Problemistics in-medical-education
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Transcript of Problemistics in-medical-education
Problemistics and
Problem-Centred Health Professional Education
Prof KR Sethuraman. MD, PGDHE
Email: [email protected]
Overview• What is Problem Centred Learning (PCL)• Why PCL? • Types of PCL: PBL versus PSE• Challenges of implementing PBL• Problem-Knowledge coupling (PKC) for finding
holistic solutions to patient problems• Problemistics – the science of Problem dealing• Spectrum of PBL / PSE
POME 3
T: “Tell me 10 causes of Anemia”S: “I know 50 Sir!
Shall I tell all of them?”
Memorize and Recite!
POME 4
T: How will you treat a pregnant woman with anemia for Rs.30 per month?S: Hmm…Errr…
Bowled by a simple Problem!
5
COGNITIVE
“Tomorrow’s Doctors” 1993 & 2009 - http://www.gmc-uk.org/education/undergraduate/tomorrows_doctors_2009.asp
Hybrid CurriculaHybrid CurriculaThe The S P I C E S S P I C E S modelmodel
SStudent-centred ..……………...…….Teacher-centredtudent-centred ..……………...…….Teacher-centred
PProblem-based ……………...……Passive acquisitionroblem-based ……………...……Passive acquisition
IIntegrated ………...…………...……Discipline-basedntegrated ………...…………...……Discipline-based
CCommunity……..……………...……..Hospital-basedommunity……..……………...……..Hospital-based
EElectives ……………...………...…….Standardizedlectives ……………...………...…….Standardized
SSystematic...……………….....……….Opportunisticystematic...……………….....……….Opportunistic
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HardenHarden
| | = Where We Are
What is Problem-Centred Learning?• Essential principles of PCL The problem, – activates prior learning – resembles real life cases – facilitates transfer of learning to other problems
• Solving the problem involves – elaboration of knowledge via group-discussion and – reflection to consolidate learning experiences.
• Includes problem-solving exercise (PSE) and problem-based learning (PBL)
Why Problem-Centred Learning?
• Solving authentic problems matches 21st Century skills
• What are 21st C Skills?
21st Century Education• Learning ‘to be’
– not ‘learn about’• Learn by doing
– not just listening• Learning how to learn
– Generation Y (web-2.0 gen) is – participatory – cooperative & adapted for – constructivist learning
Goals for Problem-Centred Learning
• Structure knowledge for practice
• Develop clinical reasoning
• Develop self-directed learning
• Increase motivation
• Problem-centred learning predates 21st century skills but is more relevant now
PCL Types: PSE & PBLPCL Types: PSE & PBL- - Different but RelatedDifferent but Related - -
Problem-solvingProblem-solving - arriving at - arriving at solutions based on solutions based on prior prior knowledge and reasoningknowledge and reasoning
Problem-based learningProblem-based learning - the - the process of acquiring process of acquiring newnew knowledge based on knowledge based on recognition of a need to learnrecognition of a need to learn
POME 12
T: How will you treat a pregnant woman with anemia for Rs.30 per month?
Teach & Solve = PSE
Learn by Solving = PBL
PBL & PCL begin with a problem
–Group analysis of what needs to be known
– Individual research
– Developing a solution
– Reflection on process & learning
Characteristics of PBL1. Starting point is a problem
2. Authentic for professionals
3. Knowledge organised around problems
4. Students have responsibility for learning
5. Most learning in small groups, not lectures
6. Andragogy (adult learning) - Not pedagogy
The Relative Proportion of PSE toThe Relative Proportion of PSE to PBL PBL Changes with Curriculum ProgressChanges with Curriculum Progress
Time in the curriculum Time in the curriculum
Problem Problem solvingsolving
Problem-based Problem-based learninglearning
Mostly
Known !
Mostly New !
How “pure” must PBL be?
– Barrows proposed a taxonomy
– Spectrum of methods Achieving objectives by degrees
PBL PCL
Six methods in the spectrum
Barrows’ taxonomy of PBL methodsSCC CRP SDL MOT
Lecture-based cases 1 1 0 1
Case-based lectures 2 2 0 2
Case method 3 3 3 4
Modified case-based 4 3 3 5
Problem-based 4 4 4 5
Closed-loop problem-based 5 5 5 5
Complete case or case vignette
Partial problem simulation
Full problem simulation (free inquiry)
Teacher-directed learning
Student-directed learning
Partially student & teacher directed
Abbreviations:CRP - Clinical Reasoning ProcessSCC - Student Centered CurriculumSDL – Self Directed LearningMOT – Motivation to Learn
Fidelity in PBL - i
• Presentation format: – simulated patient (high fidelity) to – "case write up"(low fidelity).
• Manifestation: – ill structured with a range of possibilities (high
fidelity) to – a "text-book case" (low fidelity & 'bookish').
Fidelity in PBL - ii• Signal-Noise Ratio
– “noise” (associated problems) overlaying the “signal” (main problem) = high fidelity
– pure filtered one-dimensional problem = low fidelity
• Context: – permit real-life situations, eg., talk with family
members of the patient (high fidelity)– more contrived (low fidelity).
Fidelity in PBL - iii• Objectives:
– patient-centred and integrated across disciplines (high fidelity)
– only disease-focussed, discrete and piece-meal (low fidelity and artificial)
• Low-fidelity problems borrowed from textbooks are counterproductive in terms of the Goals of PBL. – Jayawickramarajah. Problems for Problem-Based Learning: a
comparative study of documents. Medical Education, 1996;30:272-282
Effectiveness of PBL Curricula:Research and Theory
• “No convincing evidence that PBL improves knowledge base and clinical performance, – at least not of the magnitude that
would be expected given the resources required for a PBL curriculum.”
• Jerry A. Colliver, Acad. Med. 2000;75:259–266.
POME 23
Individualising Solutions
"Give me ‘standard patients’ and I'll practice standard medicine." --James S. Todd, MD. AMA Executive Vice President, 1990-1996
POME 24
Problem Knowledge Coupling
POME 25
What is Problemistics ?
• It is the science of dealing with problems
• It is an activity aimed at - – the resolution of a Problem &
– the development of Well-Being
POME 26
Problemistics – contd…
• It is concerned with -
Problem Framing – Context Problem Finding – Holistic approachProblem Solving – Appropriate
resolutionProblem Acting - Systematic action
*
POME 27
Spheres of Problem Experience • Bio-sphere - nature and
environment (e.g., infections)
• Socio-sphere - individuals & groups (e.g., phobic neurosis)
• Techno-sphere - tools and artifacts (e.g., implant malfunction iatrogenesis etc)
POME 28
Problem Dealer (Professional in Making) • Cultivate following characteristics –
– Dimensions - cognition, emotion & volition
– Qualities - thrill, skill, will • Thrill - emotive ( enthusiastic )• Skill - cognitive ( mindful & critical *)
• Will - volitional ( proactive )
Range of Problem-Centred Education
DURATION = DURATION = SEMESTER(S)SEMESTER(S)
Example -Example -
FULL TIME P B L orFULL TIME P B L or
HYBRID CURRICULUMHYBRID CURRICULUM
DURATION = DURATION =
Hours to DaysHours to Days
Example -Example -
Integrated Modules Integrated Modules
Orientation WorkshopsOrientation Workshops
DURATION = DURATION =
1 – 3 hours1 – 3 hours
Example -Example -
Problem Solving Problem Solving ExercisesExercises
Simulation GamesSimulation Games
DURATION = DURATION =
3 to 10 minutes3 to 10 minutes
Example -Example -
Buzz SessionBuzz Session
Simulated Initial Simulated Initial ManagementManagement
We must make our Graduates
• Think critically and be able to solve complex, real-world problems
• Find, evaluate, and use appropriate learning resources
• Work cooperatively in teams and small groups• Demonstrate versatile and effective communication
skills, both verbal and written • Become life-long learners to update their
knowledge and skills acquired at the university
Can We Do it ?
We can !If we have the self belief and motivation like this modeler, who shapes “mere Clay” in to “Desirable objects”
POME 36
THANK YOU All !
(visit www.problemistics.org andwww.pkc.org for more information)
The Handout has more details on PKC & Problemistics