used for recording the proceedings At the start of the session depending on the trigger material either the student chair reads out the scenario or all students study the material If the trigger is a real patient in a ward clinic or surgery then a student may be asked to take a clinical history or identify an abnormal physical sign before the group moves to a tutorial room For each module students may be given a handbook containing the problem scenarios and suggested learning resources or learning materials may be handed out at appropriate times as the tutorials progress

Examples of trigger material for PBL scenarios bull Paper based clinical scenarios bull Experimental or clinical laboratory data bull Photographs bull Video clips bull Newspaper articles bull All or part of an article from a scientific

journal bull A real or simulated patient bull A family tree showing an inherited

disorder

PBL tutorial process ndash Step 1 Identify and clarify unfamiliar terms presented in the scenario

scribe lists those that remain unexplained after discussion ndash Step 2 Define the problem or problems to be discussed students may

have different views on the issues but all should be considered scribe records a list of agreed problems

ndash Step 3 Brainstorming session to discuss the problem(s) suggestingpossible explanations on basis of prior knowledge students draw on each others knowledge and identify areas of incomplete knowledge scribe records all discussion

ndash Step 4 Review steps 2 and 3 and arrange explanations into tentativesolutions scribe organises the explanations and restructures if necessary

ndash Step 5 Formulate learning objectives group reaches consensus onthe learning objectives tutor ensures learning objectives are focused achievable comprehensive and appropriate

ndash Step 6 Private study (all students gather information related to eachlearning objective)

ndash Step 7 Group shares results of private study (students identify theirlearning resources and share their results) tutor checks learning and may assess the group

bull The role of the tutor is to facilitate the proceedings (helping the chair to maintain group dynamics and moving the group through the task) and to ensure that the group achieves appropriate learning objectives in line with those set by the curriculum design team The tutor may need to take a more active role in step 7 of the process to ensure that all the students have done the appropriate work and to help the chair to suggest a suitable format for group members to use to present the results of their private study The tutor should encourage students to check their understanding of the material He or she can do this by encouraging the students to ask open questions and ask each other to explain topics in their own words or by the use of drawings and diagrams

PBL in curriculum design bull PBL may be used either as the mainstay of an entire

curriculum or for the delivery of individual courses In practice PBL is usually part of an integrated curriculum using a systems based approach with non-clinical material delivered in the context of clinical practice A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge skills and attitudes A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios Sufficient time should be allowed each week for students to do the self directed learning required for PBL

bull

Copyright copy2003 BMJ Publishing Group Ltd

Wood D F BMJ 2003326328-330

No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found

Writing PBL scenarios

bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives

bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after

studying the scenario should be consistent with the faculty learning objectives

bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding

bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice

bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge

bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented

bull The problem should be sufficiently open so that discussion is not curtailed too early in the process

bull Scenarios should promote participation by the students in seeking information from various learning resources

bull Adapted from Dolmans et al Med Teacher 199719185-9

Staff development

bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)

A dysfunctional group a dominant character may

make it difficult for other students to be heard

A dysfunctional group a dominant character may make it difficult for other students to be heard

bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties

Advantages of PBL bull Student centred PBLIt fostersactive learning improved

understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks

Disadvantagesbull Tutors who cant teachTutorsenjoy passing on

their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful

Assessment of PBL

bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods

bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL

Conclusion

bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning

bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL

PBL 5 Easy Steps

bull Read the problem

Mrs Paula Embledon

Mrs Paula Embledon is a 78 year old woman who has come to the emergency room complaining of shortness of breath and pain in her chest She had been in relatively good health until three weeks previously when she sprained

2 Brain storm

bull Brainstorm

bull ndash hypotheses

bull - what do we know in support of the hypothesis

bull - what do we need to know to test the hypothesis

ndash learning issues

Brainstorm

bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)

ndash specific issues (for individuals to look up)

ndash overlapping issues

bull 4 Individual Reading - Research - Preparation

bull 5 Return

bull ndash review case so far ndash report and discuss

ndash assess progress - continue pagenext pagecomplete

ndash self-evaluation - How did things go Any suggestions for next time

ndash next problem

bull 5 Return

THE FIRST GROUP SESSION

bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day

bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session

bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr

bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine

bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise

bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator

bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues

bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know

bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)

bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)

bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)

  • PROBLEM BASED LEARNING
  • New Horizons in Medical Education
  • Slide 3
  • Domains of essential Global Requirements of ME
  • What was the response to these challenges
  • New Educational Strategies
  • New Tools amp Aids
  • PBL
  • PBL
  • Advantages
  • Slide 11
  • Slide 12
  • Slide 13
  • Slide 14
  • Framework for PBL
  • Framework for PBL - II
  • Characteristics of an effective PBL Group
  • Staff Development
  • Tutorrsquos Role in Assessment
  • Slide 20
  • Evaluating PBL Tutorials-II
  • PBL
  • Slide 23
  • PBL Starting the case
  • PBL Case (contd)
  • PBL Case contd
  • The Process of PBL
  • The Process of PBL contd
  • Learn from each other
  • Determine priorities for learning
  • Slide 31
  • Slide 32
  • Learning Issues
  • Learning Issues in PBL First Session
  • PBL Second Session
  • PBL Third Session
  • Slide 37
  • Slide 38
  • During Tutorial Session students will
  • Tutorial Session contd
  • Between Tutorial Session
  • Slide 42
  • Slide 43
  • Problem-based learning is designed to develop
  • Slide 45
  • What is problem based learning
  • Slide 47
  • Slide 48
  • Slide 49
  • Rationale for using PBL
  • Slide 51
  • Slide 52
  • The group learning process acquiring desirable learning skills
  • Generic Skills amp attitudes
  • Slide 55
  • Slide 56
  • Slide 57
  • What happens in a PBL tutorial
  • Slide 59
  • Examples of trigger material for PBL scenarios
  • PBL tutorial process
  • Slide 62
  • PBL in curriculum design
  • Slide 64
  • Writing PBL scenarios
  • Slide 66
  • Staff development
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • Slide 70
  • Advantages of PBL
  • Slide 72
  • Slide 73
  • Disadvantages
  • Assessment of PBL
  • Slide 76
  • Conclusion
  • Slide 78
  • PBL 5 Easy Steps
  • 2 Brain storm
  • Brainstorm
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • THE FIRST GROUP SESSION
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
Page 34: Problem based learning

PBL Second Session

8 Independent Self-Directed Study of Learning Issues

PBL Third Session

bull 9 Discussion of Learning Issues and Application of New Knowledge to the Case

bull 10 Continued Unfolding of the Case Incrementally

bull 11 AssessmentReflection

During Tutorial Session students will

1048708 Come prepared to discuss the case and learning issues researched since the last tutorial

1048708 Actively participate in group discussions and contribute to the learning process in a manner that allows for the balanced participation of everyone in the group

1048708 Develop learning issues at each session phrase them as full-sentence questions write them on the board and post them on the course web page

1048708 Consider biological population behaviormental health issuesexplanations and questions of professional attitudes values and ethics related to the patientrsquos problem(s) described in the case

Tutorial Session contd1048708 Go to the board to diagram outline draw etc in

explanation of mechanisms relatedto hypotheses1048708 Debate evidence related to the case and avoid

personal attacks on others1048708 Comply with ground rules with regard to how

the group will function and how itsmembers treat one another1048708 Participate in end-of-session reflection and

assessment by giving and receivingconstructive criticism regarding self tutor

student and group performance

Between Tutorial Session

1048708 Research key learning issues using a variety of resources

1048708 Critically evaluate the credibility of sources and the validity of the information they have obtained in their research

1048708 Integrate what they have learned through research lectures labs clinical skills Perspectives in Medicine (PIM) etc into what is discussed in tutorials

1048708 Synthesize what they have learned and be prepared to discuss it without reading directly from their materials as much as possible and apply it to the case at the next tutorial session

Determine priorities for learning

bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue

bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan

bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge

bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career

PBL Starting the casebull After the introductions and discussion

are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it

bull Reading the case aloud keeps the group focused

bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here

Problem-based learning is designed to develop

1048708 Integrated context-specific knowledge base

1048708 Decision-makingcritical thinking process and skills

1048708 Self-directed life-long learning skills 1048708 Interpersonal collaboration and

communication skills 1048708 Constructive self and peer

assessment skills 1048708 Professional ethics and behavior

PBL Case (contd)

bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session

What is problem based learning

bull In PBL students use triggers from the problem case or scenario to define their own learning objectives

bull Subsequently they do independent self directed study before returning to the group to discuss and refine their acquired knowledge

bull Thus PBL is not about problem solving per se but rather it uses appropriate problems to increase knowledge and understanding

bull The process is clearly defined

PBL

bull PBL uses clinical cases as the context for students to study basic and clinical sciences

bull Its possible advantages over traditional approaches include its greater relevance to the practice of medicine its ability to promote retention and application of knowledge and its encouragement of self-directed life-long learning

bull Possible disadvantages include higher costs both in resources and staff time

PBL

bull An educational method characterized by the use of patient problems as a context for students to learn problem-solving skills and acquire knowledge about the basic and clinical sciences

bull Students usually meet in small groups two or three times a week for PBL tutorials

bull They are presented with a clinical problem (eg a patient with chest pain) and in a series of steps they discuss possible mechanisms and causes develop hypotheses and strategies to test the hypotheses are presented with further information and use this new information to refine their hypotheses finally reaching a conclusion

bull A tutor usually acts as a facilitator guiding students in this group-learning process

bull In the course of this exercise students identify both their existing levels and gaps in their knowledge These gaps form the basis for independent learning outside the PBL tutorials The identification and pursuit of these so-called learning goals is a key element of the PBL process

Rationale for using PBL bull The PBL approach is based on principles of adult

education20 and cognitive psychology21 It differs fundamentally from traditional curricula in which students acquire background knowledge of the basic sciences in the early years of the course and in the later years apply this knowledge to the diagnosis and management of clinical problems This traditional approach has been criticised for a number of reasons42223

bull It creates an artificial divide between the basic and clinical sciences

bull Time is wasted in acquiring knowledge that is subsequently forgotten or found to be irrelevant

bull Application of the acquired knowledge can be difficult bull The acquisition and retention of information that has no

apparent relevance can be boring and even demoralising for students

The group learning process acquiring

desirable learning skills

Generic Skills amp attitudes

bull Teamwork bull Critical evaluation of literature bull Chairing a group bull Self directed learning and use of

resources bull Listening Presentation skills

Recording bull Cooperation bull Respect for colleagues views

bull Group learning facilitates not only the acquisition of knowledge but also several other desirable attributes such as communication skills teamwork problem solving independent responsibility for learning sharing information and respect for others PBL can therefore be thought of as a small group teaching method that combines the acquisition of knowledge with the development of generic skills and attitudes Presentation of clinical material as the stimulus for learning enables students to understand the relevance of underlying scientific knowledge and principles in clinical practice

bull when PBL is introduced into a curriculum several other issues for curriculum design and implementation need to be tackled PBL is generally introduced in the context of a defined core curriculum and integration of basic and clinical sciences It has implications for staffing and learning resources and demands a different approach to timetabling workload and assessment PBL is often used to deliver core material in non-clinical parts of the curriculum Paper based PBL scenarios form the basis of the core curriculum and ensure that all students are exposed to the same problems Recently modified PBL techniques have been introduced into clinical education with real patients being used as the stimulus for learning Despite the essential ad hoc nature of learning clinical medicine a key cases approach can enable PBL to be used to deliver the core clinical curriculum

Copyright copy2003 BMJ Publishing Group Ltd

Wood D F BMJ 2003326328-330

No CRoles of participants in a PBL tutorial aption Found

What happens in a PBL tutorial bull PBL tutorials are conducted in several ways In

this article the examples are modelled on the Maastricht seven jump process but its format of seven steps may be shortened

bull A typical PBL tutorial consists of a group of students (usually eight to 10) and a tutor who facilitates the session The length of time (number of sessions) that a group stays together with each other and with individual tutors varies between institutions A group needs to be together long enough to allow good group dynamics to develop but may need to be changed occasionally if personality clashes or other dysfunctional behaviour emerges

bull Students elect a chair for each PBL scenario and a scribe to record the discussion The roles are rotated for each scenario Suitable flip charts or a whiteboard should be used for recording the proceedings At the start of the session depending on the trigger material either the student chair reads out the scenario or all students study the material If the trigger is a real patient in a ward clinic or surgery then a student may be asked to take a clinical history or identify an abnormal physical sign before the group moves to a tutorial room For each module students may be given a handbook containing the problem scenarios and suggested learning resources or learning materials may be handed out at appropriate times as the tutorials progress

Examples of trigger material for PBL scenarios bull Paper based clinical scenarios bull Experimental or clinical laboratory data bull Photographs bull Video clips bull Newspaper articles bull All or part of an article from a scientific

journal bull A real or simulated patient bull A family tree showing an inherited

disorder

PBL tutorial process ndash Step 1 Identify and clarify unfamiliar terms presented in the scenario

scribe lists those that remain unexplained after discussion ndash Step 2 Define the problem or problems to be discussed students may

have different views on the issues but all should be considered scribe records a list of agreed problems

ndash Step 3 Brainstorming session to discuss the problem(s) suggestingpossible explanations on basis of prior knowledge students draw on each others knowledge and identify areas of incomplete knowledge scribe records all discussion

ndash Step 4 Review steps 2 and 3 and arrange explanations into tentativesolutions scribe organises the explanations and restructures if necessary

ndash Step 5 Formulate learning objectives group reaches consensus onthe learning objectives tutor ensures learning objectives are focused achievable comprehensive and appropriate

ndash Step 6 Private study (all students gather information related to eachlearning objective)

ndash Step 7 Group shares results of private study (students identify theirlearning resources and share their results) tutor checks learning and may assess the group

bull The role of the tutor is to facilitate the proceedings (helping the chair to maintain group dynamics and moving the group through the task) and to ensure that the group achieves appropriate learning objectives in line with those set by the curriculum design team The tutor may need to take a more active role in step 7 of the process to ensure that all the students have done the appropriate work and to help the chair to suggest a suitable format for group members to use to present the results of their private study The tutor should encourage students to check their understanding of the material He or she can do this by encouraging the students to ask open questions and ask each other to explain topics in their own words or by the use of drawings and diagrams

PBL in curriculum design bull PBL may be used either as the mainstay of an entire

curriculum or for the delivery of individual courses In practice PBL is usually part of an integrated curriculum using a systems based approach with non-clinical material delivered in the context of clinical practice A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge skills and attitudes A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios Sufficient time should be allowed each week for students to do the self directed learning required for PBL

bull

Copyright copy2003 BMJ Publishing Group Ltd

Wood D F BMJ 2003326328-330

No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found

Writing PBL scenarios

bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives

bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after

studying the scenario should be consistent with the faculty learning objectives

bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding

bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice

bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge

bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented

bull The problem should be sufficiently open so that discussion is not curtailed too early in the process

bull Scenarios should promote participation by the students in seeking information from various learning resources

bull Adapted from Dolmans et al Med Teacher 199719185-9

Staff development

bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)

A dysfunctional group a dominant character may

make it difficult for other students to be heard

A dysfunctional group a dominant character may make it difficult for other students to be heard

bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties

Advantages of PBL bull Student centred PBLIt fostersactive learning improved

understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks

Disadvantagesbull Tutors who cant teachTutorsenjoy passing on

their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful

Assessment of PBL

bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods

bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL

Conclusion

bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning

bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL

PBL 5 Easy Steps

bull Read the problem

Mrs Paula Embledon

Mrs Paula Embledon is a 78 year old woman who has come to the emergency room complaining of shortness of breath and pain in her chest She had been in relatively good health until three weeks previously when she sprained

2 Brain storm

bull Brainstorm

bull ndash hypotheses

bull - what do we know in support of the hypothesis

bull - what do we need to know to test the hypothesis

ndash learning issues

Brainstorm

bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)

ndash specific issues (for individuals to look up)

ndash overlapping issues

bull 4 Individual Reading - Research - Preparation

bull 5 Return

bull ndash review case so far ndash report and discuss

ndash assess progress - continue pagenext pagecomplete

ndash self-evaluation - How did things go Any suggestions for next time

ndash next problem

bull 5 Return

THE FIRST GROUP SESSION

bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day

bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session

bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr

bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine

bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise

bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator

bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues

bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know

bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)

bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)

bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)

  • PROBLEM BASED LEARNING
  • New Horizons in Medical Education
  • Slide 3
  • Domains of essential Global Requirements of ME
  • What was the response to these challenges
  • New Educational Strategies
  • New Tools amp Aids
  • PBL
  • PBL
  • Advantages
  • Slide 11
  • Slide 12
  • Slide 13
  • Slide 14
  • Framework for PBL
  • Framework for PBL - II
  • Characteristics of an effective PBL Group
  • Staff Development
  • Tutorrsquos Role in Assessment
  • Slide 20
  • Evaluating PBL Tutorials-II
  • PBL
  • Slide 23
  • PBL Starting the case
  • PBL Case (contd)
  • PBL Case contd
  • The Process of PBL
  • The Process of PBL contd
  • Learn from each other
  • Determine priorities for learning
  • Slide 31
  • Slide 32
  • Learning Issues
  • Learning Issues in PBL First Session
  • PBL Second Session
  • PBL Third Session
  • Slide 37
  • Slide 38
  • During Tutorial Session students will
  • Tutorial Session contd
  • Between Tutorial Session
  • Slide 42
  • Slide 43
  • Problem-based learning is designed to develop
  • Slide 45
  • What is problem based learning
  • Slide 47
  • Slide 48
  • Slide 49
  • Rationale for using PBL
  • Slide 51
  • Slide 52
  • The group learning process acquiring desirable learning skills
  • Generic Skills amp attitudes
  • Slide 55
  • Slide 56
  • Slide 57
  • What happens in a PBL tutorial
  • Slide 59
  • Examples of trigger material for PBL scenarios
  • PBL tutorial process
  • Slide 62
  • PBL in curriculum design
  • Slide 64
  • Writing PBL scenarios
  • Slide 66
  • Staff development
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • Slide 70
  • Advantages of PBL
  • Slide 72
  • Slide 73
  • Disadvantages
  • Assessment of PBL
  • Slide 76
  • Conclusion
  • Slide 78
  • PBL 5 Easy Steps
  • 2 Brain storm
  • Brainstorm
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • THE FIRST GROUP SESSION
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
Page 35: Problem based learning

PBL Third Session

bull 9 Discussion of Learning Issues and Application of New Knowledge to the Case

bull 10 Continued Unfolding of the Case Incrementally

bull 11 AssessmentReflection

During Tutorial Session students will

1048708 Come prepared to discuss the case and learning issues researched since the last tutorial

1048708 Actively participate in group discussions and contribute to the learning process in a manner that allows for the balanced participation of everyone in the group

1048708 Develop learning issues at each session phrase them as full-sentence questions write them on the board and post them on the course web page

1048708 Consider biological population behaviormental health issuesexplanations and questions of professional attitudes values and ethics related to the patientrsquos problem(s) described in the case

Tutorial Session contd1048708 Go to the board to diagram outline draw etc in

explanation of mechanisms relatedto hypotheses1048708 Debate evidence related to the case and avoid

personal attacks on others1048708 Comply with ground rules with regard to how

the group will function and how itsmembers treat one another1048708 Participate in end-of-session reflection and

assessment by giving and receivingconstructive criticism regarding self tutor

student and group performance

Between Tutorial Session

1048708 Research key learning issues using a variety of resources

1048708 Critically evaluate the credibility of sources and the validity of the information they have obtained in their research

1048708 Integrate what they have learned through research lectures labs clinical skills Perspectives in Medicine (PIM) etc into what is discussed in tutorials

1048708 Synthesize what they have learned and be prepared to discuss it without reading directly from their materials as much as possible and apply it to the case at the next tutorial session

Determine priorities for learning

bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue

bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan

bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge

bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career

PBL Starting the casebull After the introductions and discussion

are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it

bull Reading the case aloud keeps the group focused

bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here

Problem-based learning is designed to develop

1048708 Integrated context-specific knowledge base

1048708 Decision-makingcritical thinking process and skills

1048708 Self-directed life-long learning skills 1048708 Interpersonal collaboration and

communication skills 1048708 Constructive self and peer

assessment skills 1048708 Professional ethics and behavior

PBL Case (contd)

bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session

What is problem based learning

bull In PBL students use triggers from the problem case or scenario to define their own learning objectives

bull Subsequently they do independent self directed study before returning to the group to discuss and refine their acquired knowledge

bull Thus PBL is not about problem solving per se but rather it uses appropriate problems to increase knowledge and understanding

bull The process is clearly defined

PBL

bull PBL uses clinical cases as the context for students to study basic and clinical sciences

bull Its possible advantages over traditional approaches include its greater relevance to the practice of medicine its ability to promote retention and application of knowledge and its encouragement of self-directed life-long learning

bull Possible disadvantages include higher costs both in resources and staff time

PBL

bull An educational method characterized by the use of patient problems as a context for students to learn problem-solving skills and acquire knowledge about the basic and clinical sciences

bull Students usually meet in small groups two or three times a week for PBL tutorials

bull They are presented with a clinical problem (eg a patient with chest pain) and in a series of steps they discuss possible mechanisms and causes develop hypotheses and strategies to test the hypotheses are presented with further information and use this new information to refine their hypotheses finally reaching a conclusion

bull A tutor usually acts as a facilitator guiding students in this group-learning process

bull In the course of this exercise students identify both their existing levels and gaps in their knowledge These gaps form the basis for independent learning outside the PBL tutorials The identification and pursuit of these so-called learning goals is a key element of the PBL process

Rationale for using PBL bull The PBL approach is based on principles of adult

education20 and cognitive psychology21 It differs fundamentally from traditional curricula in which students acquire background knowledge of the basic sciences in the early years of the course and in the later years apply this knowledge to the diagnosis and management of clinical problems This traditional approach has been criticised for a number of reasons42223

bull It creates an artificial divide between the basic and clinical sciences

bull Time is wasted in acquiring knowledge that is subsequently forgotten or found to be irrelevant

bull Application of the acquired knowledge can be difficult bull The acquisition and retention of information that has no

apparent relevance can be boring and even demoralising for students

The group learning process acquiring

desirable learning skills

Generic Skills amp attitudes

bull Teamwork bull Critical evaluation of literature bull Chairing a group bull Self directed learning and use of

resources bull Listening Presentation skills

Recording bull Cooperation bull Respect for colleagues views

bull Group learning facilitates not only the acquisition of knowledge but also several other desirable attributes such as communication skills teamwork problem solving independent responsibility for learning sharing information and respect for others PBL can therefore be thought of as a small group teaching method that combines the acquisition of knowledge with the development of generic skills and attitudes Presentation of clinical material as the stimulus for learning enables students to understand the relevance of underlying scientific knowledge and principles in clinical practice

bull when PBL is introduced into a curriculum several other issues for curriculum design and implementation need to be tackled PBL is generally introduced in the context of a defined core curriculum and integration of basic and clinical sciences It has implications for staffing and learning resources and demands a different approach to timetabling workload and assessment PBL is often used to deliver core material in non-clinical parts of the curriculum Paper based PBL scenarios form the basis of the core curriculum and ensure that all students are exposed to the same problems Recently modified PBL techniques have been introduced into clinical education with real patients being used as the stimulus for learning Despite the essential ad hoc nature of learning clinical medicine a key cases approach can enable PBL to be used to deliver the core clinical curriculum

Copyright copy2003 BMJ Publishing Group Ltd

Wood D F BMJ 2003326328-330

No CRoles of participants in a PBL tutorial aption Found

What happens in a PBL tutorial bull PBL tutorials are conducted in several ways In

this article the examples are modelled on the Maastricht seven jump process but its format of seven steps may be shortened

bull A typical PBL tutorial consists of a group of students (usually eight to 10) and a tutor who facilitates the session The length of time (number of sessions) that a group stays together with each other and with individual tutors varies between institutions A group needs to be together long enough to allow good group dynamics to develop but may need to be changed occasionally if personality clashes or other dysfunctional behaviour emerges

bull Students elect a chair for each PBL scenario and a scribe to record the discussion The roles are rotated for each scenario Suitable flip charts or a whiteboard should be used for recording the proceedings At the start of the session depending on the trigger material either the student chair reads out the scenario or all students study the material If the trigger is a real patient in a ward clinic or surgery then a student may be asked to take a clinical history or identify an abnormal physical sign before the group moves to a tutorial room For each module students may be given a handbook containing the problem scenarios and suggested learning resources or learning materials may be handed out at appropriate times as the tutorials progress

Examples of trigger material for PBL scenarios bull Paper based clinical scenarios bull Experimental or clinical laboratory data bull Photographs bull Video clips bull Newspaper articles bull All or part of an article from a scientific

journal bull A real or simulated patient bull A family tree showing an inherited

disorder

PBL tutorial process ndash Step 1 Identify and clarify unfamiliar terms presented in the scenario

scribe lists those that remain unexplained after discussion ndash Step 2 Define the problem or problems to be discussed students may

have different views on the issues but all should be considered scribe records a list of agreed problems

ndash Step 3 Brainstorming session to discuss the problem(s) suggestingpossible explanations on basis of prior knowledge students draw on each others knowledge and identify areas of incomplete knowledge scribe records all discussion

ndash Step 4 Review steps 2 and 3 and arrange explanations into tentativesolutions scribe organises the explanations and restructures if necessary

ndash Step 5 Formulate learning objectives group reaches consensus onthe learning objectives tutor ensures learning objectives are focused achievable comprehensive and appropriate

ndash Step 6 Private study (all students gather information related to eachlearning objective)

ndash Step 7 Group shares results of private study (students identify theirlearning resources and share their results) tutor checks learning and may assess the group

bull The role of the tutor is to facilitate the proceedings (helping the chair to maintain group dynamics and moving the group through the task) and to ensure that the group achieves appropriate learning objectives in line with those set by the curriculum design team The tutor may need to take a more active role in step 7 of the process to ensure that all the students have done the appropriate work and to help the chair to suggest a suitable format for group members to use to present the results of their private study The tutor should encourage students to check their understanding of the material He or she can do this by encouraging the students to ask open questions and ask each other to explain topics in their own words or by the use of drawings and diagrams

PBL in curriculum design bull PBL may be used either as the mainstay of an entire

curriculum or for the delivery of individual courses In practice PBL is usually part of an integrated curriculum using a systems based approach with non-clinical material delivered in the context of clinical practice A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge skills and attitudes A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios Sufficient time should be allowed each week for students to do the self directed learning required for PBL

bull

Copyright copy2003 BMJ Publishing Group Ltd

Wood D F BMJ 2003326328-330

No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found

Writing PBL scenarios

bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives

bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after

studying the scenario should be consistent with the faculty learning objectives

bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding

bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice

bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge

bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented

bull The problem should be sufficiently open so that discussion is not curtailed too early in the process

bull Scenarios should promote participation by the students in seeking information from various learning resources

bull Adapted from Dolmans et al Med Teacher 199719185-9

Staff development

bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)

A dysfunctional group a dominant character may

make it difficult for other students to be heard

A dysfunctional group a dominant character may make it difficult for other students to be heard

bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties

Advantages of PBL bull Student centred PBLIt fostersactive learning improved

understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks

Disadvantagesbull Tutors who cant teachTutorsenjoy passing on

their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful

Assessment of PBL

bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods

bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL

Conclusion

bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning

bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL

PBL 5 Easy Steps

bull Read the problem

Mrs Paula Embledon

Mrs Paula Embledon is a 78 year old woman who has come to the emergency room complaining of shortness of breath and pain in her chest She had been in relatively good health until three weeks previously when she sprained

2 Brain storm

bull Brainstorm

bull ndash hypotheses

bull - what do we know in support of the hypothesis

bull - what do we need to know to test the hypothesis

ndash learning issues

Brainstorm

bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)

ndash specific issues (for individuals to look up)

ndash overlapping issues

bull 4 Individual Reading - Research - Preparation

bull 5 Return

bull ndash review case so far ndash report and discuss

ndash assess progress - continue pagenext pagecomplete

ndash self-evaluation - How did things go Any suggestions for next time

ndash next problem

bull 5 Return

THE FIRST GROUP SESSION

bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day

bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session

bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr

bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine

bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise

bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator

bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues

bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know

bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)

bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)

bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)

  • PROBLEM BASED LEARNING
  • New Horizons in Medical Education
  • Slide 3
  • Domains of essential Global Requirements of ME
  • What was the response to these challenges
  • New Educational Strategies
  • New Tools amp Aids
  • PBL
  • PBL
  • Advantages
  • Slide 11
  • Slide 12
  • Slide 13
  • Slide 14
  • Framework for PBL
  • Framework for PBL - II
  • Characteristics of an effective PBL Group
  • Staff Development
  • Tutorrsquos Role in Assessment
  • Slide 20
  • Evaluating PBL Tutorials-II
  • PBL
  • Slide 23
  • PBL Starting the case
  • PBL Case (contd)
  • PBL Case contd
  • The Process of PBL
  • The Process of PBL contd
  • Learn from each other
  • Determine priorities for learning
  • Slide 31
  • Slide 32
  • Learning Issues
  • Learning Issues in PBL First Session
  • PBL Second Session
  • PBL Third Session
  • Slide 37
  • Slide 38
  • During Tutorial Session students will
  • Tutorial Session contd
  • Between Tutorial Session
  • Slide 42
  • Slide 43
  • Problem-based learning is designed to develop
  • Slide 45
  • What is problem based learning
  • Slide 47
  • Slide 48
  • Slide 49
  • Rationale for using PBL
  • Slide 51
  • Slide 52
  • The group learning process acquiring desirable learning skills
  • Generic Skills amp attitudes
  • Slide 55
  • Slide 56
  • Slide 57
  • What happens in a PBL tutorial
  • Slide 59
  • Examples of trigger material for PBL scenarios
  • PBL tutorial process
  • Slide 62
  • PBL in curriculum design
  • Slide 64
  • Writing PBL scenarios
  • Slide 66
  • Staff development
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • Slide 70
  • Advantages of PBL
  • Slide 72
  • Slide 73
  • Disadvantages
  • Assessment of PBL
  • Slide 76
  • Conclusion
  • Slide 78
  • PBL 5 Easy Steps
  • 2 Brain storm
  • Brainstorm
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • THE FIRST GROUP SESSION
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
Page 36: Problem based learning

During Tutorial Session students will

1048708 Come prepared to discuss the case and learning issues researched since the last tutorial

1048708 Actively participate in group discussions and contribute to the learning process in a manner that allows for the balanced participation of everyone in the group

1048708 Develop learning issues at each session phrase them as full-sentence questions write them on the board and post them on the course web page

1048708 Consider biological population behaviormental health issuesexplanations and questions of professional attitudes values and ethics related to the patientrsquos problem(s) described in the case

Tutorial Session contd1048708 Go to the board to diagram outline draw etc in

explanation of mechanisms relatedto hypotheses1048708 Debate evidence related to the case and avoid

personal attacks on others1048708 Comply with ground rules with regard to how

the group will function and how itsmembers treat one another1048708 Participate in end-of-session reflection and

assessment by giving and receivingconstructive criticism regarding self tutor

student and group performance

Between Tutorial Session

1048708 Research key learning issues using a variety of resources

1048708 Critically evaluate the credibility of sources and the validity of the information they have obtained in their research

1048708 Integrate what they have learned through research lectures labs clinical skills Perspectives in Medicine (PIM) etc into what is discussed in tutorials

1048708 Synthesize what they have learned and be prepared to discuss it without reading directly from their materials as much as possible and apply it to the case at the next tutorial session

Determine priorities for learning

bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue

bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan

bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge

bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career

PBL Starting the casebull After the introductions and discussion

are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it

bull Reading the case aloud keeps the group focused

bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here

Problem-based learning is designed to develop

1048708 Integrated context-specific knowledge base

1048708 Decision-makingcritical thinking process and skills

1048708 Self-directed life-long learning skills 1048708 Interpersonal collaboration and

communication skills 1048708 Constructive self and peer

assessment skills 1048708 Professional ethics and behavior

PBL Case (contd)

bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session

What is problem based learning

bull In PBL students use triggers from the problem case or scenario to define their own learning objectives

bull Subsequently they do independent self directed study before returning to the group to discuss and refine their acquired knowledge

bull Thus PBL is not about problem solving per se but rather it uses appropriate problems to increase knowledge and understanding

bull The process is clearly defined

PBL

bull PBL uses clinical cases as the context for students to study basic and clinical sciences

bull Its possible advantages over traditional approaches include its greater relevance to the practice of medicine its ability to promote retention and application of knowledge and its encouragement of self-directed life-long learning

bull Possible disadvantages include higher costs both in resources and staff time

PBL

bull An educational method characterized by the use of patient problems as a context for students to learn problem-solving skills and acquire knowledge about the basic and clinical sciences

bull Students usually meet in small groups two or three times a week for PBL tutorials

bull They are presented with a clinical problem (eg a patient with chest pain) and in a series of steps they discuss possible mechanisms and causes develop hypotheses and strategies to test the hypotheses are presented with further information and use this new information to refine their hypotheses finally reaching a conclusion

bull A tutor usually acts as a facilitator guiding students in this group-learning process

bull In the course of this exercise students identify both their existing levels and gaps in their knowledge These gaps form the basis for independent learning outside the PBL tutorials The identification and pursuit of these so-called learning goals is a key element of the PBL process

Rationale for using PBL bull The PBL approach is based on principles of adult

education20 and cognitive psychology21 It differs fundamentally from traditional curricula in which students acquire background knowledge of the basic sciences in the early years of the course and in the later years apply this knowledge to the diagnosis and management of clinical problems This traditional approach has been criticised for a number of reasons42223

bull It creates an artificial divide between the basic and clinical sciences

bull Time is wasted in acquiring knowledge that is subsequently forgotten or found to be irrelevant

bull Application of the acquired knowledge can be difficult bull The acquisition and retention of information that has no

apparent relevance can be boring and even demoralising for students

The group learning process acquiring

desirable learning skills

Generic Skills amp attitudes

bull Teamwork bull Critical evaluation of literature bull Chairing a group bull Self directed learning and use of

resources bull Listening Presentation skills

Recording bull Cooperation bull Respect for colleagues views

bull Group learning facilitates not only the acquisition of knowledge but also several other desirable attributes such as communication skills teamwork problem solving independent responsibility for learning sharing information and respect for others PBL can therefore be thought of as a small group teaching method that combines the acquisition of knowledge with the development of generic skills and attitudes Presentation of clinical material as the stimulus for learning enables students to understand the relevance of underlying scientific knowledge and principles in clinical practice

bull when PBL is introduced into a curriculum several other issues for curriculum design and implementation need to be tackled PBL is generally introduced in the context of a defined core curriculum and integration of basic and clinical sciences It has implications for staffing and learning resources and demands a different approach to timetabling workload and assessment PBL is often used to deliver core material in non-clinical parts of the curriculum Paper based PBL scenarios form the basis of the core curriculum and ensure that all students are exposed to the same problems Recently modified PBL techniques have been introduced into clinical education with real patients being used as the stimulus for learning Despite the essential ad hoc nature of learning clinical medicine a key cases approach can enable PBL to be used to deliver the core clinical curriculum

Copyright copy2003 BMJ Publishing Group Ltd

Wood D F BMJ 2003326328-330

No CRoles of participants in a PBL tutorial aption Found

What happens in a PBL tutorial bull PBL tutorials are conducted in several ways In

this article the examples are modelled on the Maastricht seven jump process but its format of seven steps may be shortened

bull A typical PBL tutorial consists of a group of students (usually eight to 10) and a tutor who facilitates the session The length of time (number of sessions) that a group stays together with each other and with individual tutors varies between institutions A group needs to be together long enough to allow good group dynamics to develop but may need to be changed occasionally if personality clashes or other dysfunctional behaviour emerges

bull Students elect a chair for each PBL scenario and a scribe to record the discussion The roles are rotated for each scenario Suitable flip charts or a whiteboard should be used for recording the proceedings At the start of the session depending on the trigger material either the student chair reads out the scenario or all students study the material If the trigger is a real patient in a ward clinic or surgery then a student may be asked to take a clinical history or identify an abnormal physical sign before the group moves to a tutorial room For each module students may be given a handbook containing the problem scenarios and suggested learning resources or learning materials may be handed out at appropriate times as the tutorials progress

Examples of trigger material for PBL scenarios bull Paper based clinical scenarios bull Experimental or clinical laboratory data bull Photographs bull Video clips bull Newspaper articles bull All or part of an article from a scientific

journal bull A real or simulated patient bull A family tree showing an inherited

disorder

PBL tutorial process ndash Step 1 Identify and clarify unfamiliar terms presented in the scenario

scribe lists those that remain unexplained after discussion ndash Step 2 Define the problem or problems to be discussed students may

have different views on the issues but all should be considered scribe records a list of agreed problems

ndash Step 3 Brainstorming session to discuss the problem(s) suggestingpossible explanations on basis of prior knowledge students draw on each others knowledge and identify areas of incomplete knowledge scribe records all discussion

ndash Step 4 Review steps 2 and 3 and arrange explanations into tentativesolutions scribe organises the explanations and restructures if necessary

ndash Step 5 Formulate learning objectives group reaches consensus onthe learning objectives tutor ensures learning objectives are focused achievable comprehensive and appropriate

ndash Step 6 Private study (all students gather information related to eachlearning objective)

ndash Step 7 Group shares results of private study (students identify theirlearning resources and share their results) tutor checks learning and may assess the group

bull The role of the tutor is to facilitate the proceedings (helping the chair to maintain group dynamics and moving the group through the task) and to ensure that the group achieves appropriate learning objectives in line with those set by the curriculum design team The tutor may need to take a more active role in step 7 of the process to ensure that all the students have done the appropriate work and to help the chair to suggest a suitable format for group members to use to present the results of their private study The tutor should encourage students to check their understanding of the material He or she can do this by encouraging the students to ask open questions and ask each other to explain topics in their own words or by the use of drawings and diagrams

PBL in curriculum design bull PBL may be used either as the mainstay of an entire

curriculum or for the delivery of individual courses In practice PBL is usually part of an integrated curriculum using a systems based approach with non-clinical material delivered in the context of clinical practice A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge skills and attitudes A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios Sufficient time should be allowed each week for students to do the self directed learning required for PBL

bull

Copyright copy2003 BMJ Publishing Group Ltd

Wood D F BMJ 2003326328-330

No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found

Writing PBL scenarios

bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives

bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after

studying the scenario should be consistent with the faculty learning objectives

bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding

bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice

bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge

bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented

bull The problem should be sufficiently open so that discussion is not curtailed too early in the process

bull Scenarios should promote participation by the students in seeking information from various learning resources

bull Adapted from Dolmans et al Med Teacher 199719185-9

Staff development

bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)

A dysfunctional group a dominant character may

make it difficult for other students to be heard

A dysfunctional group a dominant character may make it difficult for other students to be heard

bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties

Advantages of PBL bull Student centred PBLIt fostersactive learning improved

understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks

Disadvantagesbull Tutors who cant teachTutorsenjoy passing on

their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful

Assessment of PBL

bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods

bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL

Conclusion

bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning

bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL

PBL 5 Easy Steps

bull Read the problem

Mrs Paula Embledon

Mrs Paula Embledon is a 78 year old woman who has come to the emergency room complaining of shortness of breath and pain in her chest She had been in relatively good health until three weeks previously when she sprained

2 Brain storm

bull Brainstorm

bull ndash hypotheses

bull - what do we know in support of the hypothesis

bull - what do we need to know to test the hypothesis

ndash learning issues

Brainstorm

bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)

ndash specific issues (for individuals to look up)

ndash overlapping issues

bull 4 Individual Reading - Research - Preparation

bull 5 Return

bull ndash review case so far ndash report and discuss

ndash assess progress - continue pagenext pagecomplete

ndash self-evaluation - How did things go Any suggestions for next time

ndash next problem

bull 5 Return

THE FIRST GROUP SESSION

bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day

bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session

bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr

bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine

bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise

bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator

bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues

bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know

bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)

bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)

bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)

  • PROBLEM BASED LEARNING
  • New Horizons in Medical Education
  • Slide 3
  • Domains of essential Global Requirements of ME
  • What was the response to these challenges
  • New Educational Strategies
  • New Tools amp Aids
  • PBL
  • PBL
  • Advantages
  • Slide 11
  • Slide 12
  • Slide 13
  • Slide 14
  • Framework for PBL
  • Framework for PBL - II
  • Characteristics of an effective PBL Group
  • Staff Development
  • Tutorrsquos Role in Assessment
  • Slide 20
  • Evaluating PBL Tutorials-II
  • PBL
  • Slide 23
  • PBL Starting the case
  • PBL Case (contd)
  • PBL Case contd
  • The Process of PBL
  • The Process of PBL contd
  • Learn from each other
  • Determine priorities for learning
  • Slide 31
  • Slide 32
  • Learning Issues
  • Learning Issues in PBL First Session
  • PBL Second Session
  • PBL Third Session
  • Slide 37
  • Slide 38
  • During Tutorial Session students will
  • Tutorial Session contd
  • Between Tutorial Session
  • Slide 42
  • Slide 43
  • Problem-based learning is designed to develop
  • Slide 45
  • What is problem based learning
  • Slide 47
  • Slide 48
  • Slide 49
  • Rationale for using PBL
  • Slide 51
  • Slide 52
  • The group learning process acquiring desirable learning skills
  • Generic Skills amp attitudes
  • Slide 55
  • Slide 56
  • Slide 57
  • What happens in a PBL tutorial
  • Slide 59
  • Examples of trigger material for PBL scenarios
  • PBL tutorial process
  • Slide 62
  • PBL in curriculum design
  • Slide 64
  • Writing PBL scenarios
  • Slide 66
  • Staff development
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • Slide 70
  • Advantages of PBL
  • Slide 72
  • Slide 73
  • Disadvantages
  • Assessment of PBL
  • Slide 76
  • Conclusion
  • Slide 78
  • PBL 5 Easy Steps
  • 2 Brain storm
  • Brainstorm
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • THE FIRST GROUP SESSION
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
Page 37: Problem based learning

Tutorial Session contd1048708 Go to the board to diagram outline draw etc in

explanation of mechanisms relatedto hypotheses1048708 Debate evidence related to the case and avoid

personal attacks on others1048708 Comply with ground rules with regard to how

the group will function and how itsmembers treat one another1048708 Participate in end-of-session reflection and

assessment by giving and receivingconstructive criticism regarding self tutor

student and group performance

Between Tutorial Session

1048708 Research key learning issues using a variety of resources

1048708 Critically evaluate the credibility of sources and the validity of the information they have obtained in their research

1048708 Integrate what they have learned through research lectures labs clinical skills Perspectives in Medicine (PIM) etc into what is discussed in tutorials

1048708 Synthesize what they have learned and be prepared to discuss it without reading directly from their materials as much as possible and apply it to the case at the next tutorial session

Determine priorities for learning

bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue

bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan

bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge

bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career

PBL Starting the casebull After the introductions and discussion

are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it

bull Reading the case aloud keeps the group focused

bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here

Problem-based learning is designed to develop

1048708 Integrated context-specific knowledge base

1048708 Decision-makingcritical thinking process and skills

1048708 Self-directed life-long learning skills 1048708 Interpersonal collaboration and

communication skills 1048708 Constructive self and peer

assessment skills 1048708 Professional ethics and behavior

PBL Case (contd)

bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session

What is problem based learning

bull In PBL students use triggers from the problem case or scenario to define their own learning objectives

bull Subsequently they do independent self directed study before returning to the group to discuss and refine their acquired knowledge

bull Thus PBL is not about problem solving per se but rather it uses appropriate problems to increase knowledge and understanding

bull The process is clearly defined

PBL

bull PBL uses clinical cases as the context for students to study basic and clinical sciences

bull Its possible advantages over traditional approaches include its greater relevance to the practice of medicine its ability to promote retention and application of knowledge and its encouragement of self-directed life-long learning

bull Possible disadvantages include higher costs both in resources and staff time

PBL

bull An educational method characterized by the use of patient problems as a context for students to learn problem-solving skills and acquire knowledge about the basic and clinical sciences

bull Students usually meet in small groups two or three times a week for PBL tutorials

bull They are presented with a clinical problem (eg a patient with chest pain) and in a series of steps they discuss possible mechanisms and causes develop hypotheses and strategies to test the hypotheses are presented with further information and use this new information to refine their hypotheses finally reaching a conclusion

bull A tutor usually acts as a facilitator guiding students in this group-learning process

bull In the course of this exercise students identify both their existing levels and gaps in their knowledge These gaps form the basis for independent learning outside the PBL tutorials The identification and pursuit of these so-called learning goals is a key element of the PBL process

Rationale for using PBL bull The PBL approach is based on principles of adult

education20 and cognitive psychology21 It differs fundamentally from traditional curricula in which students acquire background knowledge of the basic sciences in the early years of the course and in the later years apply this knowledge to the diagnosis and management of clinical problems This traditional approach has been criticised for a number of reasons42223

bull It creates an artificial divide between the basic and clinical sciences

bull Time is wasted in acquiring knowledge that is subsequently forgotten or found to be irrelevant

bull Application of the acquired knowledge can be difficult bull The acquisition and retention of information that has no

apparent relevance can be boring and even demoralising for students

The group learning process acquiring

desirable learning skills

Generic Skills amp attitudes

bull Teamwork bull Critical evaluation of literature bull Chairing a group bull Self directed learning and use of

resources bull Listening Presentation skills

Recording bull Cooperation bull Respect for colleagues views

bull Group learning facilitates not only the acquisition of knowledge but also several other desirable attributes such as communication skills teamwork problem solving independent responsibility for learning sharing information and respect for others PBL can therefore be thought of as a small group teaching method that combines the acquisition of knowledge with the development of generic skills and attitudes Presentation of clinical material as the stimulus for learning enables students to understand the relevance of underlying scientific knowledge and principles in clinical practice

bull when PBL is introduced into a curriculum several other issues for curriculum design and implementation need to be tackled PBL is generally introduced in the context of a defined core curriculum and integration of basic and clinical sciences It has implications for staffing and learning resources and demands a different approach to timetabling workload and assessment PBL is often used to deliver core material in non-clinical parts of the curriculum Paper based PBL scenarios form the basis of the core curriculum and ensure that all students are exposed to the same problems Recently modified PBL techniques have been introduced into clinical education with real patients being used as the stimulus for learning Despite the essential ad hoc nature of learning clinical medicine a key cases approach can enable PBL to be used to deliver the core clinical curriculum

Copyright copy2003 BMJ Publishing Group Ltd

Wood D F BMJ 2003326328-330

No CRoles of participants in a PBL tutorial aption Found

What happens in a PBL tutorial bull PBL tutorials are conducted in several ways In

this article the examples are modelled on the Maastricht seven jump process but its format of seven steps may be shortened

bull A typical PBL tutorial consists of a group of students (usually eight to 10) and a tutor who facilitates the session The length of time (number of sessions) that a group stays together with each other and with individual tutors varies between institutions A group needs to be together long enough to allow good group dynamics to develop but may need to be changed occasionally if personality clashes or other dysfunctional behaviour emerges

bull Students elect a chair for each PBL scenario and a scribe to record the discussion The roles are rotated for each scenario Suitable flip charts or a whiteboard should be used for recording the proceedings At the start of the session depending on the trigger material either the student chair reads out the scenario or all students study the material If the trigger is a real patient in a ward clinic or surgery then a student may be asked to take a clinical history or identify an abnormal physical sign before the group moves to a tutorial room For each module students may be given a handbook containing the problem scenarios and suggested learning resources or learning materials may be handed out at appropriate times as the tutorials progress

Examples of trigger material for PBL scenarios bull Paper based clinical scenarios bull Experimental or clinical laboratory data bull Photographs bull Video clips bull Newspaper articles bull All or part of an article from a scientific

journal bull A real or simulated patient bull A family tree showing an inherited

disorder

PBL tutorial process ndash Step 1 Identify and clarify unfamiliar terms presented in the scenario

scribe lists those that remain unexplained after discussion ndash Step 2 Define the problem or problems to be discussed students may

have different views on the issues but all should be considered scribe records a list of agreed problems

ndash Step 3 Brainstorming session to discuss the problem(s) suggestingpossible explanations on basis of prior knowledge students draw on each others knowledge and identify areas of incomplete knowledge scribe records all discussion

ndash Step 4 Review steps 2 and 3 and arrange explanations into tentativesolutions scribe organises the explanations and restructures if necessary

ndash Step 5 Formulate learning objectives group reaches consensus onthe learning objectives tutor ensures learning objectives are focused achievable comprehensive and appropriate

ndash Step 6 Private study (all students gather information related to eachlearning objective)

ndash Step 7 Group shares results of private study (students identify theirlearning resources and share their results) tutor checks learning and may assess the group

bull The role of the tutor is to facilitate the proceedings (helping the chair to maintain group dynamics and moving the group through the task) and to ensure that the group achieves appropriate learning objectives in line with those set by the curriculum design team The tutor may need to take a more active role in step 7 of the process to ensure that all the students have done the appropriate work and to help the chair to suggest a suitable format for group members to use to present the results of their private study The tutor should encourage students to check their understanding of the material He or she can do this by encouraging the students to ask open questions and ask each other to explain topics in their own words or by the use of drawings and diagrams

PBL in curriculum design bull PBL may be used either as the mainstay of an entire

curriculum or for the delivery of individual courses In practice PBL is usually part of an integrated curriculum using a systems based approach with non-clinical material delivered in the context of clinical practice A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge skills and attitudes A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios Sufficient time should be allowed each week for students to do the self directed learning required for PBL

bull

Copyright copy2003 BMJ Publishing Group Ltd

Wood D F BMJ 2003326328-330

No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found

Writing PBL scenarios

bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives

bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after

studying the scenario should be consistent with the faculty learning objectives

bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding

bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice

bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge

bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented

bull The problem should be sufficiently open so that discussion is not curtailed too early in the process

bull Scenarios should promote participation by the students in seeking information from various learning resources

bull Adapted from Dolmans et al Med Teacher 199719185-9

Staff development

bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)

A dysfunctional group a dominant character may

make it difficult for other students to be heard

A dysfunctional group a dominant character may make it difficult for other students to be heard

bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties

Advantages of PBL bull Student centred PBLIt fostersactive learning improved

understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks

Disadvantagesbull Tutors who cant teachTutorsenjoy passing on

their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful

Assessment of PBL

bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods

bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL

Conclusion

bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning

bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL

PBL 5 Easy Steps

bull Read the problem

Mrs Paula Embledon

Mrs Paula Embledon is a 78 year old woman who has come to the emergency room complaining of shortness of breath and pain in her chest She had been in relatively good health until three weeks previously when she sprained

2 Brain storm

bull Brainstorm

bull ndash hypotheses

bull - what do we know in support of the hypothesis

bull - what do we need to know to test the hypothesis

ndash learning issues

Brainstorm

bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)

ndash specific issues (for individuals to look up)

ndash overlapping issues

bull 4 Individual Reading - Research - Preparation

bull 5 Return

bull ndash review case so far ndash report and discuss

ndash assess progress - continue pagenext pagecomplete

ndash self-evaluation - How did things go Any suggestions for next time

ndash next problem

bull 5 Return

THE FIRST GROUP SESSION

bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day

bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session

bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr

bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine

bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise

bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator

bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues

bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know

bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)

bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)

bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)

  • PROBLEM BASED LEARNING
  • New Horizons in Medical Education
  • Slide 3
  • Domains of essential Global Requirements of ME
  • What was the response to these challenges
  • New Educational Strategies
  • New Tools amp Aids
  • PBL
  • PBL
  • Advantages
  • Slide 11
  • Slide 12
  • Slide 13
  • Slide 14
  • Framework for PBL
  • Framework for PBL - II
  • Characteristics of an effective PBL Group
  • Staff Development
  • Tutorrsquos Role in Assessment
  • Slide 20
  • Evaluating PBL Tutorials-II
  • PBL
  • Slide 23
  • PBL Starting the case
  • PBL Case (contd)
  • PBL Case contd
  • The Process of PBL
  • The Process of PBL contd
  • Learn from each other
  • Determine priorities for learning
  • Slide 31
  • Slide 32
  • Learning Issues
  • Learning Issues in PBL First Session
  • PBL Second Session
  • PBL Third Session
  • Slide 37
  • Slide 38
  • During Tutorial Session students will
  • Tutorial Session contd
  • Between Tutorial Session
  • Slide 42
  • Slide 43
  • Problem-based learning is designed to develop
  • Slide 45
  • What is problem based learning
  • Slide 47
  • Slide 48
  • Slide 49
  • Rationale for using PBL
  • Slide 51
  • Slide 52
  • The group learning process acquiring desirable learning skills
  • Generic Skills amp attitudes
  • Slide 55
  • Slide 56
  • Slide 57
  • What happens in a PBL tutorial
  • Slide 59
  • Examples of trigger material for PBL scenarios
  • PBL tutorial process
  • Slide 62
  • PBL in curriculum design
  • Slide 64
  • Writing PBL scenarios
  • Slide 66
  • Staff development
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • Slide 70
  • Advantages of PBL
  • Slide 72
  • Slide 73
  • Disadvantages
  • Assessment of PBL
  • Slide 76
  • Conclusion
  • Slide 78
  • PBL 5 Easy Steps
  • 2 Brain storm
  • Brainstorm
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • THE FIRST GROUP SESSION
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
Page 38: Problem based learning

Between Tutorial Session

1048708 Research key learning issues using a variety of resources

1048708 Critically evaluate the credibility of sources and the validity of the information they have obtained in their research

1048708 Integrate what they have learned through research lectures labs clinical skills Perspectives in Medicine (PIM) etc into what is discussed in tutorials

1048708 Synthesize what they have learned and be prepared to discuss it without reading directly from their materials as much as possible and apply it to the case at the next tutorial session

Determine priorities for learning

bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue

bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan

bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge

bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career

PBL Starting the casebull After the introductions and discussion

are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it

bull Reading the case aloud keeps the group focused

bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here

Problem-based learning is designed to develop

1048708 Integrated context-specific knowledge base

1048708 Decision-makingcritical thinking process and skills

1048708 Self-directed life-long learning skills 1048708 Interpersonal collaboration and

communication skills 1048708 Constructive self and peer

assessment skills 1048708 Professional ethics and behavior

PBL Case (contd)

bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session

What is problem based learning

bull In PBL students use triggers from the problem case or scenario to define their own learning objectives

bull Subsequently they do independent self directed study before returning to the group to discuss and refine their acquired knowledge

bull Thus PBL is not about problem solving per se but rather it uses appropriate problems to increase knowledge and understanding

bull The process is clearly defined

PBL

bull PBL uses clinical cases as the context for students to study basic and clinical sciences

bull Its possible advantages over traditional approaches include its greater relevance to the practice of medicine its ability to promote retention and application of knowledge and its encouragement of self-directed life-long learning

bull Possible disadvantages include higher costs both in resources and staff time

PBL

bull An educational method characterized by the use of patient problems as a context for students to learn problem-solving skills and acquire knowledge about the basic and clinical sciences

bull Students usually meet in small groups two or three times a week for PBL tutorials

bull They are presented with a clinical problem (eg a patient with chest pain) and in a series of steps they discuss possible mechanisms and causes develop hypotheses and strategies to test the hypotheses are presented with further information and use this new information to refine their hypotheses finally reaching a conclusion

bull A tutor usually acts as a facilitator guiding students in this group-learning process

bull In the course of this exercise students identify both their existing levels and gaps in their knowledge These gaps form the basis for independent learning outside the PBL tutorials The identification and pursuit of these so-called learning goals is a key element of the PBL process

Rationale for using PBL bull The PBL approach is based on principles of adult

education20 and cognitive psychology21 It differs fundamentally from traditional curricula in which students acquire background knowledge of the basic sciences in the early years of the course and in the later years apply this knowledge to the diagnosis and management of clinical problems This traditional approach has been criticised for a number of reasons42223

bull It creates an artificial divide between the basic and clinical sciences

bull Time is wasted in acquiring knowledge that is subsequently forgotten or found to be irrelevant

bull Application of the acquired knowledge can be difficult bull The acquisition and retention of information that has no

apparent relevance can be boring and even demoralising for students

The group learning process acquiring

desirable learning skills

Generic Skills amp attitudes

bull Teamwork bull Critical evaluation of literature bull Chairing a group bull Self directed learning and use of

resources bull Listening Presentation skills

Recording bull Cooperation bull Respect for colleagues views

bull Group learning facilitates not only the acquisition of knowledge but also several other desirable attributes such as communication skills teamwork problem solving independent responsibility for learning sharing information and respect for others PBL can therefore be thought of as a small group teaching method that combines the acquisition of knowledge with the development of generic skills and attitudes Presentation of clinical material as the stimulus for learning enables students to understand the relevance of underlying scientific knowledge and principles in clinical practice

bull when PBL is introduced into a curriculum several other issues for curriculum design and implementation need to be tackled PBL is generally introduced in the context of a defined core curriculum and integration of basic and clinical sciences It has implications for staffing and learning resources and demands a different approach to timetabling workload and assessment PBL is often used to deliver core material in non-clinical parts of the curriculum Paper based PBL scenarios form the basis of the core curriculum and ensure that all students are exposed to the same problems Recently modified PBL techniques have been introduced into clinical education with real patients being used as the stimulus for learning Despite the essential ad hoc nature of learning clinical medicine a key cases approach can enable PBL to be used to deliver the core clinical curriculum

Copyright copy2003 BMJ Publishing Group Ltd

Wood D F BMJ 2003326328-330

No CRoles of participants in a PBL tutorial aption Found

What happens in a PBL tutorial bull PBL tutorials are conducted in several ways In

this article the examples are modelled on the Maastricht seven jump process but its format of seven steps may be shortened

bull A typical PBL tutorial consists of a group of students (usually eight to 10) and a tutor who facilitates the session The length of time (number of sessions) that a group stays together with each other and with individual tutors varies between institutions A group needs to be together long enough to allow good group dynamics to develop but may need to be changed occasionally if personality clashes or other dysfunctional behaviour emerges

bull Students elect a chair for each PBL scenario and a scribe to record the discussion The roles are rotated for each scenario Suitable flip charts or a whiteboard should be used for recording the proceedings At the start of the session depending on the trigger material either the student chair reads out the scenario or all students study the material If the trigger is a real patient in a ward clinic or surgery then a student may be asked to take a clinical history or identify an abnormal physical sign before the group moves to a tutorial room For each module students may be given a handbook containing the problem scenarios and suggested learning resources or learning materials may be handed out at appropriate times as the tutorials progress

Examples of trigger material for PBL scenarios bull Paper based clinical scenarios bull Experimental or clinical laboratory data bull Photographs bull Video clips bull Newspaper articles bull All or part of an article from a scientific

journal bull A real or simulated patient bull A family tree showing an inherited

disorder

PBL tutorial process ndash Step 1 Identify and clarify unfamiliar terms presented in the scenario

scribe lists those that remain unexplained after discussion ndash Step 2 Define the problem or problems to be discussed students may

have different views on the issues but all should be considered scribe records a list of agreed problems

ndash Step 3 Brainstorming session to discuss the problem(s) suggestingpossible explanations on basis of prior knowledge students draw on each others knowledge and identify areas of incomplete knowledge scribe records all discussion

ndash Step 4 Review steps 2 and 3 and arrange explanations into tentativesolutions scribe organises the explanations and restructures if necessary

ndash Step 5 Formulate learning objectives group reaches consensus onthe learning objectives tutor ensures learning objectives are focused achievable comprehensive and appropriate

ndash Step 6 Private study (all students gather information related to eachlearning objective)

ndash Step 7 Group shares results of private study (students identify theirlearning resources and share their results) tutor checks learning and may assess the group

bull The role of the tutor is to facilitate the proceedings (helping the chair to maintain group dynamics and moving the group through the task) and to ensure that the group achieves appropriate learning objectives in line with those set by the curriculum design team The tutor may need to take a more active role in step 7 of the process to ensure that all the students have done the appropriate work and to help the chair to suggest a suitable format for group members to use to present the results of their private study The tutor should encourage students to check their understanding of the material He or she can do this by encouraging the students to ask open questions and ask each other to explain topics in their own words or by the use of drawings and diagrams

PBL in curriculum design bull PBL may be used either as the mainstay of an entire

curriculum or for the delivery of individual courses In practice PBL is usually part of an integrated curriculum using a systems based approach with non-clinical material delivered in the context of clinical practice A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge skills and attitudes A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios Sufficient time should be allowed each week for students to do the self directed learning required for PBL

bull

Copyright copy2003 BMJ Publishing Group Ltd

Wood D F BMJ 2003326328-330

No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found

Writing PBL scenarios

bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives

bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after

studying the scenario should be consistent with the faculty learning objectives

bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding

bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice

bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge

bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented

bull The problem should be sufficiently open so that discussion is not curtailed too early in the process

bull Scenarios should promote participation by the students in seeking information from various learning resources

bull Adapted from Dolmans et al Med Teacher 199719185-9

Staff development

bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)

A dysfunctional group a dominant character may

make it difficult for other students to be heard

A dysfunctional group a dominant character may make it difficult for other students to be heard

bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties

Advantages of PBL bull Student centred PBLIt fostersactive learning improved

understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks

Disadvantagesbull Tutors who cant teachTutorsenjoy passing on

their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful

Assessment of PBL

bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods

bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL

Conclusion

bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning

bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL

PBL 5 Easy Steps

bull Read the problem

Mrs Paula Embledon

Mrs Paula Embledon is a 78 year old woman who has come to the emergency room complaining of shortness of breath and pain in her chest She had been in relatively good health until three weeks previously when she sprained

2 Brain storm

bull Brainstorm

bull ndash hypotheses

bull - what do we know in support of the hypothesis

bull - what do we need to know to test the hypothesis

ndash learning issues

Brainstorm

bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)

ndash specific issues (for individuals to look up)

ndash overlapping issues

bull 4 Individual Reading - Research - Preparation

bull 5 Return

bull ndash review case so far ndash report and discuss

ndash assess progress - continue pagenext pagecomplete

ndash self-evaluation - How did things go Any suggestions for next time

ndash next problem

bull 5 Return

THE FIRST GROUP SESSION

bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day

bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session

bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr

bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine

bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise

bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator

bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues

bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know

bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)

bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)

bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)

  • PROBLEM BASED LEARNING
  • New Horizons in Medical Education
  • Slide 3
  • Domains of essential Global Requirements of ME
  • What was the response to these challenges
  • New Educational Strategies
  • New Tools amp Aids
  • PBL
  • PBL
  • Advantages
  • Slide 11
  • Slide 12
  • Slide 13
  • Slide 14
  • Framework for PBL
  • Framework for PBL - II
  • Characteristics of an effective PBL Group
  • Staff Development
  • Tutorrsquos Role in Assessment
  • Slide 20
  • Evaluating PBL Tutorials-II
  • PBL
  • Slide 23
  • PBL Starting the case
  • PBL Case (contd)
  • PBL Case contd
  • The Process of PBL
  • The Process of PBL contd
  • Learn from each other
  • Determine priorities for learning
  • Slide 31
  • Slide 32
  • Learning Issues
  • Learning Issues in PBL First Session
  • PBL Second Session
  • PBL Third Session
  • Slide 37
  • Slide 38
  • During Tutorial Session students will
  • Tutorial Session contd
  • Between Tutorial Session
  • Slide 42
  • Slide 43
  • Problem-based learning is designed to develop
  • Slide 45
  • What is problem based learning
  • Slide 47
  • Slide 48
  • Slide 49
  • Rationale for using PBL
  • Slide 51
  • Slide 52
  • The group learning process acquiring desirable learning skills
  • Generic Skills amp attitudes
  • Slide 55
  • Slide 56
  • Slide 57
  • What happens in a PBL tutorial
  • Slide 59
  • Examples of trigger material for PBL scenarios
  • PBL tutorial process
  • Slide 62
  • PBL in curriculum design
  • Slide 64
  • Writing PBL scenarios
  • Slide 66
  • Staff development
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • Slide 70
  • Advantages of PBL
  • Slide 72
  • Slide 73
  • Disadvantages
  • Assessment of PBL
  • Slide 76
  • Conclusion
  • Slide 78
  • PBL 5 Easy Steps
  • 2 Brain storm
  • Brainstorm
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • THE FIRST GROUP SESSION
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
Page 39: Problem based learning

Determine priorities for learning

bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue

bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan

bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge

bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career

PBL Starting the casebull After the introductions and discussion

are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it

bull Reading the case aloud keeps the group focused

bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here

Problem-based learning is designed to develop

1048708 Integrated context-specific knowledge base

1048708 Decision-makingcritical thinking process and skills

1048708 Self-directed life-long learning skills 1048708 Interpersonal collaboration and

communication skills 1048708 Constructive self and peer

assessment skills 1048708 Professional ethics and behavior

PBL Case (contd)

bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session

What is problem based learning

bull In PBL students use triggers from the problem case or scenario to define their own learning objectives

bull Subsequently they do independent self directed study before returning to the group to discuss and refine their acquired knowledge

bull Thus PBL is not about problem solving per se but rather it uses appropriate problems to increase knowledge and understanding

bull The process is clearly defined

PBL

bull PBL uses clinical cases as the context for students to study basic and clinical sciences

bull Its possible advantages over traditional approaches include its greater relevance to the practice of medicine its ability to promote retention and application of knowledge and its encouragement of self-directed life-long learning

bull Possible disadvantages include higher costs both in resources and staff time

PBL

bull An educational method characterized by the use of patient problems as a context for students to learn problem-solving skills and acquire knowledge about the basic and clinical sciences

bull Students usually meet in small groups two or three times a week for PBL tutorials

bull They are presented with a clinical problem (eg a patient with chest pain) and in a series of steps they discuss possible mechanisms and causes develop hypotheses and strategies to test the hypotheses are presented with further information and use this new information to refine their hypotheses finally reaching a conclusion

bull A tutor usually acts as a facilitator guiding students in this group-learning process

bull In the course of this exercise students identify both their existing levels and gaps in their knowledge These gaps form the basis for independent learning outside the PBL tutorials The identification and pursuit of these so-called learning goals is a key element of the PBL process

Rationale for using PBL bull The PBL approach is based on principles of adult

education20 and cognitive psychology21 It differs fundamentally from traditional curricula in which students acquire background knowledge of the basic sciences in the early years of the course and in the later years apply this knowledge to the diagnosis and management of clinical problems This traditional approach has been criticised for a number of reasons42223

bull It creates an artificial divide between the basic and clinical sciences

bull Time is wasted in acquiring knowledge that is subsequently forgotten or found to be irrelevant

bull Application of the acquired knowledge can be difficult bull The acquisition and retention of information that has no

apparent relevance can be boring and even demoralising for students

The group learning process acquiring

desirable learning skills

Generic Skills amp attitudes

bull Teamwork bull Critical evaluation of literature bull Chairing a group bull Self directed learning and use of

resources bull Listening Presentation skills

Recording bull Cooperation bull Respect for colleagues views

bull Group learning facilitates not only the acquisition of knowledge but also several other desirable attributes such as communication skills teamwork problem solving independent responsibility for learning sharing information and respect for others PBL can therefore be thought of as a small group teaching method that combines the acquisition of knowledge with the development of generic skills and attitudes Presentation of clinical material as the stimulus for learning enables students to understand the relevance of underlying scientific knowledge and principles in clinical practice

bull when PBL is introduced into a curriculum several other issues for curriculum design and implementation need to be tackled PBL is generally introduced in the context of a defined core curriculum and integration of basic and clinical sciences It has implications for staffing and learning resources and demands a different approach to timetabling workload and assessment PBL is often used to deliver core material in non-clinical parts of the curriculum Paper based PBL scenarios form the basis of the core curriculum and ensure that all students are exposed to the same problems Recently modified PBL techniques have been introduced into clinical education with real patients being used as the stimulus for learning Despite the essential ad hoc nature of learning clinical medicine a key cases approach can enable PBL to be used to deliver the core clinical curriculum

Copyright copy2003 BMJ Publishing Group Ltd

Wood D F BMJ 2003326328-330

No CRoles of participants in a PBL tutorial aption Found

What happens in a PBL tutorial bull PBL tutorials are conducted in several ways In

this article the examples are modelled on the Maastricht seven jump process but its format of seven steps may be shortened

bull A typical PBL tutorial consists of a group of students (usually eight to 10) and a tutor who facilitates the session The length of time (number of sessions) that a group stays together with each other and with individual tutors varies between institutions A group needs to be together long enough to allow good group dynamics to develop but may need to be changed occasionally if personality clashes or other dysfunctional behaviour emerges

bull Students elect a chair for each PBL scenario and a scribe to record the discussion The roles are rotated for each scenario Suitable flip charts or a whiteboard should be used for recording the proceedings At the start of the session depending on the trigger material either the student chair reads out the scenario or all students study the material If the trigger is a real patient in a ward clinic or surgery then a student may be asked to take a clinical history or identify an abnormal physical sign before the group moves to a tutorial room For each module students may be given a handbook containing the problem scenarios and suggested learning resources or learning materials may be handed out at appropriate times as the tutorials progress

Examples of trigger material for PBL scenarios bull Paper based clinical scenarios bull Experimental or clinical laboratory data bull Photographs bull Video clips bull Newspaper articles bull All or part of an article from a scientific

journal bull A real or simulated patient bull A family tree showing an inherited

disorder

PBL tutorial process ndash Step 1 Identify and clarify unfamiliar terms presented in the scenario

scribe lists those that remain unexplained after discussion ndash Step 2 Define the problem or problems to be discussed students may

have different views on the issues but all should be considered scribe records a list of agreed problems

ndash Step 3 Brainstorming session to discuss the problem(s) suggestingpossible explanations on basis of prior knowledge students draw on each others knowledge and identify areas of incomplete knowledge scribe records all discussion

ndash Step 4 Review steps 2 and 3 and arrange explanations into tentativesolutions scribe organises the explanations and restructures if necessary

ndash Step 5 Formulate learning objectives group reaches consensus onthe learning objectives tutor ensures learning objectives are focused achievable comprehensive and appropriate

ndash Step 6 Private study (all students gather information related to eachlearning objective)

ndash Step 7 Group shares results of private study (students identify theirlearning resources and share their results) tutor checks learning and may assess the group

bull The role of the tutor is to facilitate the proceedings (helping the chair to maintain group dynamics and moving the group through the task) and to ensure that the group achieves appropriate learning objectives in line with those set by the curriculum design team The tutor may need to take a more active role in step 7 of the process to ensure that all the students have done the appropriate work and to help the chair to suggest a suitable format for group members to use to present the results of their private study The tutor should encourage students to check their understanding of the material He or she can do this by encouraging the students to ask open questions and ask each other to explain topics in their own words or by the use of drawings and diagrams

PBL in curriculum design bull PBL may be used either as the mainstay of an entire

curriculum or for the delivery of individual courses In practice PBL is usually part of an integrated curriculum using a systems based approach with non-clinical material delivered in the context of clinical practice A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge skills and attitudes A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios Sufficient time should be allowed each week for students to do the self directed learning required for PBL

bull

Copyright copy2003 BMJ Publishing Group Ltd

Wood D F BMJ 2003326328-330

No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found

Writing PBL scenarios

bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives

bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after

studying the scenario should be consistent with the faculty learning objectives

bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding

bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice

bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge

bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented

bull The problem should be sufficiently open so that discussion is not curtailed too early in the process

bull Scenarios should promote participation by the students in seeking information from various learning resources

bull Adapted from Dolmans et al Med Teacher 199719185-9

Staff development

bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)

A dysfunctional group a dominant character may

make it difficult for other students to be heard

A dysfunctional group a dominant character may make it difficult for other students to be heard

bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties

Advantages of PBL bull Student centred PBLIt fostersactive learning improved

understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks

Disadvantagesbull Tutors who cant teachTutorsenjoy passing on

their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful

Assessment of PBL

bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods

bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL

Conclusion

bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning

bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL

PBL 5 Easy Steps

bull Read the problem

Mrs Paula Embledon

Mrs Paula Embledon is a 78 year old woman who has come to the emergency room complaining of shortness of breath and pain in her chest She had been in relatively good health until three weeks previously when she sprained

2 Brain storm

bull Brainstorm

bull ndash hypotheses

bull - what do we know in support of the hypothesis

bull - what do we need to know to test the hypothesis

ndash learning issues

Brainstorm

bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)

ndash specific issues (for individuals to look up)

ndash overlapping issues

bull 4 Individual Reading - Research - Preparation

bull 5 Return

bull ndash review case so far ndash report and discuss

ndash assess progress - continue pagenext pagecomplete

ndash self-evaluation - How did things go Any suggestions for next time

ndash next problem

bull 5 Return

THE FIRST GROUP SESSION

bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day

bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session

bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr

bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine

bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise

bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator

bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues

bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know

bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)

bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)

bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)

  • PROBLEM BASED LEARNING
  • New Horizons in Medical Education
  • Slide 3
  • Domains of essential Global Requirements of ME
  • What was the response to these challenges
  • New Educational Strategies
  • New Tools amp Aids
  • PBL
  • PBL
  • Advantages
  • Slide 11
  • Slide 12
  • Slide 13
  • Slide 14
  • Framework for PBL
  • Framework for PBL - II
  • Characteristics of an effective PBL Group
  • Staff Development
  • Tutorrsquos Role in Assessment
  • Slide 20
  • Evaluating PBL Tutorials-II
  • PBL
  • Slide 23
  • PBL Starting the case
  • PBL Case (contd)
  • PBL Case contd
  • The Process of PBL
  • The Process of PBL contd
  • Learn from each other
  • Determine priorities for learning
  • Slide 31
  • Slide 32
  • Learning Issues
  • Learning Issues in PBL First Session
  • PBL Second Session
  • PBL Third Session
  • Slide 37
  • Slide 38
  • During Tutorial Session students will
  • Tutorial Session contd
  • Between Tutorial Session
  • Slide 42
  • Slide 43
  • Problem-based learning is designed to develop
  • Slide 45
  • What is problem based learning
  • Slide 47
  • Slide 48
  • Slide 49
  • Rationale for using PBL
  • Slide 51
  • Slide 52
  • The group learning process acquiring desirable learning skills
  • Generic Skills amp attitudes
  • Slide 55
  • Slide 56
  • Slide 57
  • What happens in a PBL tutorial
  • Slide 59
  • Examples of trigger material for PBL scenarios
  • PBL tutorial process
  • Slide 62
  • PBL in curriculum design
  • Slide 64
  • Writing PBL scenarios
  • Slide 66
  • Staff development
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • Slide 70
  • Advantages of PBL
  • Slide 72
  • Slide 73
  • Disadvantages
  • Assessment of PBL
  • Slide 76
  • Conclusion
  • Slide 78
  • PBL 5 Easy Steps
  • 2 Brain storm
  • Brainstorm
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • THE FIRST GROUP SESSION
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
Page 40: Problem based learning

PBL Starting the casebull After the introductions and discussion

are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it

bull Reading the case aloud keeps the group focused

bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here

Problem-based learning is designed to develop

1048708 Integrated context-specific knowledge base

1048708 Decision-makingcritical thinking process and skills

1048708 Self-directed life-long learning skills 1048708 Interpersonal collaboration and

communication skills 1048708 Constructive self and peer

assessment skills 1048708 Professional ethics and behavior

PBL Case (contd)

bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session

What is problem based learning

bull In PBL students use triggers from the problem case or scenario to define their own learning objectives

bull Subsequently they do independent self directed study before returning to the group to discuss and refine their acquired knowledge

bull Thus PBL is not about problem solving per se but rather it uses appropriate problems to increase knowledge and understanding

bull The process is clearly defined

PBL

bull PBL uses clinical cases as the context for students to study basic and clinical sciences

bull Its possible advantages over traditional approaches include its greater relevance to the practice of medicine its ability to promote retention and application of knowledge and its encouragement of self-directed life-long learning

bull Possible disadvantages include higher costs both in resources and staff time

PBL

bull An educational method characterized by the use of patient problems as a context for students to learn problem-solving skills and acquire knowledge about the basic and clinical sciences

bull Students usually meet in small groups two or three times a week for PBL tutorials

bull They are presented with a clinical problem (eg a patient with chest pain) and in a series of steps they discuss possible mechanisms and causes develop hypotheses and strategies to test the hypotheses are presented with further information and use this new information to refine their hypotheses finally reaching a conclusion

bull A tutor usually acts as a facilitator guiding students in this group-learning process

bull In the course of this exercise students identify both their existing levels and gaps in their knowledge These gaps form the basis for independent learning outside the PBL tutorials The identification and pursuit of these so-called learning goals is a key element of the PBL process

Rationale for using PBL bull The PBL approach is based on principles of adult

education20 and cognitive psychology21 It differs fundamentally from traditional curricula in which students acquire background knowledge of the basic sciences in the early years of the course and in the later years apply this knowledge to the diagnosis and management of clinical problems This traditional approach has been criticised for a number of reasons42223

bull It creates an artificial divide between the basic and clinical sciences

bull Time is wasted in acquiring knowledge that is subsequently forgotten or found to be irrelevant

bull Application of the acquired knowledge can be difficult bull The acquisition and retention of information that has no

apparent relevance can be boring and even demoralising for students

The group learning process acquiring

desirable learning skills

Generic Skills amp attitudes

bull Teamwork bull Critical evaluation of literature bull Chairing a group bull Self directed learning and use of

resources bull Listening Presentation skills

Recording bull Cooperation bull Respect for colleagues views

bull Group learning facilitates not only the acquisition of knowledge but also several other desirable attributes such as communication skills teamwork problem solving independent responsibility for learning sharing information and respect for others PBL can therefore be thought of as a small group teaching method that combines the acquisition of knowledge with the development of generic skills and attitudes Presentation of clinical material as the stimulus for learning enables students to understand the relevance of underlying scientific knowledge and principles in clinical practice

bull when PBL is introduced into a curriculum several other issues for curriculum design and implementation need to be tackled PBL is generally introduced in the context of a defined core curriculum and integration of basic and clinical sciences It has implications for staffing and learning resources and demands a different approach to timetabling workload and assessment PBL is often used to deliver core material in non-clinical parts of the curriculum Paper based PBL scenarios form the basis of the core curriculum and ensure that all students are exposed to the same problems Recently modified PBL techniques have been introduced into clinical education with real patients being used as the stimulus for learning Despite the essential ad hoc nature of learning clinical medicine a key cases approach can enable PBL to be used to deliver the core clinical curriculum

Copyright copy2003 BMJ Publishing Group Ltd

Wood D F BMJ 2003326328-330

No CRoles of participants in a PBL tutorial aption Found

What happens in a PBL tutorial bull PBL tutorials are conducted in several ways In

this article the examples are modelled on the Maastricht seven jump process but its format of seven steps may be shortened

bull A typical PBL tutorial consists of a group of students (usually eight to 10) and a tutor who facilitates the session The length of time (number of sessions) that a group stays together with each other and with individual tutors varies between institutions A group needs to be together long enough to allow good group dynamics to develop but may need to be changed occasionally if personality clashes or other dysfunctional behaviour emerges

bull Students elect a chair for each PBL scenario and a scribe to record the discussion The roles are rotated for each scenario Suitable flip charts or a whiteboard should be used for recording the proceedings At the start of the session depending on the trigger material either the student chair reads out the scenario or all students study the material If the trigger is a real patient in a ward clinic or surgery then a student may be asked to take a clinical history or identify an abnormal physical sign before the group moves to a tutorial room For each module students may be given a handbook containing the problem scenarios and suggested learning resources or learning materials may be handed out at appropriate times as the tutorials progress

Examples of trigger material for PBL scenarios bull Paper based clinical scenarios bull Experimental or clinical laboratory data bull Photographs bull Video clips bull Newspaper articles bull All or part of an article from a scientific

journal bull A real or simulated patient bull A family tree showing an inherited

disorder

PBL tutorial process ndash Step 1 Identify and clarify unfamiliar terms presented in the scenario

scribe lists those that remain unexplained after discussion ndash Step 2 Define the problem or problems to be discussed students may

have different views on the issues but all should be considered scribe records a list of agreed problems

ndash Step 3 Brainstorming session to discuss the problem(s) suggestingpossible explanations on basis of prior knowledge students draw on each others knowledge and identify areas of incomplete knowledge scribe records all discussion

ndash Step 4 Review steps 2 and 3 and arrange explanations into tentativesolutions scribe organises the explanations and restructures if necessary

ndash Step 5 Formulate learning objectives group reaches consensus onthe learning objectives tutor ensures learning objectives are focused achievable comprehensive and appropriate

ndash Step 6 Private study (all students gather information related to eachlearning objective)

ndash Step 7 Group shares results of private study (students identify theirlearning resources and share their results) tutor checks learning and may assess the group

bull The role of the tutor is to facilitate the proceedings (helping the chair to maintain group dynamics and moving the group through the task) and to ensure that the group achieves appropriate learning objectives in line with those set by the curriculum design team The tutor may need to take a more active role in step 7 of the process to ensure that all the students have done the appropriate work and to help the chair to suggest a suitable format for group members to use to present the results of their private study The tutor should encourage students to check their understanding of the material He or she can do this by encouraging the students to ask open questions and ask each other to explain topics in their own words or by the use of drawings and diagrams

PBL in curriculum design bull PBL may be used either as the mainstay of an entire

curriculum or for the delivery of individual courses In practice PBL is usually part of an integrated curriculum using a systems based approach with non-clinical material delivered in the context of clinical practice A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge skills and attitudes A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios Sufficient time should be allowed each week for students to do the self directed learning required for PBL

bull

Copyright copy2003 BMJ Publishing Group Ltd

Wood D F BMJ 2003326328-330

No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found

Writing PBL scenarios

bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives

bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after

studying the scenario should be consistent with the faculty learning objectives

bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding

bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice

bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge

bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented

bull The problem should be sufficiently open so that discussion is not curtailed too early in the process

bull Scenarios should promote participation by the students in seeking information from various learning resources

bull Adapted from Dolmans et al Med Teacher 199719185-9

Staff development

bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)

A dysfunctional group a dominant character may

make it difficult for other students to be heard

A dysfunctional group a dominant character may make it difficult for other students to be heard

bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties

Advantages of PBL bull Student centred PBLIt fostersactive learning improved

understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks

Disadvantagesbull Tutors who cant teachTutorsenjoy passing on

their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful

Assessment of PBL

bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods

bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL

Conclusion

bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning

bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL

PBL 5 Easy Steps

bull Read the problem

Mrs Paula Embledon

Mrs Paula Embledon is a 78 year old woman who has come to the emergency room complaining of shortness of breath and pain in her chest She had been in relatively good health until three weeks previously when she sprained

2 Brain storm

bull Brainstorm

bull ndash hypotheses

bull - what do we know in support of the hypothesis

bull - what do we need to know to test the hypothesis

ndash learning issues

Brainstorm

bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)

ndash specific issues (for individuals to look up)

ndash overlapping issues

bull 4 Individual Reading - Research - Preparation

bull 5 Return

bull ndash review case so far ndash report and discuss

ndash assess progress - continue pagenext pagecomplete

ndash self-evaluation - How did things go Any suggestions for next time

ndash next problem

bull 5 Return

THE FIRST GROUP SESSION

bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day

bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session

bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr

bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine

bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise

bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator

bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues

bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know

bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)

bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)

bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)

  • PROBLEM BASED LEARNING
  • New Horizons in Medical Education
  • Slide 3
  • Domains of essential Global Requirements of ME
  • What was the response to these challenges
  • New Educational Strategies
  • New Tools amp Aids
  • PBL
  • PBL
  • Advantages
  • Slide 11
  • Slide 12
  • Slide 13
  • Slide 14
  • Framework for PBL
  • Framework for PBL - II
  • Characteristics of an effective PBL Group
  • Staff Development
  • Tutorrsquos Role in Assessment
  • Slide 20
  • Evaluating PBL Tutorials-II
  • PBL
  • Slide 23
  • PBL Starting the case
  • PBL Case (contd)
  • PBL Case contd
  • The Process of PBL
  • The Process of PBL contd
  • Learn from each other
  • Determine priorities for learning
  • Slide 31
  • Slide 32
  • Learning Issues
  • Learning Issues in PBL First Session
  • PBL Second Session
  • PBL Third Session
  • Slide 37
  • Slide 38
  • During Tutorial Session students will
  • Tutorial Session contd
  • Between Tutorial Session
  • Slide 42
  • Slide 43
  • Problem-based learning is designed to develop
  • Slide 45
  • What is problem based learning
  • Slide 47
  • Slide 48
  • Slide 49
  • Rationale for using PBL
  • Slide 51
  • Slide 52
  • The group learning process acquiring desirable learning skills
  • Generic Skills amp attitudes
  • Slide 55
  • Slide 56
  • Slide 57
  • What happens in a PBL tutorial
  • Slide 59
  • Examples of trigger material for PBL scenarios
  • PBL tutorial process
  • Slide 62
  • PBL in curriculum design
  • Slide 64
  • Writing PBL scenarios
  • Slide 66
  • Staff development
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • Slide 70
  • Advantages of PBL
  • Slide 72
  • Slide 73
  • Disadvantages
  • Assessment of PBL
  • Slide 76
  • Conclusion
  • Slide 78
  • PBL 5 Easy Steps
  • 2 Brain storm
  • Brainstorm
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • THE FIRST GROUP SESSION
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
Page 41: Problem based learning

Problem-based learning is designed to develop

1048708 Integrated context-specific knowledge base

1048708 Decision-makingcritical thinking process and skills

1048708 Self-directed life-long learning skills 1048708 Interpersonal collaboration and

communication skills 1048708 Constructive self and peer

assessment skills 1048708 Professional ethics and behavior

PBL Case (contd)

bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session

What is problem based learning

bull In PBL students use triggers from the problem case or scenario to define their own learning objectives

bull Subsequently they do independent self directed study before returning to the group to discuss and refine their acquired knowledge

bull Thus PBL is not about problem solving per se but rather it uses appropriate problems to increase knowledge and understanding

bull The process is clearly defined

PBL

bull PBL uses clinical cases as the context for students to study basic and clinical sciences

bull Its possible advantages over traditional approaches include its greater relevance to the practice of medicine its ability to promote retention and application of knowledge and its encouragement of self-directed life-long learning

bull Possible disadvantages include higher costs both in resources and staff time

PBL

bull An educational method characterized by the use of patient problems as a context for students to learn problem-solving skills and acquire knowledge about the basic and clinical sciences

bull Students usually meet in small groups two or three times a week for PBL tutorials

bull They are presented with a clinical problem (eg a patient with chest pain) and in a series of steps they discuss possible mechanisms and causes develop hypotheses and strategies to test the hypotheses are presented with further information and use this new information to refine their hypotheses finally reaching a conclusion

bull A tutor usually acts as a facilitator guiding students in this group-learning process

bull In the course of this exercise students identify both their existing levels and gaps in their knowledge These gaps form the basis for independent learning outside the PBL tutorials The identification and pursuit of these so-called learning goals is a key element of the PBL process

Rationale for using PBL bull The PBL approach is based on principles of adult

education20 and cognitive psychology21 It differs fundamentally from traditional curricula in which students acquire background knowledge of the basic sciences in the early years of the course and in the later years apply this knowledge to the diagnosis and management of clinical problems This traditional approach has been criticised for a number of reasons42223

bull It creates an artificial divide between the basic and clinical sciences

bull Time is wasted in acquiring knowledge that is subsequently forgotten or found to be irrelevant

bull Application of the acquired knowledge can be difficult bull The acquisition and retention of information that has no

apparent relevance can be boring and even demoralising for students

The group learning process acquiring

desirable learning skills

Generic Skills amp attitudes

bull Teamwork bull Critical evaluation of literature bull Chairing a group bull Self directed learning and use of

resources bull Listening Presentation skills

Recording bull Cooperation bull Respect for colleagues views

bull Group learning facilitates not only the acquisition of knowledge but also several other desirable attributes such as communication skills teamwork problem solving independent responsibility for learning sharing information and respect for others PBL can therefore be thought of as a small group teaching method that combines the acquisition of knowledge with the development of generic skills and attitudes Presentation of clinical material as the stimulus for learning enables students to understand the relevance of underlying scientific knowledge and principles in clinical practice

bull when PBL is introduced into a curriculum several other issues for curriculum design and implementation need to be tackled PBL is generally introduced in the context of a defined core curriculum and integration of basic and clinical sciences It has implications for staffing and learning resources and demands a different approach to timetabling workload and assessment PBL is often used to deliver core material in non-clinical parts of the curriculum Paper based PBL scenarios form the basis of the core curriculum and ensure that all students are exposed to the same problems Recently modified PBL techniques have been introduced into clinical education with real patients being used as the stimulus for learning Despite the essential ad hoc nature of learning clinical medicine a key cases approach can enable PBL to be used to deliver the core clinical curriculum

Copyright copy2003 BMJ Publishing Group Ltd

Wood D F BMJ 2003326328-330

No CRoles of participants in a PBL tutorial aption Found

What happens in a PBL tutorial bull PBL tutorials are conducted in several ways In

this article the examples are modelled on the Maastricht seven jump process but its format of seven steps may be shortened

bull A typical PBL tutorial consists of a group of students (usually eight to 10) and a tutor who facilitates the session The length of time (number of sessions) that a group stays together with each other and with individual tutors varies between institutions A group needs to be together long enough to allow good group dynamics to develop but may need to be changed occasionally if personality clashes or other dysfunctional behaviour emerges

bull Students elect a chair for each PBL scenario and a scribe to record the discussion The roles are rotated for each scenario Suitable flip charts or a whiteboard should be used for recording the proceedings At the start of the session depending on the trigger material either the student chair reads out the scenario or all students study the material If the trigger is a real patient in a ward clinic or surgery then a student may be asked to take a clinical history or identify an abnormal physical sign before the group moves to a tutorial room For each module students may be given a handbook containing the problem scenarios and suggested learning resources or learning materials may be handed out at appropriate times as the tutorials progress

Examples of trigger material for PBL scenarios bull Paper based clinical scenarios bull Experimental or clinical laboratory data bull Photographs bull Video clips bull Newspaper articles bull All or part of an article from a scientific

journal bull A real or simulated patient bull A family tree showing an inherited

disorder

PBL tutorial process ndash Step 1 Identify and clarify unfamiliar terms presented in the scenario

scribe lists those that remain unexplained after discussion ndash Step 2 Define the problem or problems to be discussed students may

have different views on the issues but all should be considered scribe records a list of agreed problems

ndash Step 3 Brainstorming session to discuss the problem(s) suggestingpossible explanations on basis of prior knowledge students draw on each others knowledge and identify areas of incomplete knowledge scribe records all discussion

ndash Step 4 Review steps 2 and 3 and arrange explanations into tentativesolutions scribe organises the explanations and restructures if necessary

ndash Step 5 Formulate learning objectives group reaches consensus onthe learning objectives tutor ensures learning objectives are focused achievable comprehensive and appropriate

ndash Step 6 Private study (all students gather information related to eachlearning objective)

ndash Step 7 Group shares results of private study (students identify theirlearning resources and share their results) tutor checks learning and may assess the group

bull The role of the tutor is to facilitate the proceedings (helping the chair to maintain group dynamics and moving the group through the task) and to ensure that the group achieves appropriate learning objectives in line with those set by the curriculum design team The tutor may need to take a more active role in step 7 of the process to ensure that all the students have done the appropriate work and to help the chair to suggest a suitable format for group members to use to present the results of their private study The tutor should encourage students to check their understanding of the material He or she can do this by encouraging the students to ask open questions and ask each other to explain topics in their own words or by the use of drawings and diagrams

PBL in curriculum design bull PBL may be used either as the mainstay of an entire

curriculum or for the delivery of individual courses In practice PBL is usually part of an integrated curriculum using a systems based approach with non-clinical material delivered in the context of clinical practice A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge skills and attitudes A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios Sufficient time should be allowed each week for students to do the self directed learning required for PBL

bull

Copyright copy2003 BMJ Publishing Group Ltd

Wood D F BMJ 2003326328-330

No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found

Writing PBL scenarios

bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives

bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after

studying the scenario should be consistent with the faculty learning objectives

bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding

bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice

bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge

bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented

bull The problem should be sufficiently open so that discussion is not curtailed too early in the process

bull Scenarios should promote participation by the students in seeking information from various learning resources

bull Adapted from Dolmans et al Med Teacher 199719185-9

Staff development

bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)

A dysfunctional group a dominant character may

make it difficult for other students to be heard

A dysfunctional group a dominant character may make it difficult for other students to be heard

bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties

Advantages of PBL bull Student centred PBLIt fostersactive learning improved

understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks

Disadvantagesbull Tutors who cant teachTutorsenjoy passing on

their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful

Assessment of PBL

bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods

bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL

Conclusion

bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning

bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL

PBL 5 Easy Steps

bull Read the problem

Mrs Paula Embledon

Mrs Paula Embledon is a 78 year old woman who has come to the emergency room complaining of shortness of breath and pain in her chest She had been in relatively good health until three weeks previously when she sprained

2 Brain storm

bull Brainstorm

bull ndash hypotheses

bull - what do we know in support of the hypothesis

bull - what do we need to know to test the hypothesis

ndash learning issues

Brainstorm

bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)

ndash specific issues (for individuals to look up)

ndash overlapping issues

bull 4 Individual Reading - Research - Preparation

bull 5 Return

bull ndash review case so far ndash report and discuss

ndash assess progress - continue pagenext pagecomplete

ndash self-evaluation - How did things go Any suggestions for next time

ndash next problem

bull 5 Return

THE FIRST GROUP SESSION

bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day

bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session

bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr

bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine

bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise

bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator

bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues

bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know

bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)

bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)

bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)

  • PROBLEM BASED LEARNING
  • New Horizons in Medical Education
  • Slide 3
  • Domains of essential Global Requirements of ME
  • What was the response to these challenges
  • New Educational Strategies
  • New Tools amp Aids
  • PBL
  • PBL
  • Advantages
  • Slide 11
  • Slide 12
  • Slide 13
  • Slide 14
  • Framework for PBL
  • Framework for PBL - II
  • Characteristics of an effective PBL Group
  • Staff Development
  • Tutorrsquos Role in Assessment
  • Slide 20
  • Evaluating PBL Tutorials-II
  • PBL
  • Slide 23
  • PBL Starting the case
  • PBL Case (contd)
  • PBL Case contd
  • The Process of PBL
  • The Process of PBL contd
  • Learn from each other
  • Determine priorities for learning
  • Slide 31
  • Slide 32
  • Learning Issues
  • Learning Issues in PBL First Session
  • PBL Second Session
  • PBL Third Session
  • Slide 37
  • Slide 38
  • During Tutorial Session students will
  • Tutorial Session contd
  • Between Tutorial Session
  • Slide 42
  • Slide 43
  • Problem-based learning is designed to develop
  • Slide 45
  • What is problem based learning
  • Slide 47
  • Slide 48
  • Slide 49
  • Rationale for using PBL
  • Slide 51
  • Slide 52
  • The group learning process acquiring desirable learning skills
  • Generic Skills amp attitudes
  • Slide 55
  • Slide 56
  • Slide 57
  • What happens in a PBL tutorial
  • Slide 59
  • Examples of trigger material for PBL scenarios
  • PBL tutorial process
  • Slide 62
  • PBL in curriculum design
  • Slide 64
  • Writing PBL scenarios
  • Slide 66
  • Staff development
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • Slide 70
  • Advantages of PBL
  • Slide 72
  • Slide 73
  • Disadvantages
  • Assessment of PBL
  • Slide 76
  • Conclusion
  • Slide 78
  • PBL 5 Easy Steps
  • 2 Brain storm
  • Brainstorm
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • THE FIRST GROUP SESSION
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
Page 42: Problem based learning

PBL Case (contd)

bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session

What is problem based learning

bull In PBL students use triggers from the problem case or scenario to define their own learning objectives

bull Subsequently they do independent self directed study before returning to the group to discuss and refine their acquired knowledge

bull Thus PBL is not about problem solving per se but rather it uses appropriate problems to increase knowledge and understanding

bull The process is clearly defined

PBL

bull PBL uses clinical cases as the context for students to study basic and clinical sciences

bull Its possible advantages over traditional approaches include its greater relevance to the practice of medicine its ability to promote retention and application of knowledge and its encouragement of self-directed life-long learning

bull Possible disadvantages include higher costs both in resources and staff time

PBL

bull An educational method characterized by the use of patient problems as a context for students to learn problem-solving skills and acquire knowledge about the basic and clinical sciences

bull Students usually meet in small groups two or three times a week for PBL tutorials

bull They are presented with a clinical problem (eg a patient with chest pain) and in a series of steps they discuss possible mechanisms and causes develop hypotheses and strategies to test the hypotheses are presented with further information and use this new information to refine their hypotheses finally reaching a conclusion

bull A tutor usually acts as a facilitator guiding students in this group-learning process

bull In the course of this exercise students identify both their existing levels and gaps in their knowledge These gaps form the basis for independent learning outside the PBL tutorials The identification and pursuit of these so-called learning goals is a key element of the PBL process

Rationale for using PBL bull The PBL approach is based on principles of adult

education20 and cognitive psychology21 It differs fundamentally from traditional curricula in which students acquire background knowledge of the basic sciences in the early years of the course and in the later years apply this knowledge to the diagnosis and management of clinical problems This traditional approach has been criticised for a number of reasons42223

bull It creates an artificial divide between the basic and clinical sciences

bull Time is wasted in acquiring knowledge that is subsequently forgotten or found to be irrelevant

bull Application of the acquired knowledge can be difficult bull The acquisition and retention of information that has no

apparent relevance can be boring and even demoralising for students

The group learning process acquiring

desirable learning skills

Generic Skills amp attitudes

bull Teamwork bull Critical evaluation of literature bull Chairing a group bull Self directed learning and use of

resources bull Listening Presentation skills

Recording bull Cooperation bull Respect for colleagues views

bull Group learning facilitates not only the acquisition of knowledge but also several other desirable attributes such as communication skills teamwork problem solving independent responsibility for learning sharing information and respect for others PBL can therefore be thought of as a small group teaching method that combines the acquisition of knowledge with the development of generic skills and attitudes Presentation of clinical material as the stimulus for learning enables students to understand the relevance of underlying scientific knowledge and principles in clinical practice

bull when PBL is introduced into a curriculum several other issues for curriculum design and implementation need to be tackled PBL is generally introduced in the context of a defined core curriculum and integration of basic and clinical sciences It has implications for staffing and learning resources and demands a different approach to timetabling workload and assessment PBL is often used to deliver core material in non-clinical parts of the curriculum Paper based PBL scenarios form the basis of the core curriculum and ensure that all students are exposed to the same problems Recently modified PBL techniques have been introduced into clinical education with real patients being used as the stimulus for learning Despite the essential ad hoc nature of learning clinical medicine a key cases approach can enable PBL to be used to deliver the core clinical curriculum

Copyright copy2003 BMJ Publishing Group Ltd

Wood D F BMJ 2003326328-330

No CRoles of participants in a PBL tutorial aption Found

What happens in a PBL tutorial bull PBL tutorials are conducted in several ways In

this article the examples are modelled on the Maastricht seven jump process but its format of seven steps may be shortened

bull A typical PBL tutorial consists of a group of students (usually eight to 10) and a tutor who facilitates the session The length of time (number of sessions) that a group stays together with each other and with individual tutors varies between institutions A group needs to be together long enough to allow good group dynamics to develop but may need to be changed occasionally if personality clashes or other dysfunctional behaviour emerges

bull Students elect a chair for each PBL scenario and a scribe to record the discussion The roles are rotated for each scenario Suitable flip charts or a whiteboard should be used for recording the proceedings At the start of the session depending on the trigger material either the student chair reads out the scenario or all students study the material If the trigger is a real patient in a ward clinic or surgery then a student may be asked to take a clinical history or identify an abnormal physical sign before the group moves to a tutorial room For each module students may be given a handbook containing the problem scenarios and suggested learning resources or learning materials may be handed out at appropriate times as the tutorials progress

Examples of trigger material for PBL scenarios bull Paper based clinical scenarios bull Experimental or clinical laboratory data bull Photographs bull Video clips bull Newspaper articles bull All or part of an article from a scientific

journal bull A real or simulated patient bull A family tree showing an inherited

disorder

PBL tutorial process ndash Step 1 Identify and clarify unfamiliar terms presented in the scenario

scribe lists those that remain unexplained after discussion ndash Step 2 Define the problem or problems to be discussed students may

have different views on the issues but all should be considered scribe records a list of agreed problems

ndash Step 3 Brainstorming session to discuss the problem(s) suggestingpossible explanations on basis of prior knowledge students draw on each others knowledge and identify areas of incomplete knowledge scribe records all discussion

ndash Step 4 Review steps 2 and 3 and arrange explanations into tentativesolutions scribe organises the explanations and restructures if necessary

ndash Step 5 Formulate learning objectives group reaches consensus onthe learning objectives tutor ensures learning objectives are focused achievable comprehensive and appropriate

ndash Step 6 Private study (all students gather information related to eachlearning objective)

ndash Step 7 Group shares results of private study (students identify theirlearning resources and share their results) tutor checks learning and may assess the group

bull The role of the tutor is to facilitate the proceedings (helping the chair to maintain group dynamics and moving the group through the task) and to ensure that the group achieves appropriate learning objectives in line with those set by the curriculum design team The tutor may need to take a more active role in step 7 of the process to ensure that all the students have done the appropriate work and to help the chair to suggest a suitable format for group members to use to present the results of their private study The tutor should encourage students to check their understanding of the material He or she can do this by encouraging the students to ask open questions and ask each other to explain topics in their own words or by the use of drawings and diagrams

PBL in curriculum design bull PBL may be used either as the mainstay of an entire

curriculum or for the delivery of individual courses In practice PBL is usually part of an integrated curriculum using a systems based approach with non-clinical material delivered in the context of clinical practice A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge skills and attitudes A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios Sufficient time should be allowed each week for students to do the self directed learning required for PBL

bull

Copyright copy2003 BMJ Publishing Group Ltd

Wood D F BMJ 2003326328-330

No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found

Writing PBL scenarios

bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives

bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after

studying the scenario should be consistent with the faculty learning objectives

bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding

bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice

bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge

bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented

bull The problem should be sufficiently open so that discussion is not curtailed too early in the process

bull Scenarios should promote participation by the students in seeking information from various learning resources

bull Adapted from Dolmans et al Med Teacher 199719185-9

Staff development

bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)

A dysfunctional group a dominant character may

make it difficult for other students to be heard

A dysfunctional group a dominant character may make it difficult for other students to be heard

bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties

Advantages of PBL bull Student centred PBLIt fostersactive learning improved

understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks

Disadvantagesbull Tutors who cant teachTutorsenjoy passing on

their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful

Assessment of PBL

bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods

bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL

Conclusion

bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning

bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL

PBL 5 Easy Steps

bull Read the problem

Mrs Paula Embledon

Mrs Paula Embledon is a 78 year old woman who has come to the emergency room complaining of shortness of breath and pain in her chest She had been in relatively good health until three weeks previously when she sprained

2 Brain storm

bull Brainstorm

bull ndash hypotheses

bull - what do we know in support of the hypothesis

bull - what do we need to know to test the hypothesis

ndash learning issues

Brainstorm

bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)

ndash specific issues (for individuals to look up)

ndash overlapping issues

bull 4 Individual Reading - Research - Preparation

bull 5 Return

bull ndash review case so far ndash report and discuss

ndash assess progress - continue pagenext pagecomplete

ndash self-evaluation - How did things go Any suggestions for next time

ndash next problem

bull 5 Return

THE FIRST GROUP SESSION

bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day

bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session

bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr

bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine

bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise

bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator

bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues

bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know

bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)

bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)

bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)

  • PROBLEM BASED LEARNING
  • New Horizons in Medical Education
  • Slide 3
  • Domains of essential Global Requirements of ME
  • What was the response to these challenges
  • New Educational Strategies
  • New Tools amp Aids
  • PBL
  • PBL
  • Advantages
  • Slide 11
  • Slide 12
  • Slide 13
  • Slide 14
  • Framework for PBL
  • Framework for PBL - II
  • Characteristics of an effective PBL Group
  • Staff Development
  • Tutorrsquos Role in Assessment
  • Slide 20
  • Evaluating PBL Tutorials-II
  • PBL
  • Slide 23
  • PBL Starting the case
  • PBL Case (contd)
  • PBL Case contd
  • The Process of PBL
  • The Process of PBL contd
  • Learn from each other
  • Determine priorities for learning
  • Slide 31
  • Slide 32
  • Learning Issues
  • Learning Issues in PBL First Session
  • PBL Second Session
  • PBL Third Session
  • Slide 37
  • Slide 38
  • During Tutorial Session students will
  • Tutorial Session contd
  • Between Tutorial Session
  • Slide 42
  • Slide 43
  • Problem-based learning is designed to develop
  • Slide 45
  • What is problem based learning
  • Slide 47
  • Slide 48
  • Slide 49
  • Rationale for using PBL
  • Slide 51
  • Slide 52
  • The group learning process acquiring desirable learning skills
  • Generic Skills amp attitudes
  • Slide 55
  • Slide 56
  • Slide 57
  • What happens in a PBL tutorial
  • Slide 59
  • Examples of trigger material for PBL scenarios
  • PBL tutorial process
  • Slide 62
  • PBL in curriculum design
  • Slide 64
  • Writing PBL scenarios
  • Slide 66
  • Staff development
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • Slide 70
  • Advantages of PBL
  • Slide 72
  • Slide 73
  • Disadvantages
  • Assessment of PBL
  • Slide 76
  • Conclusion
  • Slide 78
  • PBL 5 Easy Steps
  • 2 Brain storm
  • Brainstorm
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • THE FIRST GROUP SESSION
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
Page 43: Problem based learning

What is problem based learning

bull In PBL students use triggers from the problem case or scenario to define their own learning objectives

bull Subsequently they do independent self directed study before returning to the group to discuss and refine their acquired knowledge

bull Thus PBL is not about problem solving per se but rather it uses appropriate problems to increase knowledge and understanding

bull The process is clearly defined

PBL

bull PBL uses clinical cases as the context for students to study basic and clinical sciences

bull Its possible advantages over traditional approaches include its greater relevance to the practice of medicine its ability to promote retention and application of knowledge and its encouragement of self-directed life-long learning

bull Possible disadvantages include higher costs both in resources and staff time

PBL

bull An educational method characterized by the use of patient problems as a context for students to learn problem-solving skills and acquire knowledge about the basic and clinical sciences

bull Students usually meet in small groups two or three times a week for PBL tutorials

bull They are presented with a clinical problem (eg a patient with chest pain) and in a series of steps they discuss possible mechanisms and causes develop hypotheses and strategies to test the hypotheses are presented with further information and use this new information to refine their hypotheses finally reaching a conclusion

bull A tutor usually acts as a facilitator guiding students in this group-learning process

bull In the course of this exercise students identify both their existing levels and gaps in their knowledge These gaps form the basis for independent learning outside the PBL tutorials The identification and pursuit of these so-called learning goals is a key element of the PBL process

Rationale for using PBL bull The PBL approach is based on principles of adult

education20 and cognitive psychology21 It differs fundamentally from traditional curricula in which students acquire background knowledge of the basic sciences in the early years of the course and in the later years apply this knowledge to the diagnosis and management of clinical problems This traditional approach has been criticised for a number of reasons42223

bull It creates an artificial divide between the basic and clinical sciences

bull Time is wasted in acquiring knowledge that is subsequently forgotten or found to be irrelevant

bull Application of the acquired knowledge can be difficult bull The acquisition and retention of information that has no

apparent relevance can be boring and even demoralising for students

The group learning process acquiring

desirable learning skills

Generic Skills amp attitudes

bull Teamwork bull Critical evaluation of literature bull Chairing a group bull Self directed learning and use of

resources bull Listening Presentation skills

Recording bull Cooperation bull Respect for colleagues views

bull Group learning facilitates not only the acquisition of knowledge but also several other desirable attributes such as communication skills teamwork problem solving independent responsibility for learning sharing information and respect for others PBL can therefore be thought of as a small group teaching method that combines the acquisition of knowledge with the development of generic skills and attitudes Presentation of clinical material as the stimulus for learning enables students to understand the relevance of underlying scientific knowledge and principles in clinical practice

bull when PBL is introduced into a curriculum several other issues for curriculum design and implementation need to be tackled PBL is generally introduced in the context of a defined core curriculum and integration of basic and clinical sciences It has implications for staffing and learning resources and demands a different approach to timetabling workload and assessment PBL is often used to deliver core material in non-clinical parts of the curriculum Paper based PBL scenarios form the basis of the core curriculum and ensure that all students are exposed to the same problems Recently modified PBL techniques have been introduced into clinical education with real patients being used as the stimulus for learning Despite the essential ad hoc nature of learning clinical medicine a key cases approach can enable PBL to be used to deliver the core clinical curriculum

Copyright copy2003 BMJ Publishing Group Ltd

Wood D F BMJ 2003326328-330

No CRoles of participants in a PBL tutorial aption Found

What happens in a PBL tutorial bull PBL tutorials are conducted in several ways In

this article the examples are modelled on the Maastricht seven jump process but its format of seven steps may be shortened

bull A typical PBL tutorial consists of a group of students (usually eight to 10) and a tutor who facilitates the session The length of time (number of sessions) that a group stays together with each other and with individual tutors varies between institutions A group needs to be together long enough to allow good group dynamics to develop but may need to be changed occasionally if personality clashes or other dysfunctional behaviour emerges

bull Students elect a chair for each PBL scenario and a scribe to record the discussion The roles are rotated for each scenario Suitable flip charts or a whiteboard should be used for recording the proceedings At the start of the session depending on the trigger material either the student chair reads out the scenario or all students study the material If the trigger is a real patient in a ward clinic or surgery then a student may be asked to take a clinical history or identify an abnormal physical sign before the group moves to a tutorial room For each module students may be given a handbook containing the problem scenarios and suggested learning resources or learning materials may be handed out at appropriate times as the tutorials progress

Examples of trigger material for PBL scenarios bull Paper based clinical scenarios bull Experimental or clinical laboratory data bull Photographs bull Video clips bull Newspaper articles bull All or part of an article from a scientific

journal bull A real or simulated patient bull A family tree showing an inherited

disorder

PBL tutorial process ndash Step 1 Identify and clarify unfamiliar terms presented in the scenario

scribe lists those that remain unexplained after discussion ndash Step 2 Define the problem or problems to be discussed students may

have different views on the issues but all should be considered scribe records a list of agreed problems

ndash Step 3 Brainstorming session to discuss the problem(s) suggestingpossible explanations on basis of prior knowledge students draw on each others knowledge and identify areas of incomplete knowledge scribe records all discussion

ndash Step 4 Review steps 2 and 3 and arrange explanations into tentativesolutions scribe organises the explanations and restructures if necessary

ndash Step 5 Formulate learning objectives group reaches consensus onthe learning objectives tutor ensures learning objectives are focused achievable comprehensive and appropriate

ndash Step 6 Private study (all students gather information related to eachlearning objective)

ndash Step 7 Group shares results of private study (students identify theirlearning resources and share their results) tutor checks learning and may assess the group

bull The role of the tutor is to facilitate the proceedings (helping the chair to maintain group dynamics and moving the group through the task) and to ensure that the group achieves appropriate learning objectives in line with those set by the curriculum design team The tutor may need to take a more active role in step 7 of the process to ensure that all the students have done the appropriate work and to help the chair to suggest a suitable format for group members to use to present the results of their private study The tutor should encourage students to check their understanding of the material He or she can do this by encouraging the students to ask open questions and ask each other to explain topics in their own words or by the use of drawings and diagrams

PBL in curriculum design bull PBL may be used either as the mainstay of an entire

curriculum or for the delivery of individual courses In practice PBL is usually part of an integrated curriculum using a systems based approach with non-clinical material delivered in the context of clinical practice A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge skills and attitudes A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios Sufficient time should be allowed each week for students to do the self directed learning required for PBL

bull

Copyright copy2003 BMJ Publishing Group Ltd

Wood D F BMJ 2003326328-330

No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found

Writing PBL scenarios

bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives

bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after

studying the scenario should be consistent with the faculty learning objectives

bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding

bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice

bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge

bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented

bull The problem should be sufficiently open so that discussion is not curtailed too early in the process

bull Scenarios should promote participation by the students in seeking information from various learning resources

bull Adapted from Dolmans et al Med Teacher 199719185-9

Staff development

bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)

A dysfunctional group a dominant character may

make it difficult for other students to be heard

A dysfunctional group a dominant character may make it difficult for other students to be heard

bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties

Advantages of PBL bull Student centred PBLIt fostersactive learning improved

understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks

Disadvantagesbull Tutors who cant teachTutorsenjoy passing on

their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful

Assessment of PBL

bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods

bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL

Conclusion

bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning

bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL

PBL 5 Easy Steps

bull Read the problem

Mrs Paula Embledon

Mrs Paula Embledon is a 78 year old woman who has come to the emergency room complaining of shortness of breath and pain in her chest She had been in relatively good health until three weeks previously when she sprained

2 Brain storm

bull Brainstorm

bull ndash hypotheses

bull - what do we know in support of the hypothesis

bull - what do we need to know to test the hypothesis

ndash learning issues

Brainstorm

bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)

ndash specific issues (for individuals to look up)

ndash overlapping issues

bull 4 Individual Reading - Research - Preparation

bull 5 Return

bull ndash review case so far ndash report and discuss

ndash assess progress - continue pagenext pagecomplete

ndash self-evaluation - How did things go Any suggestions for next time

ndash next problem

bull 5 Return

THE FIRST GROUP SESSION

bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day

bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session

bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr

bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine

bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise

bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator

bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues

bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know

bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)

bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)

bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)

  • PROBLEM BASED LEARNING
  • New Horizons in Medical Education
  • Slide 3
  • Domains of essential Global Requirements of ME
  • What was the response to these challenges
  • New Educational Strategies
  • New Tools amp Aids
  • PBL
  • PBL
  • Advantages
  • Slide 11
  • Slide 12
  • Slide 13
  • Slide 14
  • Framework for PBL
  • Framework for PBL - II
  • Characteristics of an effective PBL Group
  • Staff Development
  • Tutorrsquos Role in Assessment
  • Slide 20
  • Evaluating PBL Tutorials-II
  • PBL
  • Slide 23
  • PBL Starting the case
  • PBL Case (contd)
  • PBL Case contd
  • The Process of PBL
  • The Process of PBL contd
  • Learn from each other
  • Determine priorities for learning
  • Slide 31
  • Slide 32
  • Learning Issues
  • Learning Issues in PBL First Session
  • PBL Second Session
  • PBL Third Session
  • Slide 37
  • Slide 38
  • During Tutorial Session students will
  • Tutorial Session contd
  • Between Tutorial Session
  • Slide 42
  • Slide 43
  • Problem-based learning is designed to develop
  • Slide 45
  • What is problem based learning
  • Slide 47
  • Slide 48
  • Slide 49
  • Rationale for using PBL
  • Slide 51
  • Slide 52
  • The group learning process acquiring desirable learning skills
  • Generic Skills amp attitudes
  • Slide 55
  • Slide 56
  • Slide 57
  • What happens in a PBL tutorial
  • Slide 59
  • Examples of trigger material for PBL scenarios
  • PBL tutorial process
  • Slide 62
  • PBL in curriculum design
  • Slide 64
  • Writing PBL scenarios
  • Slide 66
  • Staff development
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • Slide 70
  • Advantages of PBL
  • Slide 72
  • Slide 73
  • Disadvantages
  • Assessment of PBL
  • Slide 76
  • Conclusion
  • Slide 78
  • PBL 5 Easy Steps
  • 2 Brain storm
  • Brainstorm
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • THE FIRST GROUP SESSION
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
Page 44: Problem based learning

PBL

bull PBL uses clinical cases as the context for students to study basic and clinical sciences

bull Its possible advantages over traditional approaches include its greater relevance to the practice of medicine its ability to promote retention and application of knowledge and its encouragement of self-directed life-long learning

bull Possible disadvantages include higher costs both in resources and staff time

PBL

bull An educational method characterized by the use of patient problems as a context for students to learn problem-solving skills and acquire knowledge about the basic and clinical sciences

bull Students usually meet in small groups two or three times a week for PBL tutorials

bull They are presented with a clinical problem (eg a patient with chest pain) and in a series of steps they discuss possible mechanisms and causes develop hypotheses and strategies to test the hypotheses are presented with further information and use this new information to refine their hypotheses finally reaching a conclusion

bull A tutor usually acts as a facilitator guiding students in this group-learning process

bull In the course of this exercise students identify both their existing levels and gaps in their knowledge These gaps form the basis for independent learning outside the PBL tutorials The identification and pursuit of these so-called learning goals is a key element of the PBL process

Rationale for using PBL bull The PBL approach is based on principles of adult

education20 and cognitive psychology21 It differs fundamentally from traditional curricula in which students acquire background knowledge of the basic sciences in the early years of the course and in the later years apply this knowledge to the diagnosis and management of clinical problems This traditional approach has been criticised for a number of reasons42223

bull It creates an artificial divide between the basic and clinical sciences

bull Time is wasted in acquiring knowledge that is subsequently forgotten or found to be irrelevant

bull Application of the acquired knowledge can be difficult bull The acquisition and retention of information that has no

apparent relevance can be boring and even demoralising for students

The group learning process acquiring

desirable learning skills

Generic Skills amp attitudes

bull Teamwork bull Critical evaluation of literature bull Chairing a group bull Self directed learning and use of

resources bull Listening Presentation skills

Recording bull Cooperation bull Respect for colleagues views

bull Group learning facilitates not only the acquisition of knowledge but also several other desirable attributes such as communication skills teamwork problem solving independent responsibility for learning sharing information and respect for others PBL can therefore be thought of as a small group teaching method that combines the acquisition of knowledge with the development of generic skills and attitudes Presentation of clinical material as the stimulus for learning enables students to understand the relevance of underlying scientific knowledge and principles in clinical practice

bull when PBL is introduced into a curriculum several other issues for curriculum design and implementation need to be tackled PBL is generally introduced in the context of a defined core curriculum and integration of basic and clinical sciences It has implications for staffing and learning resources and demands a different approach to timetabling workload and assessment PBL is often used to deliver core material in non-clinical parts of the curriculum Paper based PBL scenarios form the basis of the core curriculum and ensure that all students are exposed to the same problems Recently modified PBL techniques have been introduced into clinical education with real patients being used as the stimulus for learning Despite the essential ad hoc nature of learning clinical medicine a key cases approach can enable PBL to be used to deliver the core clinical curriculum

Copyright copy2003 BMJ Publishing Group Ltd

Wood D F BMJ 2003326328-330

No CRoles of participants in a PBL tutorial aption Found

What happens in a PBL tutorial bull PBL tutorials are conducted in several ways In

this article the examples are modelled on the Maastricht seven jump process but its format of seven steps may be shortened

bull A typical PBL tutorial consists of a group of students (usually eight to 10) and a tutor who facilitates the session The length of time (number of sessions) that a group stays together with each other and with individual tutors varies between institutions A group needs to be together long enough to allow good group dynamics to develop but may need to be changed occasionally if personality clashes or other dysfunctional behaviour emerges

bull Students elect a chair for each PBL scenario and a scribe to record the discussion The roles are rotated for each scenario Suitable flip charts or a whiteboard should be used for recording the proceedings At the start of the session depending on the trigger material either the student chair reads out the scenario or all students study the material If the trigger is a real patient in a ward clinic or surgery then a student may be asked to take a clinical history or identify an abnormal physical sign before the group moves to a tutorial room For each module students may be given a handbook containing the problem scenarios and suggested learning resources or learning materials may be handed out at appropriate times as the tutorials progress

Examples of trigger material for PBL scenarios bull Paper based clinical scenarios bull Experimental or clinical laboratory data bull Photographs bull Video clips bull Newspaper articles bull All or part of an article from a scientific

journal bull A real or simulated patient bull A family tree showing an inherited

disorder

PBL tutorial process ndash Step 1 Identify and clarify unfamiliar terms presented in the scenario

scribe lists those that remain unexplained after discussion ndash Step 2 Define the problem or problems to be discussed students may

have different views on the issues but all should be considered scribe records a list of agreed problems

ndash Step 3 Brainstorming session to discuss the problem(s) suggestingpossible explanations on basis of prior knowledge students draw on each others knowledge and identify areas of incomplete knowledge scribe records all discussion

ndash Step 4 Review steps 2 and 3 and arrange explanations into tentativesolutions scribe organises the explanations and restructures if necessary

ndash Step 5 Formulate learning objectives group reaches consensus onthe learning objectives tutor ensures learning objectives are focused achievable comprehensive and appropriate

ndash Step 6 Private study (all students gather information related to eachlearning objective)

ndash Step 7 Group shares results of private study (students identify theirlearning resources and share their results) tutor checks learning and may assess the group

bull The role of the tutor is to facilitate the proceedings (helping the chair to maintain group dynamics and moving the group through the task) and to ensure that the group achieves appropriate learning objectives in line with those set by the curriculum design team The tutor may need to take a more active role in step 7 of the process to ensure that all the students have done the appropriate work and to help the chair to suggest a suitable format for group members to use to present the results of their private study The tutor should encourage students to check their understanding of the material He or she can do this by encouraging the students to ask open questions and ask each other to explain topics in their own words or by the use of drawings and diagrams

PBL in curriculum design bull PBL may be used either as the mainstay of an entire

curriculum or for the delivery of individual courses In practice PBL is usually part of an integrated curriculum using a systems based approach with non-clinical material delivered in the context of clinical practice A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge skills and attitudes A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios Sufficient time should be allowed each week for students to do the self directed learning required for PBL

bull

Copyright copy2003 BMJ Publishing Group Ltd

Wood D F BMJ 2003326328-330

No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found

Writing PBL scenarios

bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives

bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after

studying the scenario should be consistent with the faculty learning objectives

bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding

bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice

bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge

bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented

bull The problem should be sufficiently open so that discussion is not curtailed too early in the process

bull Scenarios should promote participation by the students in seeking information from various learning resources

bull Adapted from Dolmans et al Med Teacher 199719185-9

Staff development

bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)

A dysfunctional group a dominant character may

make it difficult for other students to be heard

A dysfunctional group a dominant character may make it difficult for other students to be heard

bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties

Advantages of PBL bull Student centred PBLIt fostersactive learning improved

understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks

Disadvantagesbull Tutors who cant teachTutorsenjoy passing on

their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful

Assessment of PBL

bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods

bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL

Conclusion

bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning

bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL

PBL 5 Easy Steps

bull Read the problem

Mrs Paula Embledon

Mrs Paula Embledon is a 78 year old woman who has come to the emergency room complaining of shortness of breath and pain in her chest She had been in relatively good health until three weeks previously when she sprained

2 Brain storm

bull Brainstorm

bull ndash hypotheses

bull - what do we know in support of the hypothesis

bull - what do we need to know to test the hypothesis

ndash learning issues

Brainstorm

bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)

ndash specific issues (for individuals to look up)

ndash overlapping issues

bull 4 Individual Reading - Research - Preparation

bull 5 Return

bull ndash review case so far ndash report and discuss

ndash assess progress - continue pagenext pagecomplete

ndash self-evaluation - How did things go Any suggestions for next time

ndash next problem

bull 5 Return

THE FIRST GROUP SESSION

bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day

bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session

bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr

bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine

bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise

bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator

bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues

bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know

bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)

bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)

bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)

  • PROBLEM BASED LEARNING
  • New Horizons in Medical Education
  • Slide 3
  • Domains of essential Global Requirements of ME
  • What was the response to these challenges
  • New Educational Strategies
  • New Tools amp Aids
  • PBL
  • PBL
  • Advantages
  • Slide 11
  • Slide 12
  • Slide 13
  • Slide 14
  • Framework for PBL
  • Framework for PBL - II
  • Characteristics of an effective PBL Group
  • Staff Development
  • Tutorrsquos Role in Assessment
  • Slide 20
  • Evaluating PBL Tutorials-II
  • PBL
  • Slide 23
  • PBL Starting the case
  • PBL Case (contd)
  • PBL Case contd
  • The Process of PBL
  • The Process of PBL contd
  • Learn from each other
  • Determine priorities for learning
  • Slide 31
  • Slide 32
  • Learning Issues
  • Learning Issues in PBL First Session
  • PBL Second Session
  • PBL Third Session
  • Slide 37
  • Slide 38
  • During Tutorial Session students will
  • Tutorial Session contd
  • Between Tutorial Session
  • Slide 42
  • Slide 43
  • Problem-based learning is designed to develop
  • Slide 45
  • What is problem based learning
  • Slide 47
  • Slide 48
  • Slide 49
  • Rationale for using PBL
  • Slide 51
  • Slide 52
  • The group learning process acquiring desirable learning skills
  • Generic Skills amp attitudes
  • Slide 55
  • Slide 56
  • Slide 57
  • What happens in a PBL tutorial
  • Slide 59
  • Examples of trigger material for PBL scenarios
  • PBL tutorial process
  • Slide 62
  • PBL in curriculum design
  • Slide 64
  • Writing PBL scenarios
  • Slide 66
  • Staff development
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • Slide 70
  • Advantages of PBL
  • Slide 72
  • Slide 73
  • Disadvantages
  • Assessment of PBL
  • Slide 76
  • Conclusion
  • Slide 78
  • PBL 5 Easy Steps
  • 2 Brain storm
  • Brainstorm
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • THE FIRST GROUP SESSION
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
Page 45: Problem based learning

PBL

bull An educational method characterized by the use of patient problems as a context for students to learn problem-solving skills and acquire knowledge about the basic and clinical sciences

bull Students usually meet in small groups two or three times a week for PBL tutorials

bull They are presented with a clinical problem (eg a patient with chest pain) and in a series of steps they discuss possible mechanisms and causes develop hypotheses and strategies to test the hypotheses are presented with further information and use this new information to refine their hypotheses finally reaching a conclusion

bull A tutor usually acts as a facilitator guiding students in this group-learning process

bull In the course of this exercise students identify both their existing levels and gaps in their knowledge These gaps form the basis for independent learning outside the PBL tutorials The identification and pursuit of these so-called learning goals is a key element of the PBL process

Rationale for using PBL bull The PBL approach is based on principles of adult

education20 and cognitive psychology21 It differs fundamentally from traditional curricula in which students acquire background knowledge of the basic sciences in the early years of the course and in the later years apply this knowledge to the diagnosis and management of clinical problems This traditional approach has been criticised for a number of reasons42223

bull It creates an artificial divide between the basic and clinical sciences

bull Time is wasted in acquiring knowledge that is subsequently forgotten or found to be irrelevant

bull Application of the acquired knowledge can be difficult bull The acquisition and retention of information that has no

apparent relevance can be boring and even demoralising for students

The group learning process acquiring

desirable learning skills

Generic Skills amp attitudes

bull Teamwork bull Critical evaluation of literature bull Chairing a group bull Self directed learning and use of

resources bull Listening Presentation skills

Recording bull Cooperation bull Respect for colleagues views

bull Group learning facilitates not only the acquisition of knowledge but also several other desirable attributes such as communication skills teamwork problem solving independent responsibility for learning sharing information and respect for others PBL can therefore be thought of as a small group teaching method that combines the acquisition of knowledge with the development of generic skills and attitudes Presentation of clinical material as the stimulus for learning enables students to understand the relevance of underlying scientific knowledge and principles in clinical practice

bull when PBL is introduced into a curriculum several other issues for curriculum design and implementation need to be tackled PBL is generally introduced in the context of a defined core curriculum and integration of basic and clinical sciences It has implications for staffing and learning resources and demands a different approach to timetabling workload and assessment PBL is often used to deliver core material in non-clinical parts of the curriculum Paper based PBL scenarios form the basis of the core curriculum and ensure that all students are exposed to the same problems Recently modified PBL techniques have been introduced into clinical education with real patients being used as the stimulus for learning Despite the essential ad hoc nature of learning clinical medicine a key cases approach can enable PBL to be used to deliver the core clinical curriculum

Copyright copy2003 BMJ Publishing Group Ltd

Wood D F BMJ 2003326328-330

No CRoles of participants in a PBL tutorial aption Found

What happens in a PBL tutorial bull PBL tutorials are conducted in several ways In

this article the examples are modelled on the Maastricht seven jump process but its format of seven steps may be shortened

bull A typical PBL tutorial consists of a group of students (usually eight to 10) and a tutor who facilitates the session The length of time (number of sessions) that a group stays together with each other and with individual tutors varies between institutions A group needs to be together long enough to allow good group dynamics to develop but may need to be changed occasionally if personality clashes or other dysfunctional behaviour emerges

bull Students elect a chair for each PBL scenario and a scribe to record the discussion The roles are rotated for each scenario Suitable flip charts or a whiteboard should be used for recording the proceedings At the start of the session depending on the trigger material either the student chair reads out the scenario or all students study the material If the trigger is a real patient in a ward clinic or surgery then a student may be asked to take a clinical history or identify an abnormal physical sign before the group moves to a tutorial room For each module students may be given a handbook containing the problem scenarios and suggested learning resources or learning materials may be handed out at appropriate times as the tutorials progress

Examples of trigger material for PBL scenarios bull Paper based clinical scenarios bull Experimental or clinical laboratory data bull Photographs bull Video clips bull Newspaper articles bull All or part of an article from a scientific

journal bull A real or simulated patient bull A family tree showing an inherited

disorder

PBL tutorial process ndash Step 1 Identify and clarify unfamiliar terms presented in the scenario

scribe lists those that remain unexplained after discussion ndash Step 2 Define the problem or problems to be discussed students may

have different views on the issues but all should be considered scribe records a list of agreed problems

ndash Step 3 Brainstorming session to discuss the problem(s) suggestingpossible explanations on basis of prior knowledge students draw on each others knowledge and identify areas of incomplete knowledge scribe records all discussion

ndash Step 4 Review steps 2 and 3 and arrange explanations into tentativesolutions scribe organises the explanations and restructures if necessary

ndash Step 5 Formulate learning objectives group reaches consensus onthe learning objectives tutor ensures learning objectives are focused achievable comprehensive and appropriate

ndash Step 6 Private study (all students gather information related to eachlearning objective)

ndash Step 7 Group shares results of private study (students identify theirlearning resources and share their results) tutor checks learning and may assess the group

bull The role of the tutor is to facilitate the proceedings (helping the chair to maintain group dynamics and moving the group through the task) and to ensure that the group achieves appropriate learning objectives in line with those set by the curriculum design team The tutor may need to take a more active role in step 7 of the process to ensure that all the students have done the appropriate work and to help the chair to suggest a suitable format for group members to use to present the results of their private study The tutor should encourage students to check their understanding of the material He or she can do this by encouraging the students to ask open questions and ask each other to explain topics in their own words or by the use of drawings and diagrams

PBL in curriculum design bull PBL may be used either as the mainstay of an entire

curriculum or for the delivery of individual courses In practice PBL is usually part of an integrated curriculum using a systems based approach with non-clinical material delivered in the context of clinical practice A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge skills and attitudes A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios Sufficient time should be allowed each week for students to do the self directed learning required for PBL

bull

Copyright copy2003 BMJ Publishing Group Ltd

Wood D F BMJ 2003326328-330

No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found

Writing PBL scenarios

bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives

bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after

studying the scenario should be consistent with the faculty learning objectives

bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding

bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice

bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge

bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented

bull The problem should be sufficiently open so that discussion is not curtailed too early in the process

bull Scenarios should promote participation by the students in seeking information from various learning resources

bull Adapted from Dolmans et al Med Teacher 199719185-9

Staff development

bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)

A dysfunctional group a dominant character may

make it difficult for other students to be heard

A dysfunctional group a dominant character may make it difficult for other students to be heard

bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties

Advantages of PBL bull Student centred PBLIt fostersactive learning improved

understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks

Disadvantagesbull Tutors who cant teachTutorsenjoy passing on

their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful

Assessment of PBL

bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods

bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL

Conclusion

bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning

bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL

PBL 5 Easy Steps

bull Read the problem

Mrs Paula Embledon

Mrs Paula Embledon is a 78 year old woman who has come to the emergency room complaining of shortness of breath and pain in her chest She had been in relatively good health until three weeks previously when she sprained

2 Brain storm

bull Brainstorm

bull ndash hypotheses

bull - what do we know in support of the hypothesis

bull - what do we need to know to test the hypothesis

ndash learning issues

Brainstorm

bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)

ndash specific issues (for individuals to look up)

ndash overlapping issues

bull 4 Individual Reading - Research - Preparation

bull 5 Return

bull ndash review case so far ndash report and discuss

ndash assess progress - continue pagenext pagecomplete

ndash self-evaluation - How did things go Any suggestions for next time

ndash next problem

bull 5 Return

THE FIRST GROUP SESSION

bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day

bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session

bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr

bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine

bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise

bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator

bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues

bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know

bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)

bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)

bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)

  • PROBLEM BASED LEARNING
  • New Horizons in Medical Education
  • Slide 3
  • Domains of essential Global Requirements of ME
  • What was the response to these challenges
  • New Educational Strategies
  • New Tools amp Aids
  • PBL
  • PBL
  • Advantages
  • Slide 11
  • Slide 12
  • Slide 13
  • Slide 14
  • Framework for PBL
  • Framework for PBL - II
  • Characteristics of an effective PBL Group
  • Staff Development
  • Tutorrsquos Role in Assessment
  • Slide 20
  • Evaluating PBL Tutorials-II
  • PBL
  • Slide 23
  • PBL Starting the case
  • PBL Case (contd)
  • PBL Case contd
  • The Process of PBL
  • The Process of PBL contd
  • Learn from each other
  • Determine priorities for learning
  • Slide 31
  • Slide 32
  • Learning Issues
  • Learning Issues in PBL First Session
  • PBL Second Session
  • PBL Third Session
  • Slide 37
  • Slide 38
  • During Tutorial Session students will
  • Tutorial Session contd
  • Between Tutorial Session
  • Slide 42
  • Slide 43
  • Problem-based learning is designed to develop
  • Slide 45
  • What is problem based learning
  • Slide 47
  • Slide 48
  • Slide 49
  • Rationale for using PBL
  • Slide 51
  • Slide 52
  • The group learning process acquiring desirable learning skills
  • Generic Skills amp attitudes
  • Slide 55
  • Slide 56
  • Slide 57
  • What happens in a PBL tutorial
  • Slide 59
  • Examples of trigger material for PBL scenarios
  • PBL tutorial process
  • Slide 62
  • PBL in curriculum design
  • Slide 64
  • Writing PBL scenarios
  • Slide 66
  • Staff development
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • Slide 70
  • Advantages of PBL
  • Slide 72
  • Slide 73
  • Disadvantages
  • Assessment of PBL
  • Slide 76
  • Conclusion
  • Slide 78
  • PBL 5 Easy Steps
  • 2 Brain storm
  • Brainstorm
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • THE FIRST GROUP SESSION
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
Page 46: Problem based learning

bull In the course of this exercise students identify both their existing levels and gaps in their knowledge These gaps form the basis for independent learning outside the PBL tutorials The identification and pursuit of these so-called learning goals is a key element of the PBL process

Rationale for using PBL bull The PBL approach is based on principles of adult

education20 and cognitive psychology21 It differs fundamentally from traditional curricula in which students acquire background knowledge of the basic sciences in the early years of the course and in the later years apply this knowledge to the diagnosis and management of clinical problems This traditional approach has been criticised for a number of reasons42223

bull It creates an artificial divide between the basic and clinical sciences

bull Time is wasted in acquiring knowledge that is subsequently forgotten or found to be irrelevant

bull Application of the acquired knowledge can be difficult bull The acquisition and retention of information that has no

apparent relevance can be boring and even demoralising for students

The group learning process acquiring

desirable learning skills

Generic Skills amp attitudes

bull Teamwork bull Critical evaluation of literature bull Chairing a group bull Self directed learning and use of

resources bull Listening Presentation skills

Recording bull Cooperation bull Respect for colleagues views

bull Group learning facilitates not only the acquisition of knowledge but also several other desirable attributes such as communication skills teamwork problem solving independent responsibility for learning sharing information and respect for others PBL can therefore be thought of as a small group teaching method that combines the acquisition of knowledge with the development of generic skills and attitudes Presentation of clinical material as the stimulus for learning enables students to understand the relevance of underlying scientific knowledge and principles in clinical practice

bull when PBL is introduced into a curriculum several other issues for curriculum design and implementation need to be tackled PBL is generally introduced in the context of a defined core curriculum and integration of basic and clinical sciences It has implications for staffing and learning resources and demands a different approach to timetabling workload and assessment PBL is often used to deliver core material in non-clinical parts of the curriculum Paper based PBL scenarios form the basis of the core curriculum and ensure that all students are exposed to the same problems Recently modified PBL techniques have been introduced into clinical education with real patients being used as the stimulus for learning Despite the essential ad hoc nature of learning clinical medicine a key cases approach can enable PBL to be used to deliver the core clinical curriculum

Copyright copy2003 BMJ Publishing Group Ltd

Wood D F BMJ 2003326328-330

No CRoles of participants in a PBL tutorial aption Found

What happens in a PBL tutorial bull PBL tutorials are conducted in several ways In

this article the examples are modelled on the Maastricht seven jump process but its format of seven steps may be shortened

bull A typical PBL tutorial consists of a group of students (usually eight to 10) and a tutor who facilitates the session The length of time (number of sessions) that a group stays together with each other and with individual tutors varies between institutions A group needs to be together long enough to allow good group dynamics to develop but may need to be changed occasionally if personality clashes or other dysfunctional behaviour emerges

bull Students elect a chair for each PBL scenario and a scribe to record the discussion The roles are rotated for each scenario Suitable flip charts or a whiteboard should be used for recording the proceedings At the start of the session depending on the trigger material either the student chair reads out the scenario or all students study the material If the trigger is a real patient in a ward clinic or surgery then a student may be asked to take a clinical history or identify an abnormal physical sign before the group moves to a tutorial room For each module students may be given a handbook containing the problem scenarios and suggested learning resources or learning materials may be handed out at appropriate times as the tutorials progress

Examples of trigger material for PBL scenarios bull Paper based clinical scenarios bull Experimental or clinical laboratory data bull Photographs bull Video clips bull Newspaper articles bull All or part of an article from a scientific

journal bull A real or simulated patient bull A family tree showing an inherited

disorder

PBL tutorial process ndash Step 1 Identify and clarify unfamiliar terms presented in the scenario

scribe lists those that remain unexplained after discussion ndash Step 2 Define the problem or problems to be discussed students may

have different views on the issues but all should be considered scribe records a list of agreed problems

ndash Step 3 Brainstorming session to discuss the problem(s) suggestingpossible explanations on basis of prior knowledge students draw on each others knowledge and identify areas of incomplete knowledge scribe records all discussion

ndash Step 4 Review steps 2 and 3 and arrange explanations into tentativesolutions scribe organises the explanations and restructures if necessary

ndash Step 5 Formulate learning objectives group reaches consensus onthe learning objectives tutor ensures learning objectives are focused achievable comprehensive and appropriate

ndash Step 6 Private study (all students gather information related to eachlearning objective)

ndash Step 7 Group shares results of private study (students identify theirlearning resources and share their results) tutor checks learning and may assess the group

bull The role of the tutor is to facilitate the proceedings (helping the chair to maintain group dynamics and moving the group through the task) and to ensure that the group achieves appropriate learning objectives in line with those set by the curriculum design team The tutor may need to take a more active role in step 7 of the process to ensure that all the students have done the appropriate work and to help the chair to suggest a suitable format for group members to use to present the results of their private study The tutor should encourage students to check their understanding of the material He or she can do this by encouraging the students to ask open questions and ask each other to explain topics in their own words or by the use of drawings and diagrams

PBL in curriculum design bull PBL may be used either as the mainstay of an entire

curriculum or for the delivery of individual courses In practice PBL is usually part of an integrated curriculum using a systems based approach with non-clinical material delivered in the context of clinical practice A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge skills and attitudes A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios Sufficient time should be allowed each week for students to do the self directed learning required for PBL

bull

Copyright copy2003 BMJ Publishing Group Ltd

Wood D F BMJ 2003326328-330

No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found

Writing PBL scenarios

bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives

bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after

studying the scenario should be consistent with the faculty learning objectives

bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding

bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice

bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge

bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented

bull The problem should be sufficiently open so that discussion is not curtailed too early in the process

bull Scenarios should promote participation by the students in seeking information from various learning resources

bull Adapted from Dolmans et al Med Teacher 199719185-9

Staff development

bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)

A dysfunctional group a dominant character may

make it difficult for other students to be heard

A dysfunctional group a dominant character may make it difficult for other students to be heard

bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties

Advantages of PBL bull Student centred PBLIt fostersactive learning improved

understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks

Disadvantagesbull Tutors who cant teachTutorsenjoy passing on

their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful

Assessment of PBL

bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods

bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL

Conclusion

bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning

bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL

PBL 5 Easy Steps

bull Read the problem

Mrs Paula Embledon

Mrs Paula Embledon is a 78 year old woman who has come to the emergency room complaining of shortness of breath and pain in her chest She had been in relatively good health until three weeks previously when she sprained

2 Brain storm

bull Brainstorm

bull ndash hypotheses

bull - what do we know in support of the hypothesis

bull - what do we need to know to test the hypothesis

ndash learning issues

Brainstorm

bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)

ndash specific issues (for individuals to look up)

ndash overlapping issues

bull 4 Individual Reading - Research - Preparation

bull 5 Return

bull ndash review case so far ndash report and discuss

ndash assess progress - continue pagenext pagecomplete

ndash self-evaluation - How did things go Any suggestions for next time

ndash next problem

bull 5 Return

THE FIRST GROUP SESSION

bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day

bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session

bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr

bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine

bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise

bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator

bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues

bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know

bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)

bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)

bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)

  • PROBLEM BASED LEARNING
  • New Horizons in Medical Education
  • Slide 3
  • Domains of essential Global Requirements of ME
  • What was the response to these challenges
  • New Educational Strategies
  • New Tools amp Aids
  • PBL
  • PBL
  • Advantages
  • Slide 11
  • Slide 12
  • Slide 13
  • Slide 14
  • Framework for PBL
  • Framework for PBL - II
  • Characteristics of an effective PBL Group
  • Staff Development
  • Tutorrsquos Role in Assessment
  • Slide 20
  • Evaluating PBL Tutorials-II
  • PBL
  • Slide 23
  • PBL Starting the case
  • PBL Case (contd)
  • PBL Case contd
  • The Process of PBL
  • The Process of PBL contd
  • Learn from each other
  • Determine priorities for learning
  • Slide 31
  • Slide 32
  • Learning Issues
  • Learning Issues in PBL First Session
  • PBL Second Session
  • PBL Third Session
  • Slide 37
  • Slide 38
  • During Tutorial Session students will
  • Tutorial Session contd
  • Between Tutorial Session
  • Slide 42
  • Slide 43
  • Problem-based learning is designed to develop
  • Slide 45
  • What is problem based learning
  • Slide 47
  • Slide 48
  • Slide 49
  • Rationale for using PBL
  • Slide 51
  • Slide 52
  • The group learning process acquiring desirable learning skills
  • Generic Skills amp attitudes
  • Slide 55
  • Slide 56
  • Slide 57
  • What happens in a PBL tutorial
  • Slide 59
  • Examples of trigger material for PBL scenarios
  • PBL tutorial process
  • Slide 62
  • PBL in curriculum design
  • Slide 64
  • Writing PBL scenarios
  • Slide 66
  • Staff development
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • Slide 70
  • Advantages of PBL
  • Slide 72
  • Slide 73
  • Disadvantages
  • Assessment of PBL
  • Slide 76
  • Conclusion
  • Slide 78
  • PBL 5 Easy Steps
  • 2 Brain storm
  • Brainstorm
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • THE FIRST GROUP SESSION
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
Page 47: Problem based learning

Rationale for using PBL bull The PBL approach is based on principles of adult

education20 and cognitive psychology21 It differs fundamentally from traditional curricula in which students acquire background knowledge of the basic sciences in the early years of the course and in the later years apply this knowledge to the diagnosis and management of clinical problems This traditional approach has been criticised for a number of reasons42223

bull It creates an artificial divide between the basic and clinical sciences

bull Time is wasted in acquiring knowledge that is subsequently forgotten or found to be irrelevant

bull Application of the acquired knowledge can be difficult bull The acquisition and retention of information that has no

apparent relevance can be boring and even demoralising for students

The group learning process acquiring

desirable learning skills

Generic Skills amp attitudes

bull Teamwork bull Critical evaluation of literature bull Chairing a group bull Self directed learning and use of

resources bull Listening Presentation skills

Recording bull Cooperation bull Respect for colleagues views

bull Group learning facilitates not only the acquisition of knowledge but also several other desirable attributes such as communication skills teamwork problem solving independent responsibility for learning sharing information and respect for others PBL can therefore be thought of as a small group teaching method that combines the acquisition of knowledge with the development of generic skills and attitudes Presentation of clinical material as the stimulus for learning enables students to understand the relevance of underlying scientific knowledge and principles in clinical practice

bull when PBL is introduced into a curriculum several other issues for curriculum design and implementation need to be tackled PBL is generally introduced in the context of a defined core curriculum and integration of basic and clinical sciences It has implications for staffing and learning resources and demands a different approach to timetabling workload and assessment PBL is often used to deliver core material in non-clinical parts of the curriculum Paper based PBL scenarios form the basis of the core curriculum and ensure that all students are exposed to the same problems Recently modified PBL techniques have been introduced into clinical education with real patients being used as the stimulus for learning Despite the essential ad hoc nature of learning clinical medicine a key cases approach can enable PBL to be used to deliver the core clinical curriculum

Copyright copy2003 BMJ Publishing Group Ltd

Wood D F BMJ 2003326328-330

No CRoles of participants in a PBL tutorial aption Found

What happens in a PBL tutorial bull PBL tutorials are conducted in several ways In

this article the examples are modelled on the Maastricht seven jump process but its format of seven steps may be shortened

bull A typical PBL tutorial consists of a group of students (usually eight to 10) and a tutor who facilitates the session The length of time (number of sessions) that a group stays together with each other and with individual tutors varies between institutions A group needs to be together long enough to allow good group dynamics to develop but may need to be changed occasionally if personality clashes or other dysfunctional behaviour emerges

bull Students elect a chair for each PBL scenario and a scribe to record the discussion The roles are rotated for each scenario Suitable flip charts or a whiteboard should be used for recording the proceedings At the start of the session depending on the trigger material either the student chair reads out the scenario or all students study the material If the trigger is a real patient in a ward clinic or surgery then a student may be asked to take a clinical history or identify an abnormal physical sign before the group moves to a tutorial room For each module students may be given a handbook containing the problem scenarios and suggested learning resources or learning materials may be handed out at appropriate times as the tutorials progress

Examples of trigger material for PBL scenarios bull Paper based clinical scenarios bull Experimental or clinical laboratory data bull Photographs bull Video clips bull Newspaper articles bull All or part of an article from a scientific

journal bull A real or simulated patient bull A family tree showing an inherited

disorder

PBL tutorial process ndash Step 1 Identify and clarify unfamiliar terms presented in the scenario

scribe lists those that remain unexplained after discussion ndash Step 2 Define the problem or problems to be discussed students may

have different views on the issues but all should be considered scribe records a list of agreed problems

ndash Step 3 Brainstorming session to discuss the problem(s) suggestingpossible explanations on basis of prior knowledge students draw on each others knowledge and identify areas of incomplete knowledge scribe records all discussion

ndash Step 4 Review steps 2 and 3 and arrange explanations into tentativesolutions scribe organises the explanations and restructures if necessary

ndash Step 5 Formulate learning objectives group reaches consensus onthe learning objectives tutor ensures learning objectives are focused achievable comprehensive and appropriate

ndash Step 6 Private study (all students gather information related to eachlearning objective)

ndash Step 7 Group shares results of private study (students identify theirlearning resources and share their results) tutor checks learning and may assess the group

bull The role of the tutor is to facilitate the proceedings (helping the chair to maintain group dynamics and moving the group through the task) and to ensure that the group achieves appropriate learning objectives in line with those set by the curriculum design team The tutor may need to take a more active role in step 7 of the process to ensure that all the students have done the appropriate work and to help the chair to suggest a suitable format for group members to use to present the results of their private study The tutor should encourage students to check their understanding of the material He or she can do this by encouraging the students to ask open questions and ask each other to explain topics in their own words or by the use of drawings and diagrams

PBL in curriculum design bull PBL may be used either as the mainstay of an entire

curriculum or for the delivery of individual courses In practice PBL is usually part of an integrated curriculum using a systems based approach with non-clinical material delivered in the context of clinical practice A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge skills and attitudes A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios Sufficient time should be allowed each week for students to do the self directed learning required for PBL

bull

Copyright copy2003 BMJ Publishing Group Ltd

Wood D F BMJ 2003326328-330

No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found

Writing PBL scenarios

bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives

bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after

studying the scenario should be consistent with the faculty learning objectives

bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding

bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice

bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge

bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented

bull The problem should be sufficiently open so that discussion is not curtailed too early in the process

bull Scenarios should promote participation by the students in seeking information from various learning resources

bull Adapted from Dolmans et al Med Teacher 199719185-9

Staff development

bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)

A dysfunctional group a dominant character may

make it difficult for other students to be heard

A dysfunctional group a dominant character may make it difficult for other students to be heard

bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties

Advantages of PBL bull Student centred PBLIt fostersactive learning improved

understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks

Disadvantagesbull Tutors who cant teachTutorsenjoy passing on

their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful

Assessment of PBL

bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods

bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL

Conclusion

bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning

bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL

PBL 5 Easy Steps

bull Read the problem

Mrs Paula Embledon

Mrs Paula Embledon is a 78 year old woman who has come to the emergency room complaining of shortness of breath and pain in her chest She had been in relatively good health until three weeks previously when she sprained

2 Brain storm

bull Brainstorm

bull ndash hypotheses

bull - what do we know in support of the hypothesis

bull - what do we need to know to test the hypothesis

ndash learning issues

Brainstorm

bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)

ndash specific issues (for individuals to look up)

ndash overlapping issues

bull 4 Individual Reading - Research - Preparation

bull 5 Return

bull ndash review case so far ndash report and discuss

ndash assess progress - continue pagenext pagecomplete

ndash self-evaluation - How did things go Any suggestions for next time

ndash next problem

bull 5 Return

THE FIRST GROUP SESSION

bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day

bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session

bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr

bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine

bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise

bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator

bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues

bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know

bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)

bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)

bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)

  • PROBLEM BASED LEARNING
  • New Horizons in Medical Education
  • Slide 3
  • Domains of essential Global Requirements of ME
  • What was the response to these challenges
  • New Educational Strategies
  • New Tools amp Aids
  • PBL
  • PBL
  • Advantages
  • Slide 11
  • Slide 12
  • Slide 13
  • Slide 14
  • Framework for PBL
  • Framework for PBL - II
  • Characteristics of an effective PBL Group
  • Staff Development
  • Tutorrsquos Role in Assessment
  • Slide 20
  • Evaluating PBL Tutorials-II
  • PBL
  • Slide 23
  • PBL Starting the case
  • PBL Case (contd)
  • PBL Case contd
  • The Process of PBL
  • The Process of PBL contd
  • Learn from each other
  • Determine priorities for learning
  • Slide 31
  • Slide 32
  • Learning Issues
  • Learning Issues in PBL First Session
  • PBL Second Session
  • PBL Third Session
  • Slide 37
  • Slide 38
  • During Tutorial Session students will
  • Tutorial Session contd
  • Between Tutorial Session
  • Slide 42
  • Slide 43
  • Problem-based learning is designed to develop
  • Slide 45
  • What is problem based learning
  • Slide 47
  • Slide 48
  • Slide 49
  • Rationale for using PBL
  • Slide 51
  • Slide 52
  • The group learning process acquiring desirable learning skills
  • Generic Skills amp attitudes
  • Slide 55
  • Slide 56
  • Slide 57
  • What happens in a PBL tutorial
  • Slide 59
  • Examples of trigger material for PBL scenarios
  • PBL tutorial process
  • Slide 62
  • PBL in curriculum design
  • Slide 64
  • Writing PBL scenarios
  • Slide 66
  • Staff development
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • Slide 70
  • Advantages of PBL
  • Slide 72
  • Slide 73
  • Disadvantages
  • Assessment of PBL
  • Slide 76
  • Conclusion
  • Slide 78
  • PBL 5 Easy Steps
  • 2 Brain storm
  • Brainstorm
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • THE FIRST GROUP SESSION
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
Page 48: Problem based learning

The group learning process acquiring

desirable learning skills

Generic Skills amp attitudes

bull Teamwork bull Critical evaluation of literature bull Chairing a group bull Self directed learning and use of

resources bull Listening Presentation skills

Recording bull Cooperation bull Respect for colleagues views

bull Group learning facilitates not only the acquisition of knowledge but also several other desirable attributes such as communication skills teamwork problem solving independent responsibility for learning sharing information and respect for others PBL can therefore be thought of as a small group teaching method that combines the acquisition of knowledge with the development of generic skills and attitudes Presentation of clinical material as the stimulus for learning enables students to understand the relevance of underlying scientific knowledge and principles in clinical practice

bull when PBL is introduced into a curriculum several other issues for curriculum design and implementation need to be tackled PBL is generally introduced in the context of a defined core curriculum and integration of basic and clinical sciences It has implications for staffing and learning resources and demands a different approach to timetabling workload and assessment PBL is often used to deliver core material in non-clinical parts of the curriculum Paper based PBL scenarios form the basis of the core curriculum and ensure that all students are exposed to the same problems Recently modified PBL techniques have been introduced into clinical education with real patients being used as the stimulus for learning Despite the essential ad hoc nature of learning clinical medicine a key cases approach can enable PBL to be used to deliver the core clinical curriculum

Copyright copy2003 BMJ Publishing Group Ltd

Wood D F BMJ 2003326328-330

No CRoles of participants in a PBL tutorial aption Found

What happens in a PBL tutorial bull PBL tutorials are conducted in several ways In

this article the examples are modelled on the Maastricht seven jump process but its format of seven steps may be shortened

bull A typical PBL tutorial consists of a group of students (usually eight to 10) and a tutor who facilitates the session The length of time (number of sessions) that a group stays together with each other and with individual tutors varies between institutions A group needs to be together long enough to allow good group dynamics to develop but may need to be changed occasionally if personality clashes or other dysfunctional behaviour emerges

bull Students elect a chair for each PBL scenario and a scribe to record the discussion The roles are rotated for each scenario Suitable flip charts or a whiteboard should be used for recording the proceedings At the start of the session depending on the trigger material either the student chair reads out the scenario or all students study the material If the trigger is a real patient in a ward clinic or surgery then a student may be asked to take a clinical history or identify an abnormal physical sign before the group moves to a tutorial room For each module students may be given a handbook containing the problem scenarios and suggested learning resources or learning materials may be handed out at appropriate times as the tutorials progress

Examples of trigger material for PBL scenarios bull Paper based clinical scenarios bull Experimental or clinical laboratory data bull Photographs bull Video clips bull Newspaper articles bull All or part of an article from a scientific

journal bull A real or simulated patient bull A family tree showing an inherited

disorder

PBL tutorial process ndash Step 1 Identify and clarify unfamiliar terms presented in the scenario

scribe lists those that remain unexplained after discussion ndash Step 2 Define the problem or problems to be discussed students may

have different views on the issues but all should be considered scribe records a list of agreed problems

ndash Step 3 Brainstorming session to discuss the problem(s) suggestingpossible explanations on basis of prior knowledge students draw on each others knowledge and identify areas of incomplete knowledge scribe records all discussion

ndash Step 4 Review steps 2 and 3 and arrange explanations into tentativesolutions scribe organises the explanations and restructures if necessary

ndash Step 5 Formulate learning objectives group reaches consensus onthe learning objectives tutor ensures learning objectives are focused achievable comprehensive and appropriate

ndash Step 6 Private study (all students gather information related to eachlearning objective)

ndash Step 7 Group shares results of private study (students identify theirlearning resources and share their results) tutor checks learning and may assess the group

bull The role of the tutor is to facilitate the proceedings (helping the chair to maintain group dynamics and moving the group through the task) and to ensure that the group achieves appropriate learning objectives in line with those set by the curriculum design team The tutor may need to take a more active role in step 7 of the process to ensure that all the students have done the appropriate work and to help the chair to suggest a suitable format for group members to use to present the results of their private study The tutor should encourage students to check their understanding of the material He or she can do this by encouraging the students to ask open questions and ask each other to explain topics in their own words or by the use of drawings and diagrams

PBL in curriculum design bull PBL may be used either as the mainstay of an entire

curriculum or for the delivery of individual courses In practice PBL is usually part of an integrated curriculum using a systems based approach with non-clinical material delivered in the context of clinical practice A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge skills and attitudes A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios Sufficient time should be allowed each week for students to do the self directed learning required for PBL

bull

Copyright copy2003 BMJ Publishing Group Ltd

Wood D F BMJ 2003326328-330

No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found

Writing PBL scenarios

bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives

bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after

studying the scenario should be consistent with the faculty learning objectives

bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding

bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice

bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge

bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented

bull The problem should be sufficiently open so that discussion is not curtailed too early in the process

bull Scenarios should promote participation by the students in seeking information from various learning resources

bull Adapted from Dolmans et al Med Teacher 199719185-9

Staff development

bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)

A dysfunctional group a dominant character may

make it difficult for other students to be heard

A dysfunctional group a dominant character may make it difficult for other students to be heard

bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties

Advantages of PBL bull Student centred PBLIt fostersactive learning improved

understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks

Disadvantagesbull Tutors who cant teachTutorsenjoy passing on

their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful

Assessment of PBL

bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods

bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL

Conclusion

bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning

bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL

PBL 5 Easy Steps

bull Read the problem

Mrs Paula Embledon

Mrs Paula Embledon is a 78 year old woman who has come to the emergency room complaining of shortness of breath and pain in her chest She had been in relatively good health until three weeks previously when she sprained

2 Brain storm

bull Brainstorm

bull ndash hypotheses

bull - what do we know in support of the hypothesis

bull - what do we need to know to test the hypothesis

ndash learning issues

Brainstorm

bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)

ndash specific issues (for individuals to look up)

ndash overlapping issues

bull 4 Individual Reading - Research - Preparation

bull 5 Return

bull ndash review case so far ndash report and discuss

ndash assess progress - continue pagenext pagecomplete

ndash self-evaluation - How did things go Any suggestions for next time

ndash next problem

bull 5 Return

THE FIRST GROUP SESSION

bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day

bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session

bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr

bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine

bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise

bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator

bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues

bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know

bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)

bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)

bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)

  • PROBLEM BASED LEARNING
  • New Horizons in Medical Education
  • Slide 3
  • Domains of essential Global Requirements of ME
  • What was the response to these challenges
  • New Educational Strategies
  • New Tools amp Aids
  • PBL
  • PBL
  • Advantages
  • Slide 11
  • Slide 12
  • Slide 13
  • Slide 14
  • Framework for PBL
  • Framework for PBL - II
  • Characteristics of an effective PBL Group
  • Staff Development
  • Tutorrsquos Role in Assessment
  • Slide 20
  • Evaluating PBL Tutorials-II
  • PBL
  • Slide 23
  • PBL Starting the case
  • PBL Case (contd)
  • PBL Case contd
  • The Process of PBL
  • The Process of PBL contd
  • Learn from each other
  • Determine priorities for learning
  • Slide 31
  • Slide 32
  • Learning Issues
  • Learning Issues in PBL First Session
  • PBL Second Session
  • PBL Third Session
  • Slide 37
  • Slide 38
  • During Tutorial Session students will
  • Tutorial Session contd
  • Between Tutorial Session
  • Slide 42
  • Slide 43
  • Problem-based learning is designed to develop
  • Slide 45
  • What is problem based learning
  • Slide 47
  • Slide 48
  • Slide 49
  • Rationale for using PBL
  • Slide 51
  • Slide 52
  • The group learning process acquiring desirable learning skills
  • Generic Skills amp attitudes
  • Slide 55
  • Slide 56
  • Slide 57
  • What happens in a PBL tutorial
  • Slide 59
  • Examples of trigger material for PBL scenarios
  • PBL tutorial process
  • Slide 62
  • PBL in curriculum design
  • Slide 64
  • Writing PBL scenarios
  • Slide 66
  • Staff development
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • Slide 70
  • Advantages of PBL
  • Slide 72
  • Slide 73
  • Disadvantages
  • Assessment of PBL
  • Slide 76
  • Conclusion
  • Slide 78
  • PBL 5 Easy Steps
  • 2 Brain storm
  • Brainstorm
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • THE FIRST GROUP SESSION
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
Page 49: Problem based learning

Generic Skills amp attitudes

bull Teamwork bull Critical evaluation of literature bull Chairing a group bull Self directed learning and use of

resources bull Listening Presentation skills

Recording bull Cooperation bull Respect for colleagues views

bull Group learning facilitates not only the acquisition of knowledge but also several other desirable attributes such as communication skills teamwork problem solving independent responsibility for learning sharing information and respect for others PBL can therefore be thought of as a small group teaching method that combines the acquisition of knowledge with the development of generic skills and attitudes Presentation of clinical material as the stimulus for learning enables students to understand the relevance of underlying scientific knowledge and principles in clinical practice

bull when PBL is introduced into a curriculum several other issues for curriculum design and implementation need to be tackled PBL is generally introduced in the context of a defined core curriculum and integration of basic and clinical sciences It has implications for staffing and learning resources and demands a different approach to timetabling workload and assessment PBL is often used to deliver core material in non-clinical parts of the curriculum Paper based PBL scenarios form the basis of the core curriculum and ensure that all students are exposed to the same problems Recently modified PBL techniques have been introduced into clinical education with real patients being used as the stimulus for learning Despite the essential ad hoc nature of learning clinical medicine a key cases approach can enable PBL to be used to deliver the core clinical curriculum

Copyright copy2003 BMJ Publishing Group Ltd

Wood D F BMJ 2003326328-330

No CRoles of participants in a PBL tutorial aption Found

What happens in a PBL tutorial bull PBL tutorials are conducted in several ways In

this article the examples are modelled on the Maastricht seven jump process but its format of seven steps may be shortened

bull A typical PBL tutorial consists of a group of students (usually eight to 10) and a tutor who facilitates the session The length of time (number of sessions) that a group stays together with each other and with individual tutors varies between institutions A group needs to be together long enough to allow good group dynamics to develop but may need to be changed occasionally if personality clashes or other dysfunctional behaviour emerges

bull Students elect a chair for each PBL scenario and a scribe to record the discussion The roles are rotated for each scenario Suitable flip charts or a whiteboard should be used for recording the proceedings At the start of the session depending on the trigger material either the student chair reads out the scenario or all students study the material If the trigger is a real patient in a ward clinic or surgery then a student may be asked to take a clinical history or identify an abnormal physical sign before the group moves to a tutorial room For each module students may be given a handbook containing the problem scenarios and suggested learning resources or learning materials may be handed out at appropriate times as the tutorials progress

Examples of trigger material for PBL scenarios bull Paper based clinical scenarios bull Experimental or clinical laboratory data bull Photographs bull Video clips bull Newspaper articles bull All or part of an article from a scientific

journal bull A real or simulated patient bull A family tree showing an inherited

disorder

PBL tutorial process ndash Step 1 Identify and clarify unfamiliar terms presented in the scenario

scribe lists those that remain unexplained after discussion ndash Step 2 Define the problem or problems to be discussed students may

have different views on the issues but all should be considered scribe records a list of agreed problems

ndash Step 3 Brainstorming session to discuss the problem(s) suggestingpossible explanations on basis of prior knowledge students draw on each others knowledge and identify areas of incomplete knowledge scribe records all discussion

ndash Step 4 Review steps 2 and 3 and arrange explanations into tentativesolutions scribe organises the explanations and restructures if necessary

ndash Step 5 Formulate learning objectives group reaches consensus onthe learning objectives tutor ensures learning objectives are focused achievable comprehensive and appropriate

ndash Step 6 Private study (all students gather information related to eachlearning objective)

ndash Step 7 Group shares results of private study (students identify theirlearning resources and share their results) tutor checks learning and may assess the group

bull The role of the tutor is to facilitate the proceedings (helping the chair to maintain group dynamics and moving the group through the task) and to ensure that the group achieves appropriate learning objectives in line with those set by the curriculum design team The tutor may need to take a more active role in step 7 of the process to ensure that all the students have done the appropriate work and to help the chair to suggest a suitable format for group members to use to present the results of their private study The tutor should encourage students to check their understanding of the material He or she can do this by encouraging the students to ask open questions and ask each other to explain topics in their own words or by the use of drawings and diagrams

PBL in curriculum design bull PBL may be used either as the mainstay of an entire

curriculum or for the delivery of individual courses In practice PBL is usually part of an integrated curriculum using a systems based approach with non-clinical material delivered in the context of clinical practice A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge skills and attitudes A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios Sufficient time should be allowed each week for students to do the self directed learning required for PBL

bull

Copyright copy2003 BMJ Publishing Group Ltd

Wood D F BMJ 2003326328-330

No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found

Writing PBL scenarios

bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives

bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after

studying the scenario should be consistent with the faculty learning objectives

bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding

bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice

bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge

bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented

bull The problem should be sufficiently open so that discussion is not curtailed too early in the process

bull Scenarios should promote participation by the students in seeking information from various learning resources

bull Adapted from Dolmans et al Med Teacher 199719185-9

Staff development

bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)

A dysfunctional group a dominant character may

make it difficult for other students to be heard

A dysfunctional group a dominant character may make it difficult for other students to be heard

bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties

Advantages of PBL bull Student centred PBLIt fostersactive learning improved

understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks

Disadvantagesbull Tutors who cant teachTutorsenjoy passing on

their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful

Assessment of PBL

bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods

bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL

Conclusion

bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning

bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL

PBL 5 Easy Steps

bull Read the problem

Mrs Paula Embledon

Mrs Paula Embledon is a 78 year old woman who has come to the emergency room complaining of shortness of breath and pain in her chest She had been in relatively good health until three weeks previously when she sprained

2 Brain storm

bull Brainstorm

bull ndash hypotheses

bull - what do we know in support of the hypothesis

bull - what do we need to know to test the hypothesis

ndash learning issues

Brainstorm

bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)

ndash specific issues (for individuals to look up)

ndash overlapping issues

bull 4 Individual Reading - Research - Preparation

bull 5 Return

bull ndash review case so far ndash report and discuss

ndash assess progress - continue pagenext pagecomplete

ndash self-evaluation - How did things go Any suggestions for next time

ndash next problem

bull 5 Return

THE FIRST GROUP SESSION

bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day

bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session

bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr

bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine

bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise

bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator

bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues

bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know

bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)

bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)

bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)

  • PROBLEM BASED LEARNING
  • New Horizons in Medical Education
  • Slide 3
  • Domains of essential Global Requirements of ME
  • What was the response to these challenges
  • New Educational Strategies
  • New Tools amp Aids
  • PBL
  • PBL
  • Advantages
  • Slide 11
  • Slide 12
  • Slide 13
  • Slide 14
  • Framework for PBL
  • Framework for PBL - II
  • Characteristics of an effective PBL Group
  • Staff Development
  • Tutorrsquos Role in Assessment
  • Slide 20
  • Evaluating PBL Tutorials-II
  • PBL
  • Slide 23
  • PBL Starting the case
  • PBL Case (contd)
  • PBL Case contd
  • The Process of PBL
  • The Process of PBL contd
  • Learn from each other
  • Determine priorities for learning
  • Slide 31
  • Slide 32
  • Learning Issues
  • Learning Issues in PBL First Session
  • PBL Second Session
  • PBL Third Session
  • Slide 37
  • Slide 38
  • During Tutorial Session students will
  • Tutorial Session contd
  • Between Tutorial Session
  • Slide 42
  • Slide 43
  • Problem-based learning is designed to develop
  • Slide 45
  • What is problem based learning
  • Slide 47
  • Slide 48
  • Slide 49
  • Rationale for using PBL
  • Slide 51
  • Slide 52
  • The group learning process acquiring desirable learning skills
  • Generic Skills amp attitudes
  • Slide 55
  • Slide 56
  • Slide 57
  • What happens in a PBL tutorial
  • Slide 59
  • Examples of trigger material for PBL scenarios
  • PBL tutorial process
  • Slide 62
  • PBL in curriculum design
  • Slide 64
  • Writing PBL scenarios
  • Slide 66
  • Staff development
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • Slide 70
  • Advantages of PBL
  • Slide 72
  • Slide 73
  • Disadvantages
  • Assessment of PBL
  • Slide 76
  • Conclusion
  • Slide 78
  • PBL 5 Easy Steps
  • 2 Brain storm
  • Brainstorm
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • THE FIRST GROUP SESSION
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
Page 50: Problem based learning

bull Group learning facilitates not only the acquisition of knowledge but also several other desirable attributes such as communication skills teamwork problem solving independent responsibility for learning sharing information and respect for others PBL can therefore be thought of as a small group teaching method that combines the acquisition of knowledge with the development of generic skills and attitudes Presentation of clinical material as the stimulus for learning enables students to understand the relevance of underlying scientific knowledge and principles in clinical practice

bull when PBL is introduced into a curriculum several other issues for curriculum design and implementation need to be tackled PBL is generally introduced in the context of a defined core curriculum and integration of basic and clinical sciences It has implications for staffing and learning resources and demands a different approach to timetabling workload and assessment PBL is often used to deliver core material in non-clinical parts of the curriculum Paper based PBL scenarios form the basis of the core curriculum and ensure that all students are exposed to the same problems Recently modified PBL techniques have been introduced into clinical education with real patients being used as the stimulus for learning Despite the essential ad hoc nature of learning clinical medicine a key cases approach can enable PBL to be used to deliver the core clinical curriculum

Copyright copy2003 BMJ Publishing Group Ltd

Wood D F BMJ 2003326328-330

No CRoles of participants in a PBL tutorial aption Found

What happens in a PBL tutorial bull PBL tutorials are conducted in several ways In

this article the examples are modelled on the Maastricht seven jump process but its format of seven steps may be shortened

bull A typical PBL tutorial consists of a group of students (usually eight to 10) and a tutor who facilitates the session The length of time (number of sessions) that a group stays together with each other and with individual tutors varies between institutions A group needs to be together long enough to allow good group dynamics to develop but may need to be changed occasionally if personality clashes or other dysfunctional behaviour emerges

bull Students elect a chair for each PBL scenario and a scribe to record the discussion The roles are rotated for each scenario Suitable flip charts or a whiteboard should be used for recording the proceedings At the start of the session depending on the trigger material either the student chair reads out the scenario or all students study the material If the trigger is a real patient in a ward clinic or surgery then a student may be asked to take a clinical history or identify an abnormal physical sign before the group moves to a tutorial room For each module students may be given a handbook containing the problem scenarios and suggested learning resources or learning materials may be handed out at appropriate times as the tutorials progress

Examples of trigger material for PBL scenarios bull Paper based clinical scenarios bull Experimental or clinical laboratory data bull Photographs bull Video clips bull Newspaper articles bull All or part of an article from a scientific

journal bull A real or simulated patient bull A family tree showing an inherited

disorder

PBL tutorial process ndash Step 1 Identify and clarify unfamiliar terms presented in the scenario

scribe lists those that remain unexplained after discussion ndash Step 2 Define the problem or problems to be discussed students may

have different views on the issues but all should be considered scribe records a list of agreed problems

ndash Step 3 Brainstorming session to discuss the problem(s) suggestingpossible explanations on basis of prior knowledge students draw on each others knowledge and identify areas of incomplete knowledge scribe records all discussion

ndash Step 4 Review steps 2 and 3 and arrange explanations into tentativesolutions scribe organises the explanations and restructures if necessary

ndash Step 5 Formulate learning objectives group reaches consensus onthe learning objectives tutor ensures learning objectives are focused achievable comprehensive and appropriate

ndash Step 6 Private study (all students gather information related to eachlearning objective)

ndash Step 7 Group shares results of private study (students identify theirlearning resources and share their results) tutor checks learning and may assess the group

bull The role of the tutor is to facilitate the proceedings (helping the chair to maintain group dynamics and moving the group through the task) and to ensure that the group achieves appropriate learning objectives in line with those set by the curriculum design team The tutor may need to take a more active role in step 7 of the process to ensure that all the students have done the appropriate work and to help the chair to suggest a suitable format for group members to use to present the results of their private study The tutor should encourage students to check their understanding of the material He or she can do this by encouraging the students to ask open questions and ask each other to explain topics in their own words or by the use of drawings and diagrams

PBL in curriculum design bull PBL may be used either as the mainstay of an entire

curriculum or for the delivery of individual courses In practice PBL is usually part of an integrated curriculum using a systems based approach with non-clinical material delivered in the context of clinical practice A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge skills and attitudes A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios Sufficient time should be allowed each week for students to do the self directed learning required for PBL

bull

Copyright copy2003 BMJ Publishing Group Ltd

Wood D F BMJ 2003326328-330

No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found

Writing PBL scenarios

bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives

bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after

studying the scenario should be consistent with the faculty learning objectives

bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding

bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice

bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge

bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented

bull The problem should be sufficiently open so that discussion is not curtailed too early in the process

bull Scenarios should promote participation by the students in seeking information from various learning resources

bull Adapted from Dolmans et al Med Teacher 199719185-9

Staff development

bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)

A dysfunctional group a dominant character may

make it difficult for other students to be heard

A dysfunctional group a dominant character may make it difficult for other students to be heard

bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties

Advantages of PBL bull Student centred PBLIt fostersactive learning improved

understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks

Disadvantagesbull Tutors who cant teachTutorsenjoy passing on

their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful

Assessment of PBL

bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods

bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL

Conclusion

bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning

bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL

PBL 5 Easy Steps

bull Read the problem

Mrs Paula Embledon

Mrs Paula Embledon is a 78 year old woman who has come to the emergency room complaining of shortness of breath and pain in her chest She had been in relatively good health until three weeks previously when she sprained

2 Brain storm

bull Brainstorm

bull ndash hypotheses

bull - what do we know in support of the hypothesis

bull - what do we need to know to test the hypothesis

ndash learning issues

Brainstorm

bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)

ndash specific issues (for individuals to look up)

ndash overlapping issues

bull 4 Individual Reading - Research - Preparation

bull 5 Return

bull ndash review case so far ndash report and discuss

ndash assess progress - continue pagenext pagecomplete

ndash self-evaluation - How did things go Any suggestions for next time

ndash next problem

bull 5 Return

THE FIRST GROUP SESSION

bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day

bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session

bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr

bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine

bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise

bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator

bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues

bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know

bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)

bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)

bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)

  • PROBLEM BASED LEARNING
  • New Horizons in Medical Education
  • Slide 3
  • Domains of essential Global Requirements of ME
  • What was the response to these challenges
  • New Educational Strategies
  • New Tools amp Aids
  • PBL
  • PBL
  • Advantages
  • Slide 11
  • Slide 12
  • Slide 13
  • Slide 14
  • Framework for PBL
  • Framework for PBL - II
  • Characteristics of an effective PBL Group
  • Staff Development
  • Tutorrsquos Role in Assessment
  • Slide 20
  • Evaluating PBL Tutorials-II
  • PBL
  • Slide 23
  • PBL Starting the case
  • PBL Case (contd)
  • PBL Case contd
  • The Process of PBL
  • The Process of PBL contd
  • Learn from each other
  • Determine priorities for learning
  • Slide 31
  • Slide 32
  • Learning Issues
  • Learning Issues in PBL First Session
  • PBL Second Session
  • PBL Third Session
  • Slide 37
  • Slide 38
  • During Tutorial Session students will
  • Tutorial Session contd
  • Between Tutorial Session
  • Slide 42
  • Slide 43
  • Problem-based learning is designed to develop
  • Slide 45
  • What is problem based learning
  • Slide 47
  • Slide 48
  • Slide 49
  • Rationale for using PBL
  • Slide 51
  • Slide 52
  • The group learning process acquiring desirable learning skills
  • Generic Skills amp attitudes
  • Slide 55
  • Slide 56
  • Slide 57
  • What happens in a PBL tutorial
  • Slide 59
  • Examples of trigger material for PBL scenarios
  • PBL tutorial process
  • Slide 62
  • PBL in curriculum design
  • Slide 64
  • Writing PBL scenarios
  • Slide 66
  • Staff development
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • Slide 70
  • Advantages of PBL
  • Slide 72
  • Slide 73
  • Disadvantages
  • Assessment of PBL
  • Slide 76
  • Conclusion
  • Slide 78
  • PBL 5 Easy Steps
  • 2 Brain storm
  • Brainstorm
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • THE FIRST GROUP SESSION
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
Page 51: Problem based learning

bull when PBL is introduced into a curriculum several other issues for curriculum design and implementation need to be tackled PBL is generally introduced in the context of a defined core curriculum and integration of basic and clinical sciences It has implications for staffing and learning resources and demands a different approach to timetabling workload and assessment PBL is often used to deliver core material in non-clinical parts of the curriculum Paper based PBL scenarios form the basis of the core curriculum and ensure that all students are exposed to the same problems Recently modified PBL techniques have been introduced into clinical education with real patients being used as the stimulus for learning Despite the essential ad hoc nature of learning clinical medicine a key cases approach can enable PBL to be used to deliver the core clinical curriculum

Copyright copy2003 BMJ Publishing Group Ltd

Wood D F BMJ 2003326328-330

No CRoles of participants in a PBL tutorial aption Found

What happens in a PBL tutorial bull PBL tutorials are conducted in several ways In

this article the examples are modelled on the Maastricht seven jump process but its format of seven steps may be shortened

bull A typical PBL tutorial consists of a group of students (usually eight to 10) and a tutor who facilitates the session The length of time (number of sessions) that a group stays together with each other and with individual tutors varies between institutions A group needs to be together long enough to allow good group dynamics to develop but may need to be changed occasionally if personality clashes or other dysfunctional behaviour emerges

bull Students elect a chair for each PBL scenario and a scribe to record the discussion The roles are rotated for each scenario Suitable flip charts or a whiteboard should be used for recording the proceedings At the start of the session depending on the trigger material either the student chair reads out the scenario or all students study the material If the trigger is a real patient in a ward clinic or surgery then a student may be asked to take a clinical history or identify an abnormal physical sign before the group moves to a tutorial room For each module students may be given a handbook containing the problem scenarios and suggested learning resources or learning materials may be handed out at appropriate times as the tutorials progress

Examples of trigger material for PBL scenarios bull Paper based clinical scenarios bull Experimental or clinical laboratory data bull Photographs bull Video clips bull Newspaper articles bull All or part of an article from a scientific

journal bull A real or simulated patient bull A family tree showing an inherited

disorder

PBL tutorial process ndash Step 1 Identify and clarify unfamiliar terms presented in the scenario

scribe lists those that remain unexplained after discussion ndash Step 2 Define the problem or problems to be discussed students may

have different views on the issues but all should be considered scribe records a list of agreed problems

ndash Step 3 Brainstorming session to discuss the problem(s) suggestingpossible explanations on basis of prior knowledge students draw on each others knowledge and identify areas of incomplete knowledge scribe records all discussion

ndash Step 4 Review steps 2 and 3 and arrange explanations into tentativesolutions scribe organises the explanations and restructures if necessary

ndash Step 5 Formulate learning objectives group reaches consensus onthe learning objectives tutor ensures learning objectives are focused achievable comprehensive and appropriate

ndash Step 6 Private study (all students gather information related to eachlearning objective)

ndash Step 7 Group shares results of private study (students identify theirlearning resources and share their results) tutor checks learning and may assess the group

bull The role of the tutor is to facilitate the proceedings (helping the chair to maintain group dynamics and moving the group through the task) and to ensure that the group achieves appropriate learning objectives in line with those set by the curriculum design team The tutor may need to take a more active role in step 7 of the process to ensure that all the students have done the appropriate work and to help the chair to suggest a suitable format for group members to use to present the results of their private study The tutor should encourage students to check their understanding of the material He or she can do this by encouraging the students to ask open questions and ask each other to explain topics in their own words or by the use of drawings and diagrams

PBL in curriculum design bull PBL may be used either as the mainstay of an entire

curriculum or for the delivery of individual courses In practice PBL is usually part of an integrated curriculum using a systems based approach with non-clinical material delivered in the context of clinical practice A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge skills and attitudes A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios Sufficient time should be allowed each week for students to do the self directed learning required for PBL

bull

Copyright copy2003 BMJ Publishing Group Ltd

Wood D F BMJ 2003326328-330

No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found

Writing PBL scenarios

bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives

bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after

studying the scenario should be consistent with the faculty learning objectives

bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding

bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice

bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge

bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented

bull The problem should be sufficiently open so that discussion is not curtailed too early in the process

bull Scenarios should promote participation by the students in seeking information from various learning resources

bull Adapted from Dolmans et al Med Teacher 199719185-9

Staff development

bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)

A dysfunctional group a dominant character may

make it difficult for other students to be heard

A dysfunctional group a dominant character may make it difficult for other students to be heard

bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties

Advantages of PBL bull Student centred PBLIt fostersactive learning improved

understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks

Disadvantagesbull Tutors who cant teachTutorsenjoy passing on

their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful

Assessment of PBL

bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods

bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL

Conclusion

bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning

bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL

PBL 5 Easy Steps

bull Read the problem

Mrs Paula Embledon

Mrs Paula Embledon is a 78 year old woman who has come to the emergency room complaining of shortness of breath and pain in her chest She had been in relatively good health until three weeks previously when she sprained

2 Brain storm

bull Brainstorm

bull ndash hypotheses

bull - what do we know in support of the hypothesis

bull - what do we need to know to test the hypothesis

ndash learning issues

Brainstorm

bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)

ndash specific issues (for individuals to look up)

ndash overlapping issues

bull 4 Individual Reading - Research - Preparation

bull 5 Return

bull ndash review case so far ndash report and discuss

ndash assess progress - continue pagenext pagecomplete

ndash self-evaluation - How did things go Any suggestions for next time

ndash next problem

bull 5 Return

THE FIRST GROUP SESSION

bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day

bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session

bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr

bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine

bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise

bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator

bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues

bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know

bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)

bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)

bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)

  • PROBLEM BASED LEARNING
  • New Horizons in Medical Education
  • Slide 3
  • Domains of essential Global Requirements of ME
  • What was the response to these challenges
  • New Educational Strategies
  • New Tools amp Aids
  • PBL
  • PBL
  • Advantages
  • Slide 11
  • Slide 12
  • Slide 13
  • Slide 14
  • Framework for PBL
  • Framework for PBL - II
  • Characteristics of an effective PBL Group
  • Staff Development
  • Tutorrsquos Role in Assessment
  • Slide 20
  • Evaluating PBL Tutorials-II
  • PBL
  • Slide 23
  • PBL Starting the case
  • PBL Case (contd)
  • PBL Case contd
  • The Process of PBL
  • The Process of PBL contd
  • Learn from each other
  • Determine priorities for learning
  • Slide 31
  • Slide 32
  • Learning Issues
  • Learning Issues in PBL First Session
  • PBL Second Session
  • PBL Third Session
  • Slide 37
  • Slide 38
  • During Tutorial Session students will
  • Tutorial Session contd
  • Between Tutorial Session
  • Slide 42
  • Slide 43
  • Problem-based learning is designed to develop
  • Slide 45
  • What is problem based learning
  • Slide 47
  • Slide 48
  • Slide 49
  • Rationale for using PBL
  • Slide 51
  • Slide 52
  • The group learning process acquiring desirable learning skills
  • Generic Skills amp attitudes
  • Slide 55
  • Slide 56
  • Slide 57
  • What happens in a PBL tutorial
  • Slide 59
  • Examples of trigger material for PBL scenarios
  • PBL tutorial process
  • Slide 62
  • PBL in curriculum design
  • Slide 64
  • Writing PBL scenarios
  • Slide 66
  • Staff development
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • Slide 70
  • Advantages of PBL
  • Slide 72
  • Slide 73
  • Disadvantages
  • Assessment of PBL
  • Slide 76
  • Conclusion
  • Slide 78
  • PBL 5 Easy Steps
  • 2 Brain storm
  • Brainstorm
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • THE FIRST GROUP SESSION
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
Page 52: Problem based learning

Copyright copy2003 BMJ Publishing Group Ltd

Wood D F BMJ 2003326328-330

No CRoles of participants in a PBL tutorial aption Found

What happens in a PBL tutorial bull PBL tutorials are conducted in several ways In

this article the examples are modelled on the Maastricht seven jump process but its format of seven steps may be shortened

bull A typical PBL tutorial consists of a group of students (usually eight to 10) and a tutor who facilitates the session The length of time (number of sessions) that a group stays together with each other and with individual tutors varies between institutions A group needs to be together long enough to allow good group dynamics to develop but may need to be changed occasionally if personality clashes or other dysfunctional behaviour emerges

bull Students elect a chair for each PBL scenario and a scribe to record the discussion The roles are rotated for each scenario Suitable flip charts or a whiteboard should be used for recording the proceedings At the start of the session depending on the trigger material either the student chair reads out the scenario or all students study the material If the trigger is a real patient in a ward clinic or surgery then a student may be asked to take a clinical history or identify an abnormal physical sign before the group moves to a tutorial room For each module students may be given a handbook containing the problem scenarios and suggested learning resources or learning materials may be handed out at appropriate times as the tutorials progress

Examples of trigger material for PBL scenarios bull Paper based clinical scenarios bull Experimental or clinical laboratory data bull Photographs bull Video clips bull Newspaper articles bull All or part of an article from a scientific

journal bull A real or simulated patient bull A family tree showing an inherited

disorder

PBL tutorial process ndash Step 1 Identify and clarify unfamiliar terms presented in the scenario

scribe lists those that remain unexplained after discussion ndash Step 2 Define the problem or problems to be discussed students may

have different views on the issues but all should be considered scribe records a list of agreed problems

ndash Step 3 Brainstorming session to discuss the problem(s) suggestingpossible explanations on basis of prior knowledge students draw on each others knowledge and identify areas of incomplete knowledge scribe records all discussion

ndash Step 4 Review steps 2 and 3 and arrange explanations into tentativesolutions scribe organises the explanations and restructures if necessary

ndash Step 5 Formulate learning objectives group reaches consensus onthe learning objectives tutor ensures learning objectives are focused achievable comprehensive and appropriate

ndash Step 6 Private study (all students gather information related to eachlearning objective)

ndash Step 7 Group shares results of private study (students identify theirlearning resources and share their results) tutor checks learning and may assess the group

bull The role of the tutor is to facilitate the proceedings (helping the chair to maintain group dynamics and moving the group through the task) and to ensure that the group achieves appropriate learning objectives in line with those set by the curriculum design team The tutor may need to take a more active role in step 7 of the process to ensure that all the students have done the appropriate work and to help the chair to suggest a suitable format for group members to use to present the results of their private study The tutor should encourage students to check their understanding of the material He or she can do this by encouraging the students to ask open questions and ask each other to explain topics in their own words or by the use of drawings and diagrams

PBL in curriculum design bull PBL may be used either as the mainstay of an entire

curriculum or for the delivery of individual courses In practice PBL is usually part of an integrated curriculum using a systems based approach with non-clinical material delivered in the context of clinical practice A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge skills and attitudes A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios Sufficient time should be allowed each week for students to do the self directed learning required for PBL

bull

Copyright copy2003 BMJ Publishing Group Ltd

Wood D F BMJ 2003326328-330

No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found

Writing PBL scenarios

bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives

bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after

studying the scenario should be consistent with the faculty learning objectives

bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding

bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice

bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge

bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented

bull The problem should be sufficiently open so that discussion is not curtailed too early in the process

bull Scenarios should promote participation by the students in seeking information from various learning resources

bull Adapted from Dolmans et al Med Teacher 199719185-9

Staff development

bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)

A dysfunctional group a dominant character may

make it difficult for other students to be heard

A dysfunctional group a dominant character may make it difficult for other students to be heard

bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties

Advantages of PBL bull Student centred PBLIt fostersactive learning improved

understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks

Disadvantagesbull Tutors who cant teachTutorsenjoy passing on

their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful

Assessment of PBL

bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods

bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL

Conclusion

bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning

bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL

PBL 5 Easy Steps

bull Read the problem

Mrs Paula Embledon

Mrs Paula Embledon is a 78 year old woman who has come to the emergency room complaining of shortness of breath and pain in her chest She had been in relatively good health until three weeks previously when she sprained

2 Brain storm

bull Brainstorm

bull ndash hypotheses

bull - what do we know in support of the hypothesis

bull - what do we need to know to test the hypothesis

ndash learning issues

Brainstorm

bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)

ndash specific issues (for individuals to look up)

ndash overlapping issues

bull 4 Individual Reading - Research - Preparation

bull 5 Return

bull ndash review case so far ndash report and discuss

ndash assess progress - continue pagenext pagecomplete

ndash self-evaluation - How did things go Any suggestions for next time

ndash next problem

bull 5 Return

THE FIRST GROUP SESSION

bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day

bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session

bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr

bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine

bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise

bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator

bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues

bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know

bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)

bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)

bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)

  • PROBLEM BASED LEARNING
  • New Horizons in Medical Education
  • Slide 3
  • Domains of essential Global Requirements of ME
  • What was the response to these challenges
  • New Educational Strategies
  • New Tools amp Aids
  • PBL
  • PBL
  • Advantages
  • Slide 11
  • Slide 12
  • Slide 13
  • Slide 14
  • Framework for PBL
  • Framework for PBL - II
  • Characteristics of an effective PBL Group
  • Staff Development
  • Tutorrsquos Role in Assessment
  • Slide 20
  • Evaluating PBL Tutorials-II
  • PBL
  • Slide 23
  • PBL Starting the case
  • PBL Case (contd)
  • PBL Case contd
  • The Process of PBL
  • The Process of PBL contd
  • Learn from each other
  • Determine priorities for learning
  • Slide 31
  • Slide 32
  • Learning Issues
  • Learning Issues in PBL First Session
  • PBL Second Session
  • PBL Third Session
  • Slide 37
  • Slide 38
  • During Tutorial Session students will
  • Tutorial Session contd
  • Between Tutorial Session
  • Slide 42
  • Slide 43
  • Problem-based learning is designed to develop
  • Slide 45
  • What is problem based learning
  • Slide 47
  • Slide 48
  • Slide 49
  • Rationale for using PBL
  • Slide 51
  • Slide 52
  • The group learning process acquiring desirable learning skills
  • Generic Skills amp attitudes
  • Slide 55
  • Slide 56
  • Slide 57
  • What happens in a PBL tutorial
  • Slide 59
  • Examples of trigger material for PBL scenarios
  • PBL tutorial process
  • Slide 62
  • PBL in curriculum design
  • Slide 64
  • Writing PBL scenarios
  • Slide 66
  • Staff development
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • Slide 70
  • Advantages of PBL
  • Slide 72
  • Slide 73
  • Disadvantages
  • Assessment of PBL
  • Slide 76
  • Conclusion
  • Slide 78
  • PBL 5 Easy Steps
  • 2 Brain storm
  • Brainstorm
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • THE FIRST GROUP SESSION
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
Page 53: Problem based learning

What happens in a PBL tutorial bull PBL tutorials are conducted in several ways In

this article the examples are modelled on the Maastricht seven jump process but its format of seven steps may be shortened

bull A typical PBL tutorial consists of a group of students (usually eight to 10) and a tutor who facilitates the session The length of time (number of sessions) that a group stays together with each other and with individual tutors varies between institutions A group needs to be together long enough to allow good group dynamics to develop but may need to be changed occasionally if personality clashes or other dysfunctional behaviour emerges

bull Students elect a chair for each PBL scenario and a scribe to record the discussion The roles are rotated for each scenario Suitable flip charts or a whiteboard should be used for recording the proceedings At the start of the session depending on the trigger material either the student chair reads out the scenario or all students study the material If the trigger is a real patient in a ward clinic or surgery then a student may be asked to take a clinical history or identify an abnormal physical sign before the group moves to a tutorial room For each module students may be given a handbook containing the problem scenarios and suggested learning resources or learning materials may be handed out at appropriate times as the tutorials progress

Examples of trigger material for PBL scenarios bull Paper based clinical scenarios bull Experimental or clinical laboratory data bull Photographs bull Video clips bull Newspaper articles bull All or part of an article from a scientific

journal bull A real or simulated patient bull A family tree showing an inherited

disorder

PBL tutorial process ndash Step 1 Identify and clarify unfamiliar terms presented in the scenario

scribe lists those that remain unexplained after discussion ndash Step 2 Define the problem or problems to be discussed students may

have different views on the issues but all should be considered scribe records a list of agreed problems

ndash Step 3 Brainstorming session to discuss the problem(s) suggestingpossible explanations on basis of prior knowledge students draw on each others knowledge and identify areas of incomplete knowledge scribe records all discussion

ndash Step 4 Review steps 2 and 3 and arrange explanations into tentativesolutions scribe organises the explanations and restructures if necessary

ndash Step 5 Formulate learning objectives group reaches consensus onthe learning objectives tutor ensures learning objectives are focused achievable comprehensive and appropriate

ndash Step 6 Private study (all students gather information related to eachlearning objective)

ndash Step 7 Group shares results of private study (students identify theirlearning resources and share their results) tutor checks learning and may assess the group

bull The role of the tutor is to facilitate the proceedings (helping the chair to maintain group dynamics and moving the group through the task) and to ensure that the group achieves appropriate learning objectives in line with those set by the curriculum design team The tutor may need to take a more active role in step 7 of the process to ensure that all the students have done the appropriate work and to help the chair to suggest a suitable format for group members to use to present the results of their private study The tutor should encourage students to check their understanding of the material He or she can do this by encouraging the students to ask open questions and ask each other to explain topics in their own words or by the use of drawings and diagrams

PBL in curriculum design bull PBL may be used either as the mainstay of an entire

curriculum or for the delivery of individual courses In practice PBL is usually part of an integrated curriculum using a systems based approach with non-clinical material delivered in the context of clinical practice A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge skills and attitudes A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios Sufficient time should be allowed each week for students to do the self directed learning required for PBL

bull

Copyright copy2003 BMJ Publishing Group Ltd

Wood D F BMJ 2003326328-330

No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found

Writing PBL scenarios

bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives

bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after

studying the scenario should be consistent with the faculty learning objectives

bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding

bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice

bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge

bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented

bull The problem should be sufficiently open so that discussion is not curtailed too early in the process

bull Scenarios should promote participation by the students in seeking information from various learning resources

bull Adapted from Dolmans et al Med Teacher 199719185-9

Staff development

bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)

A dysfunctional group a dominant character may

make it difficult for other students to be heard

A dysfunctional group a dominant character may make it difficult for other students to be heard

bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties

Advantages of PBL bull Student centred PBLIt fostersactive learning improved

understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks

Disadvantagesbull Tutors who cant teachTutorsenjoy passing on

their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful

Assessment of PBL

bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods

bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL

Conclusion

bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning

bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL

PBL 5 Easy Steps

bull Read the problem

Mrs Paula Embledon

Mrs Paula Embledon is a 78 year old woman who has come to the emergency room complaining of shortness of breath and pain in her chest She had been in relatively good health until three weeks previously when she sprained

2 Brain storm

bull Brainstorm

bull ndash hypotheses

bull - what do we know in support of the hypothesis

bull - what do we need to know to test the hypothesis

ndash learning issues

Brainstorm

bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)

ndash specific issues (for individuals to look up)

ndash overlapping issues

bull 4 Individual Reading - Research - Preparation

bull 5 Return

bull ndash review case so far ndash report and discuss

ndash assess progress - continue pagenext pagecomplete

ndash self-evaluation - How did things go Any suggestions for next time

ndash next problem

bull 5 Return

THE FIRST GROUP SESSION

bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day

bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session

bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr

bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine

bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise

bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator

bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues

bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know

bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)

bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)

bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)

  • PROBLEM BASED LEARNING
  • New Horizons in Medical Education
  • Slide 3
  • Domains of essential Global Requirements of ME
  • What was the response to these challenges
  • New Educational Strategies
  • New Tools amp Aids
  • PBL
  • PBL
  • Advantages
  • Slide 11
  • Slide 12
  • Slide 13
  • Slide 14
  • Framework for PBL
  • Framework for PBL - II
  • Characteristics of an effective PBL Group
  • Staff Development
  • Tutorrsquos Role in Assessment
  • Slide 20
  • Evaluating PBL Tutorials-II
  • PBL
  • Slide 23
  • PBL Starting the case
  • PBL Case (contd)
  • PBL Case contd
  • The Process of PBL
  • The Process of PBL contd
  • Learn from each other
  • Determine priorities for learning
  • Slide 31
  • Slide 32
  • Learning Issues
  • Learning Issues in PBL First Session
  • PBL Second Session
  • PBL Third Session
  • Slide 37
  • Slide 38
  • During Tutorial Session students will
  • Tutorial Session contd
  • Between Tutorial Session
  • Slide 42
  • Slide 43
  • Problem-based learning is designed to develop
  • Slide 45
  • What is problem based learning
  • Slide 47
  • Slide 48
  • Slide 49
  • Rationale for using PBL
  • Slide 51
  • Slide 52
  • The group learning process acquiring desirable learning skills
  • Generic Skills amp attitudes
  • Slide 55
  • Slide 56
  • Slide 57
  • What happens in a PBL tutorial
  • Slide 59
  • Examples of trigger material for PBL scenarios
  • PBL tutorial process
  • Slide 62
  • PBL in curriculum design
  • Slide 64
  • Writing PBL scenarios
  • Slide 66
  • Staff development
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • Slide 70
  • Advantages of PBL
  • Slide 72
  • Slide 73
  • Disadvantages
  • Assessment of PBL
  • Slide 76
  • Conclusion
  • Slide 78
  • PBL 5 Easy Steps
  • 2 Brain storm
  • Brainstorm
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • THE FIRST GROUP SESSION
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
Page 54: Problem based learning

bull Students elect a chair for each PBL scenario and a scribe to record the discussion The roles are rotated for each scenario Suitable flip charts or a whiteboard should be used for recording the proceedings At the start of the session depending on the trigger material either the student chair reads out the scenario or all students study the material If the trigger is a real patient in a ward clinic or surgery then a student may be asked to take a clinical history or identify an abnormal physical sign before the group moves to a tutorial room For each module students may be given a handbook containing the problem scenarios and suggested learning resources or learning materials may be handed out at appropriate times as the tutorials progress

Examples of trigger material for PBL scenarios bull Paper based clinical scenarios bull Experimental or clinical laboratory data bull Photographs bull Video clips bull Newspaper articles bull All or part of an article from a scientific

journal bull A real or simulated patient bull A family tree showing an inherited

disorder

PBL tutorial process ndash Step 1 Identify and clarify unfamiliar terms presented in the scenario

scribe lists those that remain unexplained after discussion ndash Step 2 Define the problem or problems to be discussed students may

have different views on the issues but all should be considered scribe records a list of agreed problems

ndash Step 3 Brainstorming session to discuss the problem(s) suggestingpossible explanations on basis of prior knowledge students draw on each others knowledge and identify areas of incomplete knowledge scribe records all discussion

ndash Step 4 Review steps 2 and 3 and arrange explanations into tentativesolutions scribe organises the explanations and restructures if necessary

ndash Step 5 Formulate learning objectives group reaches consensus onthe learning objectives tutor ensures learning objectives are focused achievable comprehensive and appropriate

ndash Step 6 Private study (all students gather information related to eachlearning objective)

ndash Step 7 Group shares results of private study (students identify theirlearning resources and share their results) tutor checks learning and may assess the group

bull The role of the tutor is to facilitate the proceedings (helping the chair to maintain group dynamics and moving the group through the task) and to ensure that the group achieves appropriate learning objectives in line with those set by the curriculum design team The tutor may need to take a more active role in step 7 of the process to ensure that all the students have done the appropriate work and to help the chair to suggest a suitable format for group members to use to present the results of their private study The tutor should encourage students to check their understanding of the material He or she can do this by encouraging the students to ask open questions and ask each other to explain topics in their own words or by the use of drawings and diagrams

PBL in curriculum design bull PBL may be used either as the mainstay of an entire

curriculum or for the delivery of individual courses In practice PBL is usually part of an integrated curriculum using a systems based approach with non-clinical material delivered in the context of clinical practice A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge skills and attitudes A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios Sufficient time should be allowed each week for students to do the self directed learning required for PBL

bull

Copyright copy2003 BMJ Publishing Group Ltd

Wood D F BMJ 2003326328-330

No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found

Writing PBL scenarios

bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives

bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after

studying the scenario should be consistent with the faculty learning objectives

bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding

bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice

bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge

bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented

bull The problem should be sufficiently open so that discussion is not curtailed too early in the process

bull Scenarios should promote participation by the students in seeking information from various learning resources

bull Adapted from Dolmans et al Med Teacher 199719185-9

Staff development

bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)

A dysfunctional group a dominant character may

make it difficult for other students to be heard

A dysfunctional group a dominant character may make it difficult for other students to be heard

bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties

Advantages of PBL bull Student centred PBLIt fostersactive learning improved

understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks

Disadvantagesbull Tutors who cant teachTutorsenjoy passing on

their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful

Assessment of PBL

bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods

bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL

Conclusion

bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning

bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL

PBL 5 Easy Steps

bull Read the problem

Mrs Paula Embledon

Mrs Paula Embledon is a 78 year old woman who has come to the emergency room complaining of shortness of breath and pain in her chest She had been in relatively good health until three weeks previously when she sprained

2 Brain storm

bull Brainstorm

bull ndash hypotheses

bull - what do we know in support of the hypothesis

bull - what do we need to know to test the hypothesis

ndash learning issues

Brainstorm

bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)

ndash specific issues (for individuals to look up)

ndash overlapping issues

bull 4 Individual Reading - Research - Preparation

bull 5 Return

bull ndash review case so far ndash report and discuss

ndash assess progress - continue pagenext pagecomplete

ndash self-evaluation - How did things go Any suggestions for next time

ndash next problem

bull 5 Return

THE FIRST GROUP SESSION

bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day

bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session

bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr

bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine

bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise

bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator

bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues

bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know

bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)

bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)

bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)

  • PROBLEM BASED LEARNING
  • New Horizons in Medical Education
  • Slide 3
  • Domains of essential Global Requirements of ME
  • What was the response to these challenges
  • New Educational Strategies
  • New Tools amp Aids
  • PBL
  • PBL
  • Advantages
  • Slide 11
  • Slide 12
  • Slide 13
  • Slide 14
  • Framework for PBL
  • Framework for PBL - II
  • Characteristics of an effective PBL Group
  • Staff Development
  • Tutorrsquos Role in Assessment
  • Slide 20
  • Evaluating PBL Tutorials-II
  • PBL
  • Slide 23
  • PBL Starting the case
  • PBL Case (contd)
  • PBL Case contd
  • The Process of PBL
  • The Process of PBL contd
  • Learn from each other
  • Determine priorities for learning
  • Slide 31
  • Slide 32
  • Learning Issues
  • Learning Issues in PBL First Session
  • PBL Second Session
  • PBL Third Session
  • Slide 37
  • Slide 38
  • During Tutorial Session students will
  • Tutorial Session contd
  • Between Tutorial Session
  • Slide 42
  • Slide 43
  • Problem-based learning is designed to develop
  • Slide 45
  • What is problem based learning
  • Slide 47
  • Slide 48
  • Slide 49
  • Rationale for using PBL
  • Slide 51
  • Slide 52
  • The group learning process acquiring desirable learning skills
  • Generic Skills amp attitudes
  • Slide 55
  • Slide 56
  • Slide 57
  • What happens in a PBL tutorial
  • Slide 59
  • Examples of trigger material for PBL scenarios
  • PBL tutorial process
  • Slide 62
  • PBL in curriculum design
  • Slide 64
  • Writing PBL scenarios
  • Slide 66
  • Staff development
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • Slide 70
  • Advantages of PBL
  • Slide 72
  • Slide 73
  • Disadvantages
  • Assessment of PBL
  • Slide 76
  • Conclusion
  • Slide 78
  • PBL 5 Easy Steps
  • 2 Brain storm
  • Brainstorm
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • THE FIRST GROUP SESSION
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
Page 55: Problem based learning

Examples of trigger material for PBL scenarios bull Paper based clinical scenarios bull Experimental or clinical laboratory data bull Photographs bull Video clips bull Newspaper articles bull All or part of an article from a scientific

journal bull A real or simulated patient bull A family tree showing an inherited

disorder

PBL tutorial process ndash Step 1 Identify and clarify unfamiliar terms presented in the scenario

scribe lists those that remain unexplained after discussion ndash Step 2 Define the problem or problems to be discussed students may

have different views on the issues but all should be considered scribe records a list of agreed problems

ndash Step 3 Brainstorming session to discuss the problem(s) suggestingpossible explanations on basis of prior knowledge students draw on each others knowledge and identify areas of incomplete knowledge scribe records all discussion

ndash Step 4 Review steps 2 and 3 and arrange explanations into tentativesolutions scribe organises the explanations and restructures if necessary

ndash Step 5 Formulate learning objectives group reaches consensus onthe learning objectives tutor ensures learning objectives are focused achievable comprehensive and appropriate

ndash Step 6 Private study (all students gather information related to eachlearning objective)

ndash Step 7 Group shares results of private study (students identify theirlearning resources and share their results) tutor checks learning and may assess the group

bull The role of the tutor is to facilitate the proceedings (helping the chair to maintain group dynamics and moving the group through the task) and to ensure that the group achieves appropriate learning objectives in line with those set by the curriculum design team The tutor may need to take a more active role in step 7 of the process to ensure that all the students have done the appropriate work and to help the chair to suggest a suitable format for group members to use to present the results of their private study The tutor should encourage students to check their understanding of the material He or she can do this by encouraging the students to ask open questions and ask each other to explain topics in their own words or by the use of drawings and diagrams

PBL in curriculum design bull PBL may be used either as the mainstay of an entire

curriculum or for the delivery of individual courses In practice PBL is usually part of an integrated curriculum using a systems based approach with non-clinical material delivered in the context of clinical practice A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge skills and attitudes A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios Sufficient time should be allowed each week for students to do the self directed learning required for PBL

bull

Copyright copy2003 BMJ Publishing Group Ltd

Wood D F BMJ 2003326328-330

No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found

Writing PBL scenarios

bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives

bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after

studying the scenario should be consistent with the faculty learning objectives

bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding

bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice

bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge

bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented

bull The problem should be sufficiently open so that discussion is not curtailed too early in the process

bull Scenarios should promote participation by the students in seeking information from various learning resources

bull Adapted from Dolmans et al Med Teacher 199719185-9

Staff development

bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)

A dysfunctional group a dominant character may

make it difficult for other students to be heard

A dysfunctional group a dominant character may make it difficult for other students to be heard

bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties

Advantages of PBL bull Student centred PBLIt fostersactive learning improved

understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks

Disadvantagesbull Tutors who cant teachTutorsenjoy passing on

their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful

Assessment of PBL

bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods

bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL

Conclusion

bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning

bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL

PBL 5 Easy Steps

bull Read the problem

Mrs Paula Embledon

Mrs Paula Embledon is a 78 year old woman who has come to the emergency room complaining of shortness of breath and pain in her chest She had been in relatively good health until three weeks previously when she sprained

2 Brain storm

bull Brainstorm

bull ndash hypotheses

bull - what do we know in support of the hypothesis

bull - what do we need to know to test the hypothesis

ndash learning issues

Brainstorm

bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)

ndash specific issues (for individuals to look up)

ndash overlapping issues

bull 4 Individual Reading - Research - Preparation

bull 5 Return

bull ndash review case so far ndash report and discuss

ndash assess progress - continue pagenext pagecomplete

ndash self-evaluation - How did things go Any suggestions for next time

ndash next problem

bull 5 Return

THE FIRST GROUP SESSION

bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day

bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session

bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr

bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine

bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise

bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator

bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues

bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know

bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)

bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)

bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)

  • PROBLEM BASED LEARNING
  • New Horizons in Medical Education
  • Slide 3
  • Domains of essential Global Requirements of ME
  • What was the response to these challenges
  • New Educational Strategies
  • New Tools amp Aids
  • PBL
  • PBL
  • Advantages
  • Slide 11
  • Slide 12
  • Slide 13
  • Slide 14
  • Framework for PBL
  • Framework for PBL - II
  • Characteristics of an effective PBL Group
  • Staff Development
  • Tutorrsquos Role in Assessment
  • Slide 20
  • Evaluating PBL Tutorials-II
  • PBL
  • Slide 23
  • PBL Starting the case
  • PBL Case (contd)
  • PBL Case contd
  • The Process of PBL
  • The Process of PBL contd
  • Learn from each other
  • Determine priorities for learning
  • Slide 31
  • Slide 32
  • Learning Issues
  • Learning Issues in PBL First Session
  • PBL Second Session
  • PBL Third Session
  • Slide 37
  • Slide 38
  • During Tutorial Session students will
  • Tutorial Session contd
  • Between Tutorial Session
  • Slide 42
  • Slide 43
  • Problem-based learning is designed to develop
  • Slide 45
  • What is problem based learning
  • Slide 47
  • Slide 48
  • Slide 49
  • Rationale for using PBL
  • Slide 51
  • Slide 52
  • The group learning process acquiring desirable learning skills
  • Generic Skills amp attitudes
  • Slide 55
  • Slide 56
  • Slide 57
  • What happens in a PBL tutorial
  • Slide 59
  • Examples of trigger material for PBL scenarios
  • PBL tutorial process
  • Slide 62
  • PBL in curriculum design
  • Slide 64
  • Writing PBL scenarios
  • Slide 66
  • Staff development
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • Slide 70
  • Advantages of PBL
  • Slide 72
  • Slide 73
  • Disadvantages
  • Assessment of PBL
  • Slide 76
  • Conclusion
  • Slide 78
  • PBL 5 Easy Steps
  • 2 Brain storm
  • Brainstorm
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • THE FIRST GROUP SESSION
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
Page 56: Problem based learning

PBL tutorial process ndash Step 1 Identify and clarify unfamiliar terms presented in the scenario

scribe lists those that remain unexplained after discussion ndash Step 2 Define the problem or problems to be discussed students may

have different views on the issues but all should be considered scribe records a list of agreed problems

ndash Step 3 Brainstorming session to discuss the problem(s) suggestingpossible explanations on basis of prior knowledge students draw on each others knowledge and identify areas of incomplete knowledge scribe records all discussion

ndash Step 4 Review steps 2 and 3 and arrange explanations into tentativesolutions scribe organises the explanations and restructures if necessary

ndash Step 5 Formulate learning objectives group reaches consensus onthe learning objectives tutor ensures learning objectives are focused achievable comprehensive and appropriate

ndash Step 6 Private study (all students gather information related to eachlearning objective)

ndash Step 7 Group shares results of private study (students identify theirlearning resources and share their results) tutor checks learning and may assess the group

bull The role of the tutor is to facilitate the proceedings (helping the chair to maintain group dynamics and moving the group through the task) and to ensure that the group achieves appropriate learning objectives in line with those set by the curriculum design team The tutor may need to take a more active role in step 7 of the process to ensure that all the students have done the appropriate work and to help the chair to suggest a suitable format for group members to use to present the results of their private study The tutor should encourage students to check their understanding of the material He or she can do this by encouraging the students to ask open questions and ask each other to explain topics in their own words or by the use of drawings and diagrams

PBL in curriculum design bull PBL may be used either as the mainstay of an entire

curriculum or for the delivery of individual courses In practice PBL is usually part of an integrated curriculum using a systems based approach with non-clinical material delivered in the context of clinical practice A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge skills and attitudes A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios Sufficient time should be allowed each week for students to do the self directed learning required for PBL

bull

Copyright copy2003 BMJ Publishing Group Ltd

Wood D F BMJ 2003326328-330

No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found

Writing PBL scenarios

bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives

bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after

studying the scenario should be consistent with the faculty learning objectives

bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding

bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice

bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge

bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented

bull The problem should be sufficiently open so that discussion is not curtailed too early in the process

bull Scenarios should promote participation by the students in seeking information from various learning resources

bull Adapted from Dolmans et al Med Teacher 199719185-9

Staff development

bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)

A dysfunctional group a dominant character may

make it difficult for other students to be heard

A dysfunctional group a dominant character may make it difficult for other students to be heard

bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties

Advantages of PBL bull Student centred PBLIt fostersactive learning improved

understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks

Disadvantagesbull Tutors who cant teachTutorsenjoy passing on

their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful

Assessment of PBL

bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods

bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL

Conclusion

bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning

bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL

PBL 5 Easy Steps

bull Read the problem

Mrs Paula Embledon

Mrs Paula Embledon is a 78 year old woman who has come to the emergency room complaining of shortness of breath and pain in her chest She had been in relatively good health until three weeks previously when she sprained

2 Brain storm

bull Brainstorm

bull ndash hypotheses

bull - what do we know in support of the hypothesis

bull - what do we need to know to test the hypothesis

ndash learning issues

Brainstorm

bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)

ndash specific issues (for individuals to look up)

ndash overlapping issues

bull 4 Individual Reading - Research - Preparation

bull 5 Return

bull ndash review case so far ndash report and discuss

ndash assess progress - continue pagenext pagecomplete

ndash self-evaluation - How did things go Any suggestions for next time

ndash next problem

bull 5 Return

THE FIRST GROUP SESSION

bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day

bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session

bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr

bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine

bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise

bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator

bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues

bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know

bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)

bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)

bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)

  • PROBLEM BASED LEARNING
  • New Horizons in Medical Education
  • Slide 3
  • Domains of essential Global Requirements of ME
  • What was the response to these challenges
  • New Educational Strategies
  • New Tools amp Aids
  • PBL
  • PBL
  • Advantages
  • Slide 11
  • Slide 12
  • Slide 13
  • Slide 14
  • Framework for PBL
  • Framework for PBL - II
  • Characteristics of an effective PBL Group
  • Staff Development
  • Tutorrsquos Role in Assessment
  • Slide 20
  • Evaluating PBL Tutorials-II
  • PBL
  • Slide 23
  • PBL Starting the case
  • PBL Case (contd)
  • PBL Case contd
  • The Process of PBL
  • The Process of PBL contd
  • Learn from each other
  • Determine priorities for learning
  • Slide 31
  • Slide 32
  • Learning Issues
  • Learning Issues in PBL First Session
  • PBL Second Session
  • PBL Third Session
  • Slide 37
  • Slide 38
  • During Tutorial Session students will
  • Tutorial Session contd
  • Between Tutorial Session
  • Slide 42
  • Slide 43
  • Problem-based learning is designed to develop
  • Slide 45
  • What is problem based learning
  • Slide 47
  • Slide 48
  • Slide 49
  • Rationale for using PBL
  • Slide 51
  • Slide 52
  • The group learning process acquiring desirable learning skills
  • Generic Skills amp attitudes
  • Slide 55
  • Slide 56
  • Slide 57
  • What happens in a PBL tutorial
  • Slide 59
  • Examples of trigger material for PBL scenarios
  • PBL tutorial process
  • Slide 62
  • PBL in curriculum design
  • Slide 64
  • Writing PBL scenarios
  • Slide 66
  • Staff development
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • Slide 70
  • Advantages of PBL
  • Slide 72
  • Slide 73
  • Disadvantages
  • Assessment of PBL
  • Slide 76
  • Conclusion
  • Slide 78
  • PBL 5 Easy Steps
  • 2 Brain storm
  • Brainstorm
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • THE FIRST GROUP SESSION
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
Page 57: Problem based learning

bull The role of the tutor is to facilitate the proceedings (helping the chair to maintain group dynamics and moving the group through the task) and to ensure that the group achieves appropriate learning objectives in line with those set by the curriculum design team The tutor may need to take a more active role in step 7 of the process to ensure that all the students have done the appropriate work and to help the chair to suggest a suitable format for group members to use to present the results of their private study The tutor should encourage students to check their understanding of the material He or she can do this by encouraging the students to ask open questions and ask each other to explain topics in their own words or by the use of drawings and diagrams

PBL in curriculum design bull PBL may be used either as the mainstay of an entire

curriculum or for the delivery of individual courses In practice PBL is usually part of an integrated curriculum using a systems based approach with non-clinical material delivered in the context of clinical practice A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge skills and attitudes A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios Sufficient time should be allowed each week for students to do the self directed learning required for PBL

bull

Copyright copy2003 BMJ Publishing Group Ltd

Wood D F BMJ 2003326328-330

No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found

Writing PBL scenarios

bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives

bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after

studying the scenario should be consistent with the faculty learning objectives

bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding

bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice

bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge

bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented

bull The problem should be sufficiently open so that discussion is not curtailed too early in the process

bull Scenarios should promote participation by the students in seeking information from various learning resources

bull Adapted from Dolmans et al Med Teacher 199719185-9

Staff development

bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)

A dysfunctional group a dominant character may

make it difficult for other students to be heard

A dysfunctional group a dominant character may make it difficult for other students to be heard

bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties

Advantages of PBL bull Student centred PBLIt fostersactive learning improved

understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks

Disadvantagesbull Tutors who cant teachTutorsenjoy passing on

their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful

Assessment of PBL

bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods

bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL

Conclusion

bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning

bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL

PBL 5 Easy Steps

bull Read the problem

Mrs Paula Embledon

Mrs Paula Embledon is a 78 year old woman who has come to the emergency room complaining of shortness of breath and pain in her chest She had been in relatively good health until three weeks previously when she sprained

2 Brain storm

bull Brainstorm

bull ndash hypotheses

bull - what do we know in support of the hypothesis

bull - what do we need to know to test the hypothesis

ndash learning issues

Brainstorm

bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)

ndash specific issues (for individuals to look up)

ndash overlapping issues

bull 4 Individual Reading - Research - Preparation

bull 5 Return

bull ndash review case so far ndash report and discuss

ndash assess progress - continue pagenext pagecomplete

ndash self-evaluation - How did things go Any suggestions for next time

ndash next problem

bull 5 Return

THE FIRST GROUP SESSION

bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day

bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session

bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr

bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine

bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise

bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator

bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues

bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know

bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)

bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)

bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)

  • PROBLEM BASED LEARNING
  • New Horizons in Medical Education
  • Slide 3
  • Domains of essential Global Requirements of ME
  • What was the response to these challenges
  • New Educational Strategies
  • New Tools amp Aids
  • PBL
  • PBL
  • Advantages
  • Slide 11
  • Slide 12
  • Slide 13
  • Slide 14
  • Framework for PBL
  • Framework for PBL - II
  • Characteristics of an effective PBL Group
  • Staff Development
  • Tutorrsquos Role in Assessment
  • Slide 20
  • Evaluating PBL Tutorials-II
  • PBL
  • Slide 23
  • PBL Starting the case
  • PBL Case (contd)
  • PBL Case contd
  • The Process of PBL
  • The Process of PBL contd
  • Learn from each other
  • Determine priorities for learning
  • Slide 31
  • Slide 32
  • Learning Issues
  • Learning Issues in PBL First Session
  • PBL Second Session
  • PBL Third Session
  • Slide 37
  • Slide 38
  • During Tutorial Session students will
  • Tutorial Session contd
  • Between Tutorial Session
  • Slide 42
  • Slide 43
  • Problem-based learning is designed to develop
  • Slide 45
  • What is problem based learning
  • Slide 47
  • Slide 48
  • Slide 49
  • Rationale for using PBL
  • Slide 51
  • Slide 52
  • The group learning process acquiring desirable learning skills
  • Generic Skills amp attitudes
  • Slide 55
  • Slide 56
  • Slide 57
  • What happens in a PBL tutorial
  • Slide 59
  • Examples of trigger material for PBL scenarios
  • PBL tutorial process
  • Slide 62
  • PBL in curriculum design
  • Slide 64
  • Writing PBL scenarios
  • Slide 66
  • Staff development
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • Slide 70
  • Advantages of PBL
  • Slide 72
  • Slide 73
  • Disadvantages
  • Assessment of PBL
  • Slide 76
  • Conclusion
  • Slide 78
  • PBL 5 Easy Steps
  • 2 Brain storm
  • Brainstorm
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • THE FIRST GROUP SESSION
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
Page 58: Problem based learning

PBL in curriculum design bull PBL may be used either as the mainstay of an entire

curriculum or for the delivery of individual courses In practice PBL is usually part of an integrated curriculum using a systems based approach with non-clinical material delivered in the context of clinical practice A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge skills and attitudes A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios Sufficient time should be allowed each week for students to do the self directed learning required for PBL

bull

Copyright copy2003 BMJ Publishing Group Ltd

Wood D F BMJ 2003326328-330

No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found

Writing PBL scenarios

bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives

bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after

studying the scenario should be consistent with the faculty learning objectives

bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding

bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice

bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge

bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented

bull The problem should be sufficiently open so that discussion is not curtailed too early in the process

bull Scenarios should promote participation by the students in seeking information from various learning resources

bull Adapted from Dolmans et al Med Teacher 199719185-9

Staff development

bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)

A dysfunctional group a dominant character may

make it difficult for other students to be heard

A dysfunctional group a dominant character may make it difficult for other students to be heard

bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties

Advantages of PBL bull Student centred PBLIt fostersactive learning improved

understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks

Disadvantagesbull Tutors who cant teachTutorsenjoy passing on

their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful

Assessment of PBL

bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods

bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL

Conclusion

bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning

bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL

PBL 5 Easy Steps

bull Read the problem

Mrs Paula Embledon

Mrs Paula Embledon is a 78 year old woman who has come to the emergency room complaining of shortness of breath and pain in her chest She had been in relatively good health until three weeks previously when she sprained

2 Brain storm

bull Brainstorm

bull ndash hypotheses

bull - what do we know in support of the hypothesis

bull - what do we need to know to test the hypothesis

ndash learning issues

Brainstorm

bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)

ndash specific issues (for individuals to look up)

ndash overlapping issues

bull 4 Individual Reading - Research - Preparation

bull 5 Return

bull ndash review case so far ndash report and discuss

ndash assess progress - continue pagenext pagecomplete

ndash self-evaluation - How did things go Any suggestions for next time

ndash next problem

bull 5 Return

THE FIRST GROUP SESSION

bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day

bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session

bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr

bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine

bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise

bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator

bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues

bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know

bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)

bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)

bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)

  • PROBLEM BASED LEARNING
  • New Horizons in Medical Education
  • Slide 3
  • Domains of essential Global Requirements of ME
  • What was the response to these challenges
  • New Educational Strategies
  • New Tools amp Aids
  • PBL
  • PBL
  • Advantages
  • Slide 11
  • Slide 12
  • Slide 13
  • Slide 14
  • Framework for PBL
  • Framework for PBL - II
  • Characteristics of an effective PBL Group
  • Staff Development
  • Tutorrsquos Role in Assessment
  • Slide 20
  • Evaluating PBL Tutorials-II
  • PBL
  • Slide 23
  • PBL Starting the case
  • PBL Case (contd)
  • PBL Case contd
  • The Process of PBL
  • The Process of PBL contd
  • Learn from each other
  • Determine priorities for learning
  • Slide 31
  • Slide 32
  • Learning Issues
  • Learning Issues in PBL First Session
  • PBL Second Session
  • PBL Third Session
  • Slide 37
  • Slide 38
  • During Tutorial Session students will
  • Tutorial Session contd
  • Between Tutorial Session
  • Slide 42
  • Slide 43
  • Problem-based learning is designed to develop
  • Slide 45
  • What is problem based learning
  • Slide 47
  • Slide 48
  • Slide 49
  • Rationale for using PBL
  • Slide 51
  • Slide 52
  • The group learning process acquiring desirable learning skills
  • Generic Skills amp attitudes
  • Slide 55
  • Slide 56
  • Slide 57
  • What happens in a PBL tutorial
  • Slide 59
  • Examples of trigger material for PBL scenarios
  • PBL tutorial process
  • Slide 62
  • PBL in curriculum design
  • Slide 64
  • Writing PBL scenarios
  • Slide 66
  • Staff development
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • Slide 70
  • Advantages of PBL
  • Slide 72
  • Slide 73
  • Disadvantages
  • Assessment of PBL
  • Slide 76
  • Conclusion
  • Slide 78
  • PBL 5 Easy Steps
  • 2 Brain storm
  • Brainstorm
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • THE FIRST GROUP SESSION
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
Page 59: Problem based learning

Copyright copy2003 BMJ Publishing Group Ltd

Wood D F BMJ 2003326328-330

No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found

Writing PBL scenarios

bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives

bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after

studying the scenario should be consistent with the faculty learning objectives

bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding

bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice

bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge

bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented

bull The problem should be sufficiently open so that discussion is not curtailed too early in the process

bull Scenarios should promote participation by the students in seeking information from various learning resources

bull Adapted from Dolmans et al Med Teacher 199719185-9

Staff development

bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)

A dysfunctional group a dominant character may

make it difficult for other students to be heard

A dysfunctional group a dominant character may make it difficult for other students to be heard

bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties

Advantages of PBL bull Student centred PBLIt fostersactive learning improved

understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks

Disadvantagesbull Tutors who cant teachTutorsenjoy passing on

their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful

Assessment of PBL

bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods

bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL

Conclusion

bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning

bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL

PBL 5 Easy Steps

bull Read the problem

Mrs Paula Embledon

Mrs Paula Embledon is a 78 year old woman who has come to the emergency room complaining of shortness of breath and pain in her chest She had been in relatively good health until three weeks previously when she sprained

2 Brain storm

bull Brainstorm

bull ndash hypotheses

bull - what do we know in support of the hypothesis

bull - what do we need to know to test the hypothesis

ndash learning issues

Brainstorm

bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)

ndash specific issues (for individuals to look up)

ndash overlapping issues

bull 4 Individual Reading - Research - Preparation

bull 5 Return

bull ndash review case so far ndash report and discuss

ndash assess progress - continue pagenext pagecomplete

ndash self-evaluation - How did things go Any suggestions for next time

ndash next problem

bull 5 Return

THE FIRST GROUP SESSION

bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day

bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session

bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr

bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine

bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise

bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator

bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues

bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know

bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)

bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)

bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)

  • PROBLEM BASED LEARNING
  • New Horizons in Medical Education
  • Slide 3
  • Domains of essential Global Requirements of ME
  • What was the response to these challenges
  • New Educational Strategies
  • New Tools amp Aids
  • PBL
  • PBL
  • Advantages
  • Slide 11
  • Slide 12
  • Slide 13
  • Slide 14
  • Framework for PBL
  • Framework for PBL - II
  • Characteristics of an effective PBL Group
  • Staff Development
  • Tutorrsquos Role in Assessment
  • Slide 20
  • Evaluating PBL Tutorials-II
  • PBL
  • Slide 23
  • PBL Starting the case
  • PBL Case (contd)
  • PBL Case contd
  • The Process of PBL
  • The Process of PBL contd
  • Learn from each other
  • Determine priorities for learning
  • Slide 31
  • Slide 32
  • Learning Issues
  • Learning Issues in PBL First Session
  • PBL Second Session
  • PBL Third Session
  • Slide 37
  • Slide 38
  • During Tutorial Session students will
  • Tutorial Session contd
  • Between Tutorial Session
  • Slide 42
  • Slide 43
  • Problem-based learning is designed to develop
  • Slide 45
  • What is problem based learning
  • Slide 47
  • Slide 48
  • Slide 49
  • Rationale for using PBL
  • Slide 51
  • Slide 52
  • The group learning process acquiring desirable learning skills
  • Generic Skills amp attitudes
  • Slide 55
  • Slide 56
  • Slide 57
  • What happens in a PBL tutorial
  • Slide 59
  • Examples of trigger material for PBL scenarios
  • PBL tutorial process
  • Slide 62
  • PBL in curriculum design
  • Slide 64
  • Writing PBL scenarios
  • Slide 66
  • Staff development
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • Slide 70
  • Advantages of PBL
  • Slide 72
  • Slide 73
  • Disadvantages
  • Assessment of PBL
  • Slide 76
  • Conclusion
  • Slide 78
  • PBL 5 Easy Steps
  • 2 Brain storm
  • Brainstorm
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • THE FIRST GROUP SESSION
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
Page 60: Problem based learning

Writing PBL scenarios

bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives

bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after

studying the scenario should be consistent with the faculty learning objectives

bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding

bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice

bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge

bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented

bull The problem should be sufficiently open so that discussion is not curtailed too early in the process

bull Scenarios should promote participation by the students in seeking information from various learning resources

bull Adapted from Dolmans et al Med Teacher 199719185-9

Staff development

bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)

A dysfunctional group a dominant character may

make it difficult for other students to be heard

A dysfunctional group a dominant character may make it difficult for other students to be heard

bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties

Advantages of PBL bull Student centred PBLIt fostersactive learning improved

understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks

Disadvantagesbull Tutors who cant teachTutorsenjoy passing on

their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful

Assessment of PBL

bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods

bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL

Conclusion

bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning

bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL

PBL 5 Easy Steps

bull Read the problem

Mrs Paula Embledon

Mrs Paula Embledon is a 78 year old woman who has come to the emergency room complaining of shortness of breath and pain in her chest She had been in relatively good health until three weeks previously when she sprained

2 Brain storm

bull Brainstorm

bull ndash hypotheses

bull - what do we know in support of the hypothesis

bull - what do we need to know to test the hypothesis

ndash learning issues

Brainstorm

bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)

ndash specific issues (for individuals to look up)

ndash overlapping issues

bull 4 Individual Reading - Research - Preparation

bull 5 Return

bull ndash review case so far ndash report and discuss

ndash assess progress - continue pagenext pagecomplete

ndash self-evaluation - How did things go Any suggestions for next time

ndash next problem

bull 5 Return

THE FIRST GROUP SESSION

bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day

bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session

bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr

bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine

bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise

bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator

bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues

bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know

bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)

bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)

bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)

  • PROBLEM BASED LEARNING
  • New Horizons in Medical Education
  • Slide 3
  • Domains of essential Global Requirements of ME
  • What was the response to these challenges
  • New Educational Strategies
  • New Tools amp Aids
  • PBL
  • PBL
  • Advantages
  • Slide 11
  • Slide 12
  • Slide 13
  • Slide 14
  • Framework for PBL
  • Framework for PBL - II
  • Characteristics of an effective PBL Group
  • Staff Development
  • Tutorrsquos Role in Assessment
  • Slide 20
  • Evaluating PBL Tutorials-II
  • PBL
  • Slide 23
  • PBL Starting the case
  • PBL Case (contd)
  • PBL Case contd
  • The Process of PBL
  • The Process of PBL contd
  • Learn from each other
  • Determine priorities for learning
  • Slide 31
  • Slide 32
  • Learning Issues
  • Learning Issues in PBL First Session
  • PBL Second Session
  • PBL Third Session
  • Slide 37
  • Slide 38
  • During Tutorial Session students will
  • Tutorial Session contd
  • Between Tutorial Session
  • Slide 42
  • Slide 43
  • Problem-based learning is designed to develop
  • Slide 45
  • What is problem based learning
  • Slide 47
  • Slide 48
  • Slide 49
  • Rationale for using PBL
  • Slide 51
  • Slide 52
  • The group learning process acquiring desirable learning skills
  • Generic Skills amp attitudes
  • Slide 55
  • Slide 56
  • Slide 57
  • What happens in a PBL tutorial
  • Slide 59
  • Examples of trigger material for PBL scenarios
  • PBL tutorial process
  • Slide 62
  • PBL in curriculum design
  • Slide 64
  • Writing PBL scenarios
  • Slide 66
  • Staff development
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • Slide 70
  • Advantages of PBL
  • Slide 72
  • Slide 73
  • Disadvantages
  • Assessment of PBL
  • Slide 76
  • Conclusion
  • Slide 78
  • PBL 5 Easy Steps
  • 2 Brain storm
  • Brainstorm
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • THE FIRST GROUP SESSION
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
Page 61: Problem based learning

bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after

studying the scenario should be consistent with the faculty learning objectives

bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding

bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice

bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge

bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented

bull The problem should be sufficiently open so that discussion is not curtailed too early in the process

bull Scenarios should promote participation by the students in seeking information from various learning resources

bull Adapted from Dolmans et al Med Teacher 199719185-9

Staff development

bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)

A dysfunctional group a dominant character may

make it difficult for other students to be heard

A dysfunctional group a dominant character may make it difficult for other students to be heard

bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties

Advantages of PBL bull Student centred PBLIt fostersactive learning improved

understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks

Disadvantagesbull Tutors who cant teachTutorsenjoy passing on

their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful

Assessment of PBL

bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods

bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL

Conclusion

bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning

bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL

PBL 5 Easy Steps

bull Read the problem

Mrs Paula Embledon

Mrs Paula Embledon is a 78 year old woman who has come to the emergency room complaining of shortness of breath and pain in her chest She had been in relatively good health until three weeks previously when she sprained

2 Brain storm

bull Brainstorm

bull ndash hypotheses

bull - what do we know in support of the hypothesis

bull - what do we need to know to test the hypothesis

ndash learning issues

Brainstorm

bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)

ndash specific issues (for individuals to look up)

ndash overlapping issues

bull 4 Individual Reading - Research - Preparation

bull 5 Return

bull ndash review case so far ndash report and discuss

ndash assess progress - continue pagenext pagecomplete

ndash self-evaluation - How did things go Any suggestions for next time

ndash next problem

bull 5 Return

THE FIRST GROUP SESSION

bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day

bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session

bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr

bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine

bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise

bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator

bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues

bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know

bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)

bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)

bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)

  • PROBLEM BASED LEARNING
  • New Horizons in Medical Education
  • Slide 3
  • Domains of essential Global Requirements of ME
  • What was the response to these challenges
  • New Educational Strategies
  • New Tools amp Aids
  • PBL
  • PBL
  • Advantages
  • Slide 11
  • Slide 12
  • Slide 13
  • Slide 14
  • Framework for PBL
  • Framework for PBL - II
  • Characteristics of an effective PBL Group
  • Staff Development
  • Tutorrsquos Role in Assessment
  • Slide 20
  • Evaluating PBL Tutorials-II
  • PBL
  • Slide 23
  • PBL Starting the case
  • PBL Case (contd)
  • PBL Case contd
  • The Process of PBL
  • The Process of PBL contd
  • Learn from each other
  • Determine priorities for learning
  • Slide 31
  • Slide 32
  • Learning Issues
  • Learning Issues in PBL First Session
  • PBL Second Session
  • PBL Third Session
  • Slide 37
  • Slide 38
  • During Tutorial Session students will
  • Tutorial Session contd
  • Between Tutorial Session
  • Slide 42
  • Slide 43
  • Problem-based learning is designed to develop
  • Slide 45
  • What is problem based learning
  • Slide 47
  • Slide 48
  • Slide 49
  • Rationale for using PBL
  • Slide 51
  • Slide 52
  • The group learning process acquiring desirable learning skills
  • Generic Skills amp attitudes
  • Slide 55
  • Slide 56
  • Slide 57
  • What happens in a PBL tutorial
  • Slide 59
  • Examples of trigger material for PBL scenarios
  • PBL tutorial process
  • Slide 62
  • PBL in curriculum design
  • Slide 64
  • Writing PBL scenarios
  • Slide 66
  • Staff development
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • Slide 70
  • Advantages of PBL
  • Slide 72
  • Slide 73
  • Disadvantages
  • Assessment of PBL
  • Slide 76
  • Conclusion
  • Slide 78
  • PBL 5 Easy Steps
  • 2 Brain storm
  • Brainstorm
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • THE FIRST GROUP SESSION
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
Page 62: Problem based learning

Staff development

bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)

A dysfunctional group a dominant character may

make it difficult for other students to be heard

A dysfunctional group a dominant character may make it difficult for other students to be heard

bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties

Advantages of PBL bull Student centred PBLIt fostersactive learning improved

understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks

Disadvantagesbull Tutors who cant teachTutorsenjoy passing on

their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful

Assessment of PBL

bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods

bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL

Conclusion

bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning

bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL

PBL 5 Easy Steps

bull Read the problem

Mrs Paula Embledon

Mrs Paula Embledon is a 78 year old woman who has come to the emergency room complaining of shortness of breath and pain in her chest She had been in relatively good health until three weeks previously when she sprained

2 Brain storm

bull Brainstorm

bull ndash hypotheses

bull - what do we know in support of the hypothesis

bull - what do we need to know to test the hypothesis

ndash learning issues

Brainstorm

bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)

ndash specific issues (for individuals to look up)

ndash overlapping issues

bull 4 Individual Reading - Research - Preparation

bull 5 Return

bull ndash review case so far ndash report and discuss

ndash assess progress - continue pagenext pagecomplete

ndash self-evaluation - How did things go Any suggestions for next time

ndash next problem

bull 5 Return

THE FIRST GROUP SESSION

bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day

bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session

bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr

bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine

bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise

bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator

bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues

bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know

bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)

bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)

bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)

  • PROBLEM BASED LEARNING
  • New Horizons in Medical Education
  • Slide 3
  • Domains of essential Global Requirements of ME
  • What was the response to these challenges
  • New Educational Strategies
  • New Tools amp Aids
  • PBL
  • PBL
  • Advantages
  • Slide 11
  • Slide 12
  • Slide 13
  • Slide 14
  • Framework for PBL
  • Framework for PBL - II
  • Characteristics of an effective PBL Group
  • Staff Development
  • Tutorrsquos Role in Assessment
  • Slide 20
  • Evaluating PBL Tutorials-II
  • PBL
  • Slide 23
  • PBL Starting the case
  • PBL Case (contd)
  • PBL Case contd
  • The Process of PBL
  • The Process of PBL contd
  • Learn from each other
  • Determine priorities for learning
  • Slide 31
  • Slide 32
  • Learning Issues
  • Learning Issues in PBL First Session
  • PBL Second Session
  • PBL Third Session
  • Slide 37
  • Slide 38
  • During Tutorial Session students will
  • Tutorial Session contd
  • Between Tutorial Session
  • Slide 42
  • Slide 43
  • Problem-based learning is designed to develop
  • Slide 45
  • What is problem based learning
  • Slide 47
  • Slide 48
  • Slide 49
  • Rationale for using PBL
  • Slide 51
  • Slide 52
  • The group learning process acquiring desirable learning skills
  • Generic Skills amp attitudes
  • Slide 55
  • Slide 56
  • Slide 57
  • What happens in a PBL tutorial
  • Slide 59
  • Examples of trigger material for PBL scenarios
  • PBL tutorial process
  • Slide 62
  • PBL in curriculum design
  • Slide 64
  • Writing PBL scenarios
  • Slide 66
  • Staff development
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • Slide 70
  • Advantages of PBL
  • Slide 72
  • Slide 73
  • Disadvantages
  • Assessment of PBL
  • Slide 76
  • Conclusion
  • Slide 78
  • PBL 5 Easy Steps
  • 2 Brain storm
  • Brainstorm
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • THE FIRST GROUP SESSION
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
Page 63: Problem based learning

A dysfunctional group a dominant character may

make it difficult for other students to be heard

A dysfunctional group a dominant character may make it difficult for other students to be heard

bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties

Advantages of PBL bull Student centred PBLIt fostersactive learning improved

understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks

Disadvantagesbull Tutors who cant teachTutorsenjoy passing on

their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful

Assessment of PBL

bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods

bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL

Conclusion

bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning

bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL

PBL 5 Easy Steps

bull Read the problem

Mrs Paula Embledon

Mrs Paula Embledon is a 78 year old woman who has come to the emergency room complaining of shortness of breath and pain in her chest She had been in relatively good health until three weeks previously when she sprained

2 Brain storm

bull Brainstorm

bull ndash hypotheses

bull - what do we know in support of the hypothesis

bull - what do we need to know to test the hypothesis

ndash learning issues

Brainstorm

bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)

ndash specific issues (for individuals to look up)

ndash overlapping issues

bull 4 Individual Reading - Research - Preparation

bull 5 Return

bull ndash review case so far ndash report and discuss

ndash assess progress - continue pagenext pagecomplete

ndash self-evaluation - How did things go Any suggestions for next time

ndash next problem

bull 5 Return

THE FIRST GROUP SESSION

bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day

bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session

bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr

bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine

bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise

bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator

bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues

bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know

bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)

bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)

bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)

  • PROBLEM BASED LEARNING
  • New Horizons in Medical Education
  • Slide 3
  • Domains of essential Global Requirements of ME
  • What was the response to these challenges
  • New Educational Strategies
  • New Tools amp Aids
  • PBL
  • PBL
  • Advantages
  • Slide 11
  • Slide 12
  • Slide 13
  • Slide 14
  • Framework for PBL
  • Framework for PBL - II
  • Characteristics of an effective PBL Group
  • Staff Development
  • Tutorrsquos Role in Assessment
  • Slide 20
  • Evaluating PBL Tutorials-II
  • PBL
  • Slide 23
  • PBL Starting the case
  • PBL Case (contd)
  • PBL Case contd
  • The Process of PBL
  • The Process of PBL contd
  • Learn from each other
  • Determine priorities for learning
  • Slide 31
  • Slide 32
  • Learning Issues
  • Learning Issues in PBL First Session
  • PBL Second Session
  • PBL Third Session
  • Slide 37
  • Slide 38
  • During Tutorial Session students will
  • Tutorial Session contd
  • Between Tutorial Session
  • Slide 42
  • Slide 43
  • Problem-based learning is designed to develop
  • Slide 45
  • What is problem based learning
  • Slide 47
  • Slide 48
  • Slide 49
  • Rationale for using PBL
  • Slide 51
  • Slide 52
  • The group learning process acquiring desirable learning skills
  • Generic Skills amp attitudes
  • Slide 55
  • Slide 56
  • Slide 57
  • What happens in a PBL tutorial
  • Slide 59
  • Examples of trigger material for PBL scenarios
  • PBL tutorial process
  • Slide 62
  • PBL in curriculum design
  • Slide 64
  • Writing PBL scenarios
  • Slide 66
  • Staff development
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • Slide 70
  • Advantages of PBL
  • Slide 72
  • Slide 73
  • Disadvantages
  • Assessment of PBL
  • Slide 76
  • Conclusion
  • Slide 78
  • PBL 5 Easy Steps
  • 2 Brain storm
  • Brainstorm
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • THE FIRST GROUP SESSION
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
Page 64: Problem based learning

A dysfunctional group a dominant character may make it difficult for other students to be heard

bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties

Advantages of PBL bull Student centred PBLIt fostersactive learning improved

understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks

Disadvantagesbull Tutors who cant teachTutorsenjoy passing on

their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful

Assessment of PBL

bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods

bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL

Conclusion

bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning

bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL

PBL 5 Easy Steps

bull Read the problem

Mrs Paula Embledon

Mrs Paula Embledon is a 78 year old woman who has come to the emergency room complaining of shortness of breath and pain in her chest She had been in relatively good health until three weeks previously when she sprained

2 Brain storm

bull Brainstorm

bull ndash hypotheses

bull - what do we know in support of the hypothesis

bull - what do we need to know to test the hypothesis

ndash learning issues

Brainstorm

bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)

ndash specific issues (for individuals to look up)

ndash overlapping issues

bull 4 Individual Reading - Research - Preparation

bull 5 Return

bull ndash review case so far ndash report and discuss

ndash assess progress - continue pagenext pagecomplete

ndash self-evaluation - How did things go Any suggestions for next time

ndash next problem

bull 5 Return

THE FIRST GROUP SESSION

bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day

bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session

bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr

bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine

bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise

bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator

bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues

bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know

bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)

bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)

bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)

  • PROBLEM BASED LEARNING
  • New Horizons in Medical Education
  • Slide 3
  • Domains of essential Global Requirements of ME
  • What was the response to these challenges
  • New Educational Strategies
  • New Tools amp Aids
  • PBL
  • PBL
  • Advantages
  • Slide 11
  • Slide 12
  • Slide 13
  • Slide 14
  • Framework for PBL
  • Framework for PBL - II
  • Characteristics of an effective PBL Group
  • Staff Development
  • Tutorrsquos Role in Assessment
  • Slide 20
  • Evaluating PBL Tutorials-II
  • PBL
  • Slide 23
  • PBL Starting the case
  • PBL Case (contd)
  • PBL Case contd
  • The Process of PBL
  • The Process of PBL contd
  • Learn from each other
  • Determine priorities for learning
  • Slide 31
  • Slide 32
  • Learning Issues
  • Learning Issues in PBL First Session
  • PBL Second Session
  • PBL Third Session
  • Slide 37
  • Slide 38
  • During Tutorial Session students will
  • Tutorial Session contd
  • Between Tutorial Session
  • Slide 42
  • Slide 43
  • Problem-based learning is designed to develop
  • Slide 45
  • What is problem based learning
  • Slide 47
  • Slide 48
  • Slide 49
  • Rationale for using PBL
  • Slide 51
  • Slide 52
  • The group learning process acquiring desirable learning skills
  • Generic Skills amp attitudes
  • Slide 55
  • Slide 56
  • Slide 57
  • What happens in a PBL tutorial
  • Slide 59
  • Examples of trigger material for PBL scenarios
  • PBL tutorial process
  • Slide 62
  • PBL in curriculum design
  • Slide 64
  • Writing PBL scenarios
  • Slide 66
  • Staff development
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • Slide 70
  • Advantages of PBL
  • Slide 72
  • Slide 73
  • Disadvantages
  • Assessment of PBL
  • Slide 76
  • Conclusion
  • Slide 78
  • PBL 5 Easy Steps
  • 2 Brain storm
  • Brainstorm
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • THE FIRST GROUP SESSION
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
Page 65: Problem based learning

Advantages of PBL bull Student centred PBLIt fostersactive learning improved

understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks

Disadvantagesbull Tutors who cant teachTutorsenjoy passing on

their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful

Assessment of PBL

bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods

bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL

Conclusion

bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning

bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL

PBL 5 Easy Steps

bull Read the problem

Mrs Paula Embledon

Mrs Paula Embledon is a 78 year old woman who has come to the emergency room complaining of shortness of breath and pain in her chest She had been in relatively good health until three weeks previously when she sprained

2 Brain storm

bull Brainstorm

bull ndash hypotheses

bull - what do we know in support of the hypothesis

bull - what do we need to know to test the hypothesis

ndash learning issues

Brainstorm

bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)

ndash specific issues (for individuals to look up)

ndash overlapping issues

bull 4 Individual Reading - Research - Preparation

bull 5 Return

bull ndash review case so far ndash report and discuss

ndash assess progress - continue pagenext pagecomplete

ndash self-evaluation - How did things go Any suggestions for next time

ndash next problem

bull 5 Return

THE FIRST GROUP SESSION

bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day

bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session

bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr

bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine

bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise

bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator

bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues

bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know

bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)

bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)

bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)

  • PROBLEM BASED LEARNING
  • New Horizons in Medical Education
  • Slide 3
  • Domains of essential Global Requirements of ME
  • What was the response to these challenges
  • New Educational Strategies
  • New Tools amp Aids
  • PBL
  • PBL
  • Advantages
  • Slide 11
  • Slide 12
  • Slide 13
  • Slide 14
  • Framework for PBL
  • Framework for PBL - II
  • Characteristics of an effective PBL Group
  • Staff Development
  • Tutorrsquos Role in Assessment
  • Slide 20
  • Evaluating PBL Tutorials-II
  • PBL
  • Slide 23
  • PBL Starting the case
  • PBL Case (contd)
  • PBL Case contd
  • The Process of PBL
  • The Process of PBL contd
  • Learn from each other
  • Determine priorities for learning
  • Slide 31
  • Slide 32
  • Learning Issues
  • Learning Issues in PBL First Session
  • PBL Second Session
  • PBL Third Session
  • Slide 37
  • Slide 38
  • During Tutorial Session students will
  • Tutorial Session contd
  • Between Tutorial Session
  • Slide 42
  • Slide 43
  • Problem-based learning is designed to develop
  • Slide 45
  • What is problem based learning
  • Slide 47
  • Slide 48
  • Slide 49
  • Rationale for using PBL
  • Slide 51
  • Slide 52
  • The group learning process acquiring desirable learning skills
  • Generic Skills amp attitudes
  • Slide 55
  • Slide 56
  • Slide 57
  • What happens in a PBL tutorial
  • Slide 59
  • Examples of trigger material for PBL scenarios
  • PBL tutorial process
  • Slide 62
  • PBL in curriculum design
  • Slide 64
  • Writing PBL scenarios
  • Slide 66
  • Staff development
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • Slide 70
  • Advantages of PBL
  • Slide 72
  • Slide 73
  • Disadvantages
  • Assessment of PBL
  • Slide 76
  • Conclusion
  • Slide 78
  • PBL 5 Easy Steps
  • 2 Brain storm
  • Brainstorm
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • THE FIRST GROUP SESSION
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
Page 66: Problem based learning

Disadvantagesbull Tutors who cant teachTutorsenjoy passing on

their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful

Assessment of PBL

bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods

bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL

Conclusion

bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning

bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL

PBL 5 Easy Steps

bull Read the problem

Mrs Paula Embledon

Mrs Paula Embledon is a 78 year old woman who has come to the emergency room complaining of shortness of breath and pain in her chest She had been in relatively good health until three weeks previously when she sprained

2 Brain storm

bull Brainstorm

bull ndash hypotheses

bull - what do we know in support of the hypothesis

bull - what do we need to know to test the hypothesis

ndash learning issues

Brainstorm

bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)

ndash specific issues (for individuals to look up)

ndash overlapping issues

bull 4 Individual Reading - Research - Preparation

bull 5 Return

bull ndash review case so far ndash report and discuss

ndash assess progress - continue pagenext pagecomplete

ndash self-evaluation - How did things go Any suggestions for next time

ndash next problem

bull 5 Return

THE FIRST GROUP SESSION

bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day

bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session

bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr

bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine

bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise

bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator

bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues

bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know

bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)

bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)

bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)

  • PROBLEM BASED LEARNING
  • New Horizons in Medical Education
  • Slide 3
  • Domains of essential Global Requirements of ME
  • What was the response to these challenges
  • New Educational Strategies
  • New Tools amp Aids
  • PBL
  • PBL
  • Advantages
  • Slide 11
  • Slide 12
  • Slide 13
  • Slide 14
  • Framework for PBL
  • Framework for PBL - II
  • Characteristics of an effective PBL Group
  • Staff Development
  • Tutorrsquos Role in Assessment
  • Slide 20
  • Evaluating PBL Tutorials-II
  • PBL
  • Slide 23
  • PBL Starting the case
  • PBL Case (contd)
  • PBL Case contd
  • The Process of PBL
  • The Process of PBL contd
  • Learn from each other
  • Determine priorities for learning
  • Slide 31
  • Slide 32
  • Learning Issues
  • Learning Issues in PBL First Session
  • PBL Second Session
  • PBL Third Session
  • Slide 37
  • Slide 38
  • During Tutorial Session students will
  • Tutorial Session contd
  • Between Tutorial Session
  • Slide 42
  • Slide 43
  • Problem-based learning is designed to develop
  • Slide 45
  • What is problem based learning
  • Slide 47
  • Slide 48
  • Slide 49
  • Rationale for using PBL
  • Slide 51
  • Slide 52
  • The group learning process acquiring desirable learning skills
  • Generic Skills amp attitudes
  • Slide 55
  • Slide 56
  • Slide 57
  • What happens in a PBL tutorial
  • Slide 59
  • Examples of trigger material for PBL scenarios
  • PBL tutorial process
  • Slide 62
  • PBL in curriculum design
  • Slide 64
  • Writing PBL scenarios
  • Slide 66
  • Staff development
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • Slide 70
  • Advantages of PBL
  • Slide 72
  • Slide 73
  • Disadvantages
  • Assessment of PBL
  • Slide 76
  • Conclusion
  • Slide 78
  • PBL 5 Easy Steps
  • 2 Brain storm
  • Brainstorm
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • THE FIRST GROUP SESSION
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
Page 67: Problem based learning

Assessment of PBL

bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods

bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL

Conclusion

bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning

bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL

PBL 5 Easy Steps

bull Read the problem

Mrs Paula Embledon

Mrs Paula Embledon is a 78 year old woman who has come to the emergency room complaining of shortness of breath and pain in her chest She had been in relatively good health until three weeks previously when she sprained

2 Brain storm

bull Brainstorm

bull ndash hypotheses

bull - what do we know in support of the hypothesis

bull - what do we need to know to test the hypothesis

ndash learning issues

Brainstorm

bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)

ndash specific issues (for individuals to look up)

ndash overlapping issues

bull 4 Individual Reading - Research - Preparation

bull 5 Return

bull ndash review case so far ndash report and discuss

ndash assess progress - continue pagenext pagecomplete

ndash self-evaluation - How did things go Any suggestions for next time

ndash next problem

bull 5 Return

THE FIRST GROUP SESSION

bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day

bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session

bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr

bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine

bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise

bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator

bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues

bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know

bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)

bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)

bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)

  • PROBLEM BASED LEARNING
  • New Horizons in Medical Education
  • Slide 3
  • Domains of essential Global Requirements of ME
  • What was the response to these challenges
  • New Educational Strategies
  • New Tools amp Aids
  • PBL
  • PBL
  • Advantages
  • Slide 11
  • Slide 12
  • Slide 13
  • Slide 14
  • Framework for PBL
  • Framework for PBL - II
  • Characteristics of an effective PBL Group
  • Staff Development
  • Tutorrsquos Role in Assessment
  • Slide 20
  • Evaluating PBL Tutorials-II
  • PBL
  • Slide 23
  • PBL Starting the case
  • PBL Case (contd)
  • PBL Case contd
  • The Process of PBL
  • The Process of PBL contd
  • Learn from each other
  • Determine priorities for learning
  • Slide 31
  • Slide 32
  • Learning Issues
  • Learning Issues in PBL First Session
  • PBL Second Session
  • PBL Third Session
  • Slide 37
  • Slide 38
  • During Tutorial Session students will
  • Tutorial Session contd
  • Between Tutorial Session
  • Slide 42
  • Slide 43
  • Problem-based learning is designed to develop
  • Slide 45
  • What is problem based learning
  • Slide 47
  • Slide 48
  • Slide 49
  • Rationale for using PBL
  • Slide 51
  • Slide 52
  • The group learning process acquiring desirable learning skills
  • Generic Skills amp attitudes
  • Slide 55
  • Slide 56
  • Slide 57
  • What happens in a PBL tutorial
  • Slide 59
  • Examples of trigger material for PBL scenarios
  • PBL tutorial process
  • Slide 62
  • PBL in curriculum design
  • Slide 64
  • Writing PBL scenarios
  • Slide 66
  • Staff development
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • Slide 70
  • Advantages of PBL
  • Slide 72
  • Slide 73
  • Disadvantages
  • Assessment of PBL
  • Slide 76
  • Conclusion
  • Slide 78
  • PBL 5 Easy Steps
  • 2 Brain storm
  • Brainstorm
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • THE FIRST GROUP SESSION
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
Page 68: Problem based learning

bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL

Conclusion

bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning

bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL

PBL 5 Easy Steps

bull Read the problem

Mrs Paula Embledon

Mrs Paula Embledon is a 78 year old woman who has come to the emergency room complaining of shortness of breath and pain in her chest She had been in relatively good health until three weeks previously when she sprained

2 Brain storm

bull Brainstorm

bull ndash hypotheses

bull - what do we know in support of the hypothesis

bull - what do we need to know to test the hypothesis

ndash learning issues

Brainstorm

bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)

ndash specific issues (for individuals to look up)

ndash overlapping issues

bull 4 Individual Reading - Research - Preparation

bull 5 Return

bull ndash review case so far ndash report and discuss

ndash assess progress - continue pagenext pagecomplete

ndash self-evaluation - How did things go Any suggestions for next time

ndash next problem

bull 5 Return

THE FIRST GROUP SESSION

bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day

bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session

bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr

bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine

bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise

bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator

bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues

bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know

bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)

bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)

bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)

  • PROBLEM BASED LEARNING
  • New Horizons in Medical Education
  • Slide 3
  • Domains of essential Global Requirements of ME
  • What was the response to these challenges
  • New Educational Strategies
  • New Tools amp Aids
  • PBL
  • PBL
  • Advantages
  • Slide 11
  • Slide 12
  • Slide 13
  • Slide 14
  • Framework for PBL
  • Framework for PBL - II
  • Characteristics of an effective PBL Group
  • Staff Development
  • Tutorrsquos Role in Assessment
  • Slide 20
  • Evaluating PBL Tutorials-II
  • PBL
  • Slide 23
  • PBL Starting the case
  • PBL Case (contd)
  • PBL Case contd
  • The Process of PBL
  • The Process of PBL contd
  • Learn from each other
  • Determine priorities for learning
  • Slide 31
  • Slide 32
  • Learning Issues
  • Learning Issues in PBL First Session
  • PBL Second Session
  • PBL Third Session
  • Slide 37
  • Slide 38
  • During Tutorial Session students will
  • Tutorial Session contd
  • Between Tutorial Session
  • Slide 42
  • Slide 43
  • Problem-based learning is designed to develop
  • Slide 45
  • What is problem based learning
  • Slide 47
  • Slide 48
  • Slide 49
  • Rationale for using PBL
  • Slide 51
  • Slide 52
  • The group learning process acquiring desirable learning skills
  • Generic Skills amp attitudes
  • Slide 55
  • Slide 56
  • Slide 57
  • What happens in a PBL tutorial
  • Slide 59
  • Examples of trigger material for PBL scenarios
  • PBL tutorial process
  • Slide 62
  • PBL in curriculum design
  • Slide 64
  • Writing PBL scenarios
  • Slide 66
  • Staff development
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • Slide 70
  • Advantages of PBL
  • Slide 72
  • Slide 73
  • Disadvantages
  • Assessment of PBL
  • Slide 76
  • Conclusion
  • Slide 78
  • PBL 5 Easy Steps
  • 2 Brain storm
  • Brainstorm
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • THE FIRST GROUP SESSION
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
Page 69: Problem based learning

Conclusion

bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning

bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL

PBL 5 Easy Steps

bull Read the problem

Mrs Paula Embledon

Mrs Paula Embledon is a 78 year old woman who has come to the emergency room complaining of shortness of breath and pain in her chest She had been in relatively good health until three weeks previously when she sprained

2 Brain storm

bull Brainstorm

bull ndash hypotheses

bull - what do we know in support of the hypothesis

bull - what do we need to know to test the hypothesis

ndash learning issues

Brainstorm

bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)

ndash specific issues (for individuals to look up)

ndash overlapping issues

bull 4 Individual Reading - Research - Preparation

bull 5 Return

bull ndash review case so far ndash report and discuss

ndash assess progress - continue pagenext pagecomplete

ndash self-evaluation - How did things go Any suggestions for next time

ndash next problem

bull 5 Return

THE FIRST GROUP SESSION

bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day

bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session

bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr

bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine

bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise

bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator

bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues

bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know

bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)

bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)

bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)

  • PROBLEM BASED LEARNING
  • New Horizons in Medical Education
  • Slide 3
  • Domains of essential Global Requirements of ME
  • What was the response to these challenges
  • New Educational Strategies
  • New Tools amp Aids
  • PBL
  • PBL
  • Advantages
  • Slide 11
  • Slide 12
  • Slide 13
  • Slide 14
  • Framework for PBL
  • Framework for PBL - II
  • Characteristics of an effective PBL Group
  • Staff Development
  • Tutorrsquos Role in Assessment
  • Slide 20
  • Evaluating PBL Tutorials-II
  • PBL
  • Slide 23
  • PBL Starting the case
  • PBL Case (contd)
  • PBL Case contd
  • The Process of PBL
  • The Process of PBL contd
  • Learn from each other
  • Determine priorities for learning
  • Slide 31
  • Slide 32
  • Learning Issues
  • Learning Issues in PBL First Session
  • PBL Second Session
  • PBL Third Session
  • Slide 37
  • Slide 38
  • During Tutorial Session students will
  • Tutorial Session contd
  • Between Tutorial Session
  • Slide 42
  • Slide 43
  • Problem-based learning is designed to develop
  • Slide 45
  • What is problem based learning
  • Slide 47
  • Slide 48
  • Slide 49
  • Rationale for using PBL
  • Slide 51
  • Slide 52
  • The group learning process acquiring desirable learning skills
  • Generic Skills amp attitudes
  • Slide 55
  • Slide 56
  • Slide 57
  • What happens in a PBL tutorial
  • Slide 59
  • Examples of trigger material for PBL scenarios
  • PBL tutorial process
  • Slide 62
  • PBL in curriculum design
  • Slide 64
  • Writing PBL scenarios
  • Slide 66
  • Staff development
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • Slide 70
  • Advantages of PBL
  • Slide 72
  • Slide 73
  • Disadvantages
  • Assessment of PBL
  • Slide 76
  • Conclusion
  • Slide 78
  • PBL 5 Easy Steps
  • 2 Brain storm
  • Brainstorm
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • THE FIRST GROUP SESSION
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
Page 70: Problem based learning

bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL

PBL 5 Easy Steps

bull Read the problem

Mrs Paula Embledon

Mrs Paula Embledon is a 78 year old woman who has come to the emergency room complaining of shortness of breath and pain in her chest She had been in relatively good health until three weeks previously when she sprained

2 Brain storm

bull Brainstorm

bull ndash hypotheses

bull - what do we know in support of the hypothesis

bull - what do we need to know to test the hypothesis

ndash learning issues

Brainstorm

bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)

ndash specific issues (for individuals to look up)

ndash overlapping issues

bull 4 Individual Reading - Research - Preparation

bull 5 Return

bull ndash review case so far ndash report and discuss

ndash assess progress - continue pagenext pagecomplete

ndash self-evaluation - How did things go Any suggestions for next time

ndash next problem

bull 5 Return

THE FIRST GROUP SESSION

bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day

bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session

bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr

bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine

bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise

bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator

bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues

bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know

bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)

bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)

bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)

  • PROBLEM BASED LEARNING
  • New Horizons in Medical Education
  • Slide 3
  • Domains of essential Global Requirements of ME
  • What was the response to these challenges
  • New Educational Strategies
  • New Tools amp Aids
  • PBL
  • PBL
  • Advantages
  • Slide 11
  • Slide 12
  • Slide 13
  • Slide 14
  • Framework for PBL
  • Framework for PBL - II
  • Characteristics of an effective PBL Group
  • Staff Development
  • Tutorrsquos Role in Assessment
  • Slide 20
  • Evaluating PBL Tutorials-II
  • PBL
  • Slide 23
  • PBL Starting the case
  • PBL Case (contd)
  • PBL Case contd
  • The Process of PBL
  • The Process of PBL contd
  • Learn from each other
  • Determine priorities for learning
  • Slide 31
  • Slide 32
  • Learning Issues
  • Learning Issues in PBL First Session
  • PBL Second Session
  • PBL Third Session
  • Slide 37
  • Slide 38
  • During Tutorial Session students will
  • Tutorial Session contd
  • Between Tutorial Session
  • Slide 42
  • Slide 43
  • Problem-based learning is designed to develop
  • Slide 45
  • What is problem based learning
  • Slide 47
  • Slide 48
  • Slide 49
  • Rationale for using PBL
  • Slide 51
  • Slide 52
  • The group learning process acquiring desirable learning skills
  • Generic Skills amp attitudes
  • Slide 55
  • Slide 56
  • Slide 57
  • What happens in a PBL tutorial
  • Slide 59
  • Examples of trigger material for PBL scenarios
  • PBL tutorial process
  • Slide 62
  • PBL in curriculum design
  • Slide 64
  • Writing PBL scenarios
  • Slide 66
  • Staff development
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • Slide 70
  • Advantages of PBL
  • Slide 72
  • Slide 73
  • Disadvantages
  • Assessment of PBL
  • Slide 76
  • Conclusion
  • Slide 78
  • PBL 5 Easy Steps
  • 2 Brain storm
  • Brainstorm
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • THE FIRST GROUP SESSION
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
Page 71: Problem based learning

PBL 5 Easy Steps

bull Read the problem

Mrs Paula Embledon

Mrs Paula Embledon is a 78 year old woman who has come to the emergency room complaining of shortness of breath and pain in her chest She had been in relatively good health until three weeks previously when she sprained

2 Brain storm

bull Brainstorm

bull ndash hypotheses

bull - what do we know in support of the hypothesis

bull - what do we need to know to test the hypothesis

ndash learning issues

Brainstorm

bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)

ndash specific issues (for individuals to look up)

ndash overlapping issues

bull 4 Individual Reading - Research - Preparation

bull 5 Return

bull ndash review case so far ndash report and discuss

ndash assess progress - continue pagenext pagecomplete

ndash self-evaluation - How did things go Any suggestions for next time

ndash next problem

bull 5 Return

THE FIRST GROUP SESSION

bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day

bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session

bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr

bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine

bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise

bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator

bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues

bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know

bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)

bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)

bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)

  • PROBLEM BASED LEARNING
  • New Horizons in Medical Education
  • Slide 3
  • Domains of essential Global Requirements of ME
  • What was the response to these challenges
  • New Educational Strategies
  • New Tools amp Aids
  • PBL
  • PBL
  • Advantages
  • Slide 11
  • Slide 12
  • Slide 13
  • Slide 14
  • Framework for PBL
  • Framework for PBL - II
  • Characteristics of an effective PBL Group
  • Staff Development
  • Tutorrsquos Role in Assessment
  • Slide 20
  • Evaluating PBL Tutorials-II
  • PBL
  • Slide 23
  • PBL Starting the case
  • PBL Case (contd)
  • PBL Case contd
  • The Process of PBL
  • The Process of PBL contd
  • Learn from each other
  • Determine priorities for learning
  • Slide 31
  • Slide 32
  • Learning Issues
  • Learning Issues in PBL First Session
  • PBL Second Session
  • PBL Third Session
  • Slide 37
  • Slide 38
  • During Tutorial Session students will
  • Tutorial Session contd
  • Between Tutorial Session
  • Slide 42
  • Slide 43
  • Problem-based learning is designed to develop
  • Slide 45
  • What is problem based learning
  • Slide 47
  • Slide 48
  • Slide 49
  • Rationale for using PBL
  • Slide 51
  • Slide 52
  • The group learning process acquiring desirable learning skills
  • Generic Skills amp attitudes
  • Slide 55
  • Slide 56
  • Slide 57
  • What happens in a PBL tutorial
  • Slide 59
  • Examples of trigger material for PBL scenarios
  • PBL tutorial process
  • Slide 62
  • PBL in curriculum design
  • Slide 64
  • Writing PBL scenarios
  • Slide 66
  • Staff development
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • Slide 70
  • Advantages of PBL
  • Slide 72
  • Slide 73
  • Disadvantages
  • Assessment of PBL
  • Slide 76
  • Conclusion
  • Slide 78
  • PBL 5 Easy Steps
  • 2 Brain storm
  • Brainstorm
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • THE FIRST GROUP SESSION
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
Page 72: Problem based learning

2 Brain storm

bull Brainstorm

bull ndash hypotheses

bull - what do we know in support of the hypothesis

bull - what do we need to know to test the hypothesis

ndash learning issues

Brainstorm

bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)

ndash specific issues (for individuals to look up)

ndash overlapping issues

bull 4 Individual Reading - Research - Preparation

bull 5 Return

bull ndash review case so far ndash report and discuss

ndash assess progress - continue pagenext pagecomplete

ndash self-evaluation - How did things go Any suggestions for next time

ndash next problem

bull 5 Return

THE FIRST GROUP SESSION

bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day

bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session

bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr

bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine

bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise

bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator

bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues

bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know

bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)

bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)

bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)

  • PROBLEM BASED LEARNING
  • New Horizons in Medical Education
  • Slide 3
  • Domains of essential Global Requirements of ME
  • What was the response to these challenges
  • New Educational Strategies
  • New Tools amp Aids
  • PBL
  • PBL
  • Advantages
  • Slide 11
  • Slide 12
  • Slide 13
  • Slide 14
  • Framework for PBL
  • Framework for PBL - II
  • Characteristics of an effective PBL Group
  • Staff Development
  • Tutorrsquos Role in Assessment
  • Slide 20
  • Evaluating PBL Tutorials-II
  • PBL
  • Slide 23
  • PBL Starting the case
  • PBL Case (contd)
  • PBL Case contd
  • The Process of PBL
  • The Process of PBL contd
  • Learn from each other
  • Determine priorities for learning
  • Slide 31
  • Slide 32
  • Learning Issues
  • Learning Issues in PBL First Session
  • PBL Second Session
  • PBL Third Session
  • Slide 37
  • Slide 38
  • During Tutorial Session students will
  • Tutorial Session contd
  • Between Tutorial Session
  • Slide 42
  • Slide 43
  • Problem-based learning is designed to develop
  • Slide 45
  • What is problem based learning
  • Slide 47
  • Slide 48
  • Slide 49
  • Rationale for using PBL
  • Slide 51
  • Slide 52
  • The group learning process acquiring desirable learning skills
  • Generic Skills amp attitudes
  • Slide 55
  • Slide 56
  • Slide 57
  • What happens in a PBL tutorial
  • Slide 59
  • Examples of trigger material for PBL scenarios
  • PBL tutorial process
  • Slide 62
  • PBL in curriculum design
  • Slide 64
  • Writing PBL scenarios
  • Slide 66
  • Staff development
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • Slide 70
  • Advantages of PBL
  • Slide 72
  • Slide 73
  • Disadvantages
  • Assessment of PBL
  • Slide 76
  • Conclusion
  • Slide 78
  • PBL 5 Easy Steps
  • 2 Brain storm
  • Brainstorm
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • THE FIRST GROUP SESSION
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
Page 73: Problem based learning

Brainstorm

bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)

ndash specific issues (for individuals to look up)

ndash overlapping issues

bull 4 Individual Reading - Research - Preparation

bull 5 Return

bull ndash review case so far ndash report and discuss

ndash assess progress - continue pagenext pagecomplete

ndash self-evaluation - How did things go Any suggestions for next time

ndash next problem

bull 5 Return

THE FIRST GROUP SESSION

bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day

bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session

bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr

bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine

bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise

bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator

bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues

bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know

bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)

bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)

bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)

  • PROBLEM BASED LEARNING
  • New Horizons in Medical Education
  • Slide 3
  • Domains of essential Global Requirements of ME
  • What was the response to these challenges
  • New Educational Strategies
  • New Tools amp Aids
  • PBL
  • PBL
  • Advantages
  • Slide 11
  • Slide 12
  • Slide 13
  • Slide 14
  • Framework for PBL
  • Framework for PBL - II
  • Characteristics of an effective PBL Group
  • Staff Development
  • Tutorrsquos Role in Assessment
  • Slide 20
  • Evaluating PBL Tutorials-II
  • PBL
  • Slide 23
  • PBL Starting the case
  • PBL Case (contd)
  • PBL Case contd
  • The Process of PBL
  • The Process of PBL contd
  • Learn from each other
  • Determine priorities for learning
  • Slide 31
  • Slide 32
  • Learning Issues
  • Learning Issues in PBL First Session
  • PBL Second Session
  • PBL Third Session
  • Slide 37
  • Slide 38
  • During Tutorial Session students will
  • Tutorial Session contd
  • Between Tutorial Session
  • Slide 42
  • Slide 43
  • Problem-based learning is designed to develop
  • Slide 45
  • What is problem based learning
  • Slide 47
  • Slide 48
  • Slide 49
  • Rationale for using PBL
  • Slide 51
  • Slide 52
  • The group learning process acquiring desirable learning skills
  • Generic Skills amp attitudes
  • Slide 55
  • Slide 56
  • Slide 57
  • What happens in a PBL tutorial
  • Slide 59
  • Examples of trigger material for PBL scenarios
  • PBL tutorial process
  • Slide 62
  • PBL in curriculum design
  • Slide 64
  • Writing PBL scenarios
  • Slide 66
  • Staff development
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • Slide 70
  • Advantages of PBL
  • Slide 72
  • Slide 73
  • Disadvantages
  • Assessment of PBL
  • Slide 76
  • Conclusion
  • Slide 78
  • PBL 5 Easy Steps
  • 2 Brain storm
  • Brainstorm
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • THE FIRST GROUP SESSION
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
Page 74: Problem based learning

bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)

ndash specific issues (for individuals to look up)

ndash overlapping issues

bull 4 Individual Reading - Research - Preparation

bull 5 Return

bull ndash review case so far ndash report and discuss

ndash assess progress - continue pagenext pagecomplete

ndash self-evaluation - How did things go Any suggestions for next time

ndash next problem

bull 5 Return

THE FIRST GROUP SESSION

bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day

bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session

bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr

bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine

bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise

bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator

bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues

bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know

bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)

bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)

bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)

  • PROBLEM BASED LEARNING
  • New Horizons in Medical Education
  • Slide 3
  • Domains of essential Global Requirements of ME
  • What was the response to these challenges
  • New Educational Strategies
  • New Tools amp Aids
  • PBL
  • PBL
  • Advantages
  • Slide 11
  • Slide 12
  • Slide 13
  • Slide 14
  • Framework for PBL
  • Framework for PBL - II
  • Characteristics of an effective PBL Group
  • Staff Development
  • Tutorrsquos Role in Assessment
  • Slide 20
  • Evaluating PBL Tutorials-II
  • PBL
  • Slide 23
  • PBL Starting the case
  • PBL Case (contd)
  • PBL Case contd
  • The Process of PBL
  • The Process of PBL contd
  • Learn from each other
  • Determine priorities for learning
  • Slide 31
  • Slide 32
  • Learning Issues
  • Learning Issues in PBL First Session
  • PBL Second Session
  • PBL Third Session
  • Slide 37
  • Slide 38
  • During Tutorial Session students will
  • Tutorial Session contd
  • Between Tutorial Session
  • Slide 42
  • Slide 43
  • Problem-based learning is designed to develop
  • Slide 45
  • What is problem based learning
  • Slide 47
  • Slide 48
  • Slide 49
  • Rationale for using PBL
  • Slide 51
  • Slide 52
  • The group learning process acquiring desirable learning skills
  • Generic Skills amp attitudes
  • Slide 55
  • Slide 56
  • Slide 57
  • What happens in a PBL tutorial
  • Slide 59
  • Examples of trigger material for PBL scenarios
  • PBL tutorial process
  • Slide 62
  • PBL in curriculum design
  • Slide 64
  • Writing PBL scenarios
  • Slide 66
  • Staff development
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • Slide 70
  • Advantages of PBL
  • Slide 72
  • Slide 73
  • Disadvantages
  • Assessment of PBL
  • Slide 76
  • Conclusion
  • Slide 78
  • PBL 5 Easy Steps
  • 2 Brain storm
  • Brainstorm
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • THE FIRST GROUP SESSION
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
Page 75: Problem based learning

bull 4 Individual Reading - Research - Preparation

bull 5 Return

bull ndash review case so far ndash report and discuss

ndash assess progress - continue pagenext pagecomplete

ndash self-evaluation - How did things go Any suggestions for next time

ndash next problem

bull 5 Return

THE FIRST GROUP SESSION

bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day

bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session

bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr

bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine

bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise

bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator

bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues

bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know

bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)

bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)

bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)

  • PROBLEM BASED LEARNING
  • New Horizons in Medical Education
  • Slide 3
  • Domains of essential Global Requirements of ME
  • What was the response to these challenges
  • New Educational Strategies
  • New Tools amp Aids
  • PBL
  • PBL
  • Advantages
  • Slide 11
  • Slide 12
  • Slide 13
  • Slide 14
  • Framework for PBL
  • Framework for PBL - II
  • Characteristics of an effective PBL Group
  • Staff Development
  • Tutorrsquos Role in Assessment
  • Slide 20
  • Evaluating PBL Tutorials-II
  • PBL
  • Slide 23
  • PBL Starting the case
  • PBL Case (contd)
  • PBL Case contd
  • The Process of PBL
  • The Process of PBL contd
  • Learn from each other
  • Determine priorities for learning
  • Slide 31
  • Slide 32
  • Learning Issues
  • Learning Issues in PBL First Session
  • PBL Second Session
  • PBL Third Session
  • Slide 37
  • Slide 38
  • During Tutorial Session students will
  • Tutorial Session contd
  • Between Tutorial Session
  • Slide 42
  • Slide 43
  • Problem-based learning is designed to develop
  • Slide 45
  • What is problem based learning
  • Slide 47
  • Slide 48
  • Slide 49
  • Rationale for using PBL
  • Slide 51
  • Slide 52
  • The group learning process acquiring desirable learning skills
  • Generic Skills amp attitudes
  • Slide 55
  • Slide 56
  • Slide 57
  • What happens in a PBL tutorial
  • Slide 59
  • Examples of trigger material for PBL scenarios
  • PBL tutorial process
  • Slide 62
  • PBL in curriculum design
  • Slide 64
  • Writing PBL scenarios
  • Slide 66
  • Staff development
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • Slide 70
  • Advantages of PBL
  • Slide 72
  • Slide 73
  • Disadvantages
  • Assessment of PBL
  • Slide 76
  • Conclusion
  • Slide 78
  • PBL 5 Easy Steps
  • 2 Brain storm
  • Brainstorm
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • THE FIRST GROUP SESSION
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
Page 76: Problem based learning

bull 5 Return

bull ndash review case so far ndash report and discuss

ndash assess progress - continue pagenext pagecomplete

ndash self-evaluation - How did things go Any suggestions for next time

ndash next problem

bull 5 Return

THE FIRST GROUP SESSION

bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day

bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session

bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr

bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine

bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise

bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator

bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues

bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know

bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)

bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)

bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)

  • PROBLEM BASED LEARNING
  • New Horizons in Medical Education
  • Slide 3
  • Domains of essential Global Requirements of ME
  • What was the response to these challenges
  • New Educational Strategies
  • New Tools amp Aids
  • PBL
  • PBL
  • Advantages
  • Slide 11
  • Slide 12
  • Slide 13
  • Slide 14
  • Framework for PBL
  • Framework for PBL - II
  • Characteristics of an effective PBL Group
  • Staff Development
  • Tutorrsquos Role in Assessment
  • Slide 20
  • Evaluating PBL Tutorials-II
  • PBL
  • Slide 23
  • PBL Starting the case
  • PBL Case (contd)
  • PBL Case contd
  • The Process of PBL
  • The Process of PBL contd
  • Learn from each other
  • Determine priorities for learning
  • Slide 31
  • Slide 32
  • Learning Issues
  • Learning Issues in PBL First Session
  • PBL Second Session
  • PBL Third Session
  • Slide 37
  • Slide 38
  • During Tutorial Session students will
  • Tutorial Session contd
  • Between Tutorial Session
  • Slide 42
  • Slide 43
  • Problem-based learning is designed to develop
  • Slide 45
  • What is problem based learning
  • Slide 47
  • Slide 48
  • Slide 49
  • Rationale for using PBL
  • Slide 51
  • Slide 52
  • The group learning process acquiring desirable learning skills
  • Generic Skills amp attitudes
  • Slide 55
  • Slide 56
  • Slide 57
  • What happens in a PBL tutorial
  • Slide 59
  • Examples of trigger material for PBL scenarios
  • PBL tutorial process
  • Slide 62
  • PBL in curriculum design
  • Slide 64
  • Writing PBL scenarios
  • Slide 66
  • Staff development
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • Slide 70
  • Advantages of PBL
  • Slide 72
  • Slide 73
  • Disadvantages
  • Assessment of PBL
  • Slide 76
  • Conclusion
  • Slide 78
  • PBL 5 Easy Steps
  • 2 Brain storm
  • Brainstorm
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • THE FIRST GROUP SESSION
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
Page 77: Problem based learning

bull 5 Return

THE FIRST GROUP SESSION

bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day

bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session

bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr

bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine

bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise

bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator

bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues

bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know

bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)

bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)

bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)

  • PROBLEM BASED LEARNING
  • New Horizons in Medical Education
  • Slide 3
  • Domains of essential Global Requirements of ME
  • What was the response to these challenges
  • New Educational Strategies
  • New Tools amp Aids
  • PBL
  • PBL
  • Advantages
  • Slide 11
  • Slide 12
  • Slide 13
  • Slide 14
  • Framework for PBL
  • Framework for PBL - II
  • Characteristics of an effective PBL Group
  • Staff Development
  • Tutorrsquos Role in Assessment
  • Slide 20
  • Evaluating PBL Tutorials-II
  • PBL
  • Slide 23
  • PBL Starting the case
  • PBL Case (contd)
  • PBL Case contd
  • The Process of PBL
  • The Process of PBL contd
  • Learn from each other
  • Determine priorities for learning
  • Slide 31
  • Slide 32
  • Learning Issues
  • Learning Issues in PBL First Session
  • PBL Second Session
  • PBL Third Session
  • Slide 37
  • Slide 38
  • During Tutorial Session students will
  • Tutorial Session contd
  • Between Tutorial Session
  • Slide 42
  • Slide 43
  • Problem-based learning is designed to develop
  • Slide 45
  • What is problem based learning
  • Slide 47
  • Slide 48
  • Slide 49
  • Rationale for using PBL
  • Slide 51
  • Slide 52
  • The group learning process acquiring desirable learning skills
  • Generic Skills amp attitudes
  • Slide 55
  • Slide 56
  • Slide 57
  • What happens in a PBL tutorial
  • Slide 59
  • Examples of trigger material for PBL scenarios
  • PBL tutorial process
  • Slide 62
  • PBL in curriculum design
  • Slide 64
  • Writing PBL scenarios
  • Slide 66
  • Staff development
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • Slide 70
  • Advantages of PBL
  • Slide 72
  • Slide 73
  • Disadvantages
  • Assessment of PBL
  • Slide 76
  • Conclusion
  • Slide 78
  • PBL 5 Easy Steps
  • 2 Brain storm
  • Brainstorm
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • THE FIRST GROUP SESSION
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
Page 78: Problem based learning

THE FIRST GROUP SESSION

bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day

bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session

bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr

bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine

bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise

bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator

bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues

bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know

bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)

bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)

bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)

  • PROBLEM BASED LEARNING
  • New Horizons in Medical Education
  • Slide 3
  • Domains of essential Global Requirements of ME
  • What was the response to these challenges
  • New Educational Strategies
  • New Tools amp Aids
  • PBL
  • PBL
  • Advantages
  • Slide 11
  • Slide 12
  • Slide 13
  • Slide 14
  • Framework for PBL
  • Framework for PBL - II
  • Characteristics of an effective PBL Group
  • Staff Development
  • Tutorrsquos Role in Assessment
  • Slide 20
  • Evaluating PBL Tutorials-II
  • PBL
  • Slide 23
  • PBL Starting the case
  • PBL Case (contd)
  • PBL Case contd
  • The Process of PBL
  • The Process of PBL contd
  • Learn from each other
  • Determine priorities for learning
  • Slide 31
  • Slide 32
  • Learning Issues
  • Learning Issues in PBL First Session
  • PBL Second Session
  • PBL Third Session
  • Slide 37
  • Slide 38
  • During Tutorial Session students will
  • Tutorial Session contd
  • Between Tutorial Session
  • Slide 42
  • Slide 43
  • Problem-based learning is designed to develop
  • Slide 45
  • What is problem based learning
  • Slide 47
  • Slide 48
  • Slide 49
  • Rationale for using PBL
  • Slide 51
  • Slide 52
  • The group learning process acquiring desirable learning skills
  • Generic Skills amp attitudes
  • Slide 55
  • Slide 56
  • Slide 57
  • What happens in a PBL tutorial
  • Slide 59
  • Examples of trigger material for PBL scenarios
  • PBL tutorial process
  • Slide 62
  • PBL in curriculum design
  • Slide 64
  • Writing PBL scenarios
  • Slide 66
  • Staff development
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • Slide 70
  • Advantages of PBL
  • Slide 72
  • Slide 73
  • Disadvantages
  • Assessment of PBL
  • Slide 76
  • Conclusion
  • Slide 78
  • PBL 5 Easy Steps
  • 2 Brain storm
  • Brainstorm
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • THE FIRST GROUP SESSION
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
Page 79: Problem based learning

bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine

bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise

bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator

bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues

bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know

bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)

bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)

bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)

  • PROBLEM BASED LEARNING
  • New Horizons in Medical Education
  • Slide 3
  • Domains of essential Global Requirements of ME
  • What was the response to these challenges
  • New Educational Strategies
  • New Tools amp Aids
  • PBL
  • PBL
  • Advantages
  • Slide 11
  • Slide 12
  • Slide 13
  • Slide 14
  • Framework for PBL
  • Framework for PBL - II
  • Characteristics of an effective PBL Group
  • Staff Development
  • Tutorrsquos Role in Assessment
  • Slide 20
  • Evaluating PBL Tutorials-II
  • PBL
  • Slide 23
  • PBL Starting the case
  • PBL Case (contd)
  • PBL Case contd
  • The Process of PBL
  • The Process of PBL contd
  • Learn from each other
  • Determine priorities for learning
  • Slide 31
  • Slide 32
  • Learning Issues
  • Learning Issues in PBL First Session
  • PBL Second Session
  • PBL Third Session
  • Slide 37
  • Slide 38
  • During Tutorial Session students will
  • Tutorial Session contd
  • Between Tutorial Session
  • Slide 42
  • Slide 43
  • Problem-based learning is designed to develop
  • Slide 45
  • What is problem based learning
  • Slide 47
  • Slide 48
  • Slide 49
  • Rationale for using PBL
  • Slide 51
  • Slide 52
  • The group learning process acquiring desirable learning skills
  • Generic Skills amp attitudes
  • Slide 55
  • Slide 56
  • Slide 57
  • What happens in a PBL tutorial
  • Slide 59
  • Examples of trigger material for PBL scenarios
  • PBL tutorial process
  • Slide 62
  • PBL in curriculum design
  • Slide 64
  • Writing PBL scenarios
  • Slide 66
  • Staff development
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • Slide 70
  • Advantages of PBL
  • Slide 72
  • Slide 73
  • Disadvantages
  • Assessment of PBL
  • Slide 76
  • Conclusion
  • Slide 78
  • PBL 5 Easy Steps
  • 2 Brain storm
  • Brainstorm
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • THE FIRST GROUP SESSION
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
Page 80: Problem based learning

bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues

bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know

bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)

bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)

bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)

  • PROBLEM BASED LEARNING
  • New Horizons in Medical Education
  • Slide 3
  • Domains of essential Global Requirements of ME
  • What was the response to these challenges
  • New Educational Strategies
  • New Tools amp Aids
  • PBL
  • PBL
  • Advantages
  • Slide 11
  • Slide 12
  • Slide 13
  • Slide 14
  • Framework for PBL
  • Framework for PBL - II
  • Characteristics of an effective PBL Group
  • Staff Development
  • Tutorrsquos Role in Assessment
  • Slide 20
  • Evaluating PBL Tutorials-II
  • PBL
  • Slide 23
  • PBL Starting the case
  • PBL Case (contd)
  • PBL Case contd
  • The Process of PBL
  • The Process of PBL contd
  • Learn from each other
  • Determine priorities for learning
  • Slide 31
  • Slide 32
  • Learning Issues
  • Learning Issues in PBL First Session
  • PBL Second Session
  • PBL Third Session
  • Slide 37
  • Slide 38
  • During Tutorial Session students will
  • Tutorial Session contd
  • Between Tutorial Session
  • Slide 42
  • Slide 43
  • Problem-based learning is designed to develop
  • Slide 45
  • What is problem based learning
  • Slide 47
  • Slide 48
  • Slide 49
  • Rationale for using PBL
  • Slide 51
  • Slide 52
  • The group learning process acquiring desirable learning skills
  • Generic Skills amp attitudes
  • Slide 55
  • Slide 56
  • Slide 57
  • What happens in a PBL tutorial
  • Slide 59
  • Examples of trigger material for PBL scenarios
  • PBL tutorial process
  • Slide 62
  • PBL in curriculum design
  • Slide 64
  • Writing PBL scenarios
  • Slide 66
  • Staff development
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • Slide 70
  • Advantages of PBL
  • Slide 72
  • Slide 73
  • Disadvantages
  • Assessment of PBL
  • Slide 76
  • Conclusion
  • Slide 78
  • PBL 5 Easy Steps
  • 2 Brain storm
  • Brainstorm
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • THE FIRST GROUP SESSION
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
Page 81: Problem based learning

bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by

bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know

bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)

bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)

bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)

  • PROBLEM BASED LEARNING
  • New Horizons in Medical Education
  • Slide 3
  • Domains of essential Global Requirements of ME
  • What was the response to these challenges
  • New Educational Strategies
  • New Tools amp Aids
  • PBL
  • PBL
  • Advantages
  • Slide 11
  • Slide 12
  • Slide 13
  • Slide 14
  • Framework for PBL
  • Framework for PBL - II
  • Characteristics of an effective PBL Group
  • Staff Development
  • Tutorrsquos Role in Assessment
  • Slide 20
  • Evaluating PBL Tutorials-II
  • PBL
  • Slide 23
  • PBL Starting the case
  • PBL Case (contd)
  • PBL Case contd
  • The Process of PBL
  • The Process of PBL contd
  • Learn from each other
  • Determine priorities for learning
  • Slide 31
  • Slide 32
  • Learning Issues
  • Learning Issues in PBL First Session
  • PBL Second Session
  • PBL Third Session
  • Slide 37
  • Slide 38
  • During Tutorial Session students will
  • Tutorial Session contd
  • Between Tutorial Session
  • Slide 42
  • Slide 43
  • Problem-based learning is designed to develop
  • Slide 45
  • What is problem based learning
  • Slide 47
  • Slide 48
  • Slide 49
  • Rationale for using PBL
  • Slide 51
  • Slide 52
  • The group learning process acquiring desirable learning skills
  • Generic Skills amp attitudes
  • Slide 55
  • Slide 56
  • Slide 57
  • What happens in a PBL tutorial
  • Slide 59
  • Examples of trigger material for PBL scenarios
  • PBL tutorial process
  • Slide 62
  • PBL in curriculum design
  • Slide 64
  • Writing PBL scenarios
  • Slide 66
  • Staff development
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • Slide 70
  • Advantages of PBL
  • Slide 72
  • Slide 73
  • Disadvantages
  • Assessment of PBL
  • Slide 76
  • Conclusion
  • Slide 78
  • PBL 5 Easy Steps
  • 2 Brain storm
  • Brainstorm
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • THE FIRST GROUP SESSION
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90
Page 82: Problem based learning
  • PROBLEM BASED LEARNING
  • New Horizons in Medical Education
  • Slide 3
  • Domains of essential Global Requirements of ME
  • What was the response to these challenges
  • New Educational Strategies
  • New Tools amp Aids
  • PBL
  • PBL
  • Advantages
  • Slide 11
  • Slide 12
  • Slide 13
  • Slide 14
  • Framework for PBL
  • Framework for PBL - II
  • Characteristics of an effective PBL Group
  • Staff Development
  • Tutorrsquos Role in Assessment
  • Slide 20
  • Evaluating PBL Tutorials-II
  • PBL
  • Slide 23
  • PBL Starting the case
  • PBL Case (contd)
  • PBL Case contd
  • The Process of PBL
  • The Process of PBL contd
  • Learn from each other
  • Determine priorities for learning
  • Slide 31
  • Slide 32
  • Learning Issues
  • Learning Issues in PBL First Session
  • PBL Second Session
  • PBL Third Session
  • Slide 37
  • Slide 38
  • During Tutorial Session students will
  • Tutorial Session contd
  • Between Tutorial Session
  • Slide 42
  • Slide 43
  • Problem-based learning is designed to develop
  • Slide 45
  • What is problem based learning
  • Slide 47
  • Slide 48
  • Slide 49
  • Rationale for using PBL
  • Slide 51
  • Slide 52
  • The group learning process acquiring desirable learning skills
  • Generic Skills amp attitudes
  • Slide 55
  • Slide 56
  • Slide 57
  • What happens in a PBL tutorial
  • Slide 59
  • Examples of trigger material for PBL scenarios
  • PBL tutorial process
  • Slide 62
  • PBL in curriculum design
  • Slide 64
  • Writing PBL scenarios
  • Slide 66
  • Staff development
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • A dysfunctional group a dominant character may make it difficult for other students to be heard
  • Slide 70
  • Advantages of PBL
  • Slide 72
  • Slide 73
  • Disadvantages
  • Assessment of PBL
  • Slide 76
  • Conclusion
  • Slide 78
  • PBL 5 Easy Steps
  • 2 Brain storm
  • Brainstorm
  • Slide 82
  • Slide 83
  • Slide 84
  • Slide 85
  • THE FIRST GROUP SESSION
  • Slide 87
  • Slide 88
  • Slide 89
  • Slide 90

PROBLEM BASED LEARNING DAN INQUIRY BASED LEARNING

PROBLEM BASED LEARNING DAN INQUIRY BASED LEARNING

Mathematics Learning Tools Development Based on Problem ... filedeveloped RPP and LKPD based Problem Based Learning (PBL) to ... Keywords—Problem Based Learning, Problem Solving

Mathematics Learning Tools Development Based on Problem ... filedeveloped RPP and LKPD based Problem Based Learning (PBL) to ... Keywords—Problem Based Learning, Problem Solving

Problem Based Learning

Problem Based Learning

Problem-Based Learning. Done Right. Finally.toolboxforteachers.s3.amazonaws.com/PBL-Books/PBL-Books_sample... · “Problem-Based Learning” Problem-Based Learning is an instructional

Problem-Based Learning. Done Right. Finally.toolboxforteachers.s3.amazonaws.com/PBL-Books/PBL-Books_sample... · “Problem-Based Learning” Problem-Based Learning is an instructional

Problem-based Learning

Problem-based Learning

Problem Based Learning

Problem Based Learning