Problem-based learning

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Problem-based learning

• Dr. Kieran Walsh,
• Editor,
• BMJ Learning.

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Problem-based learning

• Still a hot topic
• Much debate
• Become widespread

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Problem-based learning what is it

• Learning in context of a problem
• Student-driven
• Student generates issues, finds answers, shares
  answers
• Active learning
• Group process
• Facilitated gt taught

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Problem-based learning why?

• Help the student
• Acquire necessary knowledge and skills
• Learn how to apply this
• Become a life long learner

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Problem-based learning what is it

• The curriculum
• Worked example

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Problem-based learning Session 1

• 40 year old man with jaundice. Took 40
• paracetamol tablets 72 hours ago. History of
• asthma. Says he wants to die. Doesnt want
• any treatment.
• How will you deal with the issues that he
• presents?

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Problem-based learning Session 1

• Talk through scenario, understand it, decide on
  the problems
• Define/analyse the problems
• Brainstorming
• Prioritise the problems, restructure
• Decide on learning objectives
• Every member has a task private study

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Problem-based learning Session 2

• Feedback on what they have discovered
• Everyone contributes
• Reflection

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Problem-based learning what is a good problem?

• Realistic, common, important
• Sufficiently open
• Complexity a number of components
• Maybe a problem that actually happened and that
  was poorly managed

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Problem-based learning what is a good trigger?

• Clinical scenarios on paper
• Laboratory data
• Photograph
• Video
• Real/simulated patient

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Problem-based learning - benefits

• Natural
• Motivational
• Learn applied knowledge
• Encourages preparation and homework
• Team based
• Searching skills
• Critical thinking and clinical reasoning
• Close, more equal student-faculty relationship
• Enjoyable
• Presentational skills

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PBL the problems with PBL

• Cost
• Time
• Workload
• Tutor quality
• Unscheduled time
• Students with no supervision .. The tutor
  takes over
• One faculty member for each group of students!

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PBL the problems with PBL

• One of the hardest things about running a
• problem-based learning curriculum is making
• sure that what is happening is actually PBL.
• David Taylor
• Problem based learning is successful only if the
  scenarios
• are of high quality.
• Diana Wood

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PBL the problem with tutors

• Need a facilitator gt tutor
• Problem first gt subject first
• Encouragement, guidance
• Dont solve the problem, dont even hint at the
  solution, dont even even tell them the problem
• Not necessarily a subject expert
• It wasnt like this in my day
• Hospital super-specialists can feel uncomfortable
  
• These are all difficult concepts for traditional
  medical teachers

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PBL the problem with students

• Products of didactic secondary schools
• Lost
• Not consulted in curriculum change
• Teach yourself medicine
• Gaps in knowledge
• Whilst medical educators wish to develop
  critical thinkers and life-
• long learners, the early years of PBL cause much
  anxiety amongst
• young learners, many who enter directly from
  school.
• Michelle McLean

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PBL the problem with cost

• Cost depends on
• Group size (6-8)
• Number of groups
• Number of hours of facilitation per week

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PBL the problem with studies of its
effectiveness

• What does effective mean?
• Is what is being studied actually PBL?
• Confounding
• What outcomes are we looking at?
• Good evidence for enjoyment and enthusiasm
• Apart from that PBL graduates are
  indistinguishable from their traditional
  counterparts

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PBL the problem with studies of its
effectiveness

• Most attempts at longitudinal, controlled
• intervention studies in PBL have been
• overtaken by events.
• Brian Jolly
• Deciding whether problem based learning
• produces better doctors requires, at least,
• clear consensus on what constitutes a better
• doctor.
• Lambert Schuwirth and Peter Cantillon

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Problem-based learning - assessment

• Assessment drives learning Miller
• If just factual recall, little motivation for PBL
• Assessment should be blueprinted to the learning
  outcomes

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PBL strategies to introduce

• Preclinical clinical OR not
• Established school/new school
• Introduce PBL year by year or all at once
• Introduce PBL dept by dept or all at once
• Change management

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Problem-based learning mixing it with other
methods

• Simulation/simulated patients
• Interprofessional education should the group
  include nurses/AHPs?
• E-learning

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Problem-based learning

• Doesnt suit everything
• E.g. learning resuscitation skills

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Problem-based learning last word?

• PBL should be regarded as a tool, a means,
• and not as an end.
• Shimon Glick

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Problem-based learning - references

• Donner RS, Bickley H. Problem-based learning in
  American medical education an
• overview. Bull Med Libr Assoc. 1993
  Jul81(3)294-8.
• Wood DF. Problem based learning. BMJ. 2003 Feb
  8326(7384)328-30.
• Kilroy DA. Problem based learning. Emerg Med J.
  2004 Jul21(4)411-3.
• Walton HJ, Matthews MB. Essentials of
  problem-based learning. Med Educ. 1989
• Nov23(6)542-58.
• Mellon AF, Mellon J. Logical debate on problem
  based learning. BMJ. 2006 Mar
• 4332(7540)550-1.
• Wood DF. Problem based learning. BMJ. 2008 May
  3336(7651)971.