ProblemBased Learning Student Workshop

1
Problem-Based LearningStudent Workshop
Hugh Pross MD,PhD,FRCPC Professor
EmeritusQueens University School of Medicine,
Kingston, Canada Associate Dean, Undergraduate
Medical Education (1990-1996)Coordinator,
Problem-Based Learning (1993-2003) prossh_at_queensu.
ca
http//meds.queensu.ca/pbl/
http//meds.queensu.ca/pbl/
2
A Note of Caution
These slides are intended for academic,
non-commercial use, with permission and
appropriate acknowledgement. They represent a
collection of slides useful for several different
workshops and seminars student workshops, tutor
training, case-writing, etc. Hugh Pross
ltprossh_at_queensu.cagt
3
Objectives of the Seminar
At the end of this session you will be able to
describe/define

• The characteristics objectives of PBL
• The role of PBL in Queens hybrid curriculum
• The process of problem-based learning
• How learning issues can be generated from a
  clinical scenario

4
Introducing PBL to Students and Tutors- the
overall process -
Several components

• Everyone is expected to have read the
  handbook or PBL web page

• Participation in the workshop
• Ongoing process evaluation as part of the PBL
  group function
• Review of the process with new group members
  at the start of each unit

5
The PBL web page Useful stuff for PBL students

• Comprehensive, updated handbook
• Current PBL program information
• Links to Queens Web resources
• Links to searchable MEDLINE sites
• Opportunity for input, self- assessment

6
The PBL web page Useful stuff for PBL tutors

• Comprehensive, updated handbook
• Links to other schools using PBL
• Links to PBL literature databases
• Viewable, downloadable PowerPoint presentation
  on PBL

7
PBL - what is it?
8
What is problem-based learning?

• A learning method based on the principle of
  using problems as a starting point for the
  acquisition and integration of new knowledge.
• H.S. Barrows 1982

9
Problem-solving vs problem-based learning-
different but inter-related -

• Problem-solving - arriving at decisions based on
  prior knowledge and reasoning
• Problem-based learning - the process of acquiring
  new knowledge based on recognition of a need to
  learn.

10
The Relative Proportion of Problem-Solving to
Problem-Based Learning Changes as the Curriculum
Progresses
Branda
11
Objectives of the PBL process
To develop
Knowledge - basic and clinical content in
context Skills - scientific reasoning, critical
appraisal, information literacy, the skills of
self-directed, life-long learning Attitudes -
value of teamwork, inter-personal skills, and
psychosocial issues
12
Curriculum change - Why?

• Too much information - too little time
• The need to foster the skills for self-directed
  life-long learning

13
Hybrid CurriculaThe SPICES model

• Student-centred ......Teacher-centred
• Problem-based .....Passive acquis.
• Integrated ......Discipline-based
• Community.......Hospital-based
• Electives .......Standardized
• Systematic.........Opportunistic

Q Q Q
Q Q Q
Q Queens
Harden
14
New curriculum - systems-based and integrated
(1991, revised 1997)
E V A L
Intro Basic Sci. Clin Skills, MIS.
Yr 1 Yr 2 Yr 3 Yr 4
Micro/Imm, Inf.Dse MSK, Derm, Hem/onc
E V A L
PBL
Neurosci, Psych, ENT, Ophth
G-U, Resp, Cardiovasc
Critical Enquiry
E V A L
E V A L
PBL
PBL
Repro,Endocrine, GI/Metab. (A.M.) Clin Skills
(P.M.)
- Clerkship
E V A L
PBL
- Clerkship -
LMCC
15
PBL and Medicine in Society- integrated with the
various systems -
Information Literacy Ethics Law Psycho-social
Aspects of Medicine History of Medicine Growth
and Development Community Health and Epidemiology
16
PBL - an iterative process
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.....
A new bridge has been constructed spanning a
river 1 kilometer wide. In a recent storm, during
which winds gusted to 120 km/hr, the bridge was
observed to be oscillating from side to side ..
You are the owner of a small antique shop in
Kingston. Mrs. Jones, an old friend, has brought
to you for appraisal a landscape painting which
appears to be about 200 years old. She is
convinced there is another painting beneath the
landscape..
You are a researcher in a cellular immunology
lab. You have been given two blood samples one
of which contains anti-coagulant. An aliquot of
the latter sample can be shown to lyse tumour
cells. You conduct further studies to determine
the mechanism of the killing
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.....

• Read the problem

EVALUATE
17
Characteristics of the PBL process

• Usually based on clinical cases
• Students come in cold to the first
  tutorial
• Students determine the learning issues
• Sessions are open-ended to allow learning in
  the interval
• The tutor is a facilitator - not necessarily an
  expert, except in the process

18
A Typical Case

• Opening Scenario
• History of present illness
• Past history, family history, social context
• Physical examination
• Investigations
• Management
• Sequellae

Each step may lead back to a previous step, as
well as leading to the next step
19
Characteristics of PBL Cases

• Relevant, realistic, logical
• Not too complex

• Cases are characterized by progressive
  disclosure
• - story unfolds, step-by-step
• - introduce unanticipated issues
• - narrative provokes discussion leading to
  next step

20
Progressive Disclosure

• May involve cue statements
• You ask a few more questions
• You order some investigations...
• She says her sister died young...

21
Characteristics of PBL Cases (2)
Hold for seminars on case-writing

• Enough issues for in-depth study between
  sessions
• Not too many distractors or red herrings
• Avoid overlap with other sessions
• Try to introduce unanticipated issues in second
  session
• Confine third session to discussion and wrap-up
  - no new issues

22
-Session Breaks At the end of the first and
second sessions

• Leave students with enough to work on - issues
  essential for all - individual issues
• Reading between sessions should lead naturally
  to the next page - e.g., leading to a
  differential diagnosis while the next session
  presents new data

23
PBL cases are open-ended and the process is
iterative
Intro, Review Process
Case 1
Case 1
Case 2
Case 2
2-3 Hr.
Case 2
Case 1
Case 2
Case 3
Case 1
Wk1
Wk2
Wk3
Wk4
Wk5
2 weeks
2 weeks
Most programs schedule 1 case over 3 sessions,
one or two sessions a week Some do 2-3 sessions a
week - Case of the Week
24
Tutor
Traditional Tutorial
Students
25
Tutor
PBL Tutorial
Students
26
Tutorial Part 1 Introduction to the group and to
PBL
Tutor
What is your background? What is your
understanding of the PBL process?
Students
27
Tutorial Part 2 Starting the problem
(Tutorial Session 1)
What do we know What do we need to
know Discuss list learning issues Organize who
does what
Students
Tutor
28
An important part of PBL is the learning between
sessions
29
Show version
Tutorial Part 3 Reporting Back (Tutorials 2 and
half of 3)
Recap case Discuss in a logical order Avoid
mini-lectures Interact/Question each other Move
to next page or case
Students
Tutor
30
The process of PBL - the roles of students vs
tutor -
Students determination of their own level of
ignorance (Learning Issues), by themselves, is
fundamental to PBL
31
The process of PBL - the roles of students vs
tutor -
The facilitators role is to prompt, guide and
question, when necessary, to ensure that
predetermined learning issues (the tutor guide)
are identified, researched and discussed
32
Characteristics of a good PBL student

• Prompt and present for all sessions
• A knowledge of the process of PBL
• Commitment to self/student-directed learning
• Active participation in discussion and critical
  thinking while contributing to a friendly,
  non-intimidating environment
• Willingness to make constructive evaluation
  of self, group and tutor

33
Characteristics of a good PBL tutor

• A knowledge of the process of PBL
• Commitment to student-directed learning
• Ability to generate a non-threatening
  environment while still acting to promote
  discussion and critical thinking
• Willingness to make constructive evaluation
  of student and group performance

34
Evaluation- several levels -

• Of the group - after each case - how did we do?

• Of the student
• - Self-assessment - comprehensives, web page
• - Formative - tutor comments
• - Summative - satisfactory/unsatisfactory
  - 2 unsatisfactories

Deans letter

• Of the tutor - submitted to the undergrad office

35
Evaluation
Absent Unsatisfactory Let colleagues/tutor
know if you are sick and wont make it to a
session
Kuby
36
AND NOW. TO WORK!!!!!!
37
Mr. John Appleseed
You are a family practitioner in a small town
north of Ottawa. Mr. Appleseed is a 38 y.o. white
male who comes complaining of a painful swelling
in the palm of his right hand. About 4 days ago
he was clearing brush behind the barn and pricked
his hand on a thorn. The thorn entered about 1
and half inches. There was very little blood and
he thought it was OK until yesterday. He tells
you he last had a tetanus shot 11 years ago. You
examine his hand. It is red, swollen and
inflamed. He is tender along his inner forearm
and there is a tender swelling in his axilla.
Otherwise his physical exam is normal.
38
Student PBL Workshop Task (normally 45 minutes)
Read the case What do you know about this
scenario? What do you need to know? Discuss
list learning issues Discuss list potential
sources of information Organize who
(theoretically) will do what Evaluate how you
performed as a group
39
Black screen for overhead to write down student
suggestions of learning issues
OH
40
PBL does it work?
41
Does problem-based learning work?

• Weaker in the basic sciences
• Albanese and Mitchell (93), Vernon and Blake
  (93)
• No difference USMLE Step 1 (Basic Science)
• Harvard data (Vernon and Blake 93), Berkson
  (93), Distlehorst and Robbs (98)
• No difference or better in clerkship and Step 2
• Albanese and Mitchell (93), Vernon and Blake
  (93), Blake (98), Harvard data (Vernon and
  Blake 93), Berkson (93), Distlehorst and Robbs
  (98), Richards et al (96), Blake et al (2000)

42
Hmlo, C.E. Teaching and Learning in Medicine 10
92-100, 1998
Compared full, elective and non-PBL PBL students
generate explanations that are more accurate,
coherent, and comprehensive than non-PBL
students PBL students transfer the reasoning
strategies that they are taught and are more
likely to use science concepts in their
explanations Effect is stronger for the
full-time PBL students
43
Blake, R.L., Hosokawa, M.C. and S. Riley.
Academic Medicine 7566-70, 2000
Scores were higher on USMLE Step 1 for the PBL
curriculum than for the traditional
curriculum Scores for Step 2 were above the
national mean for the PBL curriculum and below
the mean for the traditional curriculum PBL did
not compromise the performances on the
licensing examinations in fact, it may have
contributed to higher scores
44
Patel et al. Cognition and Instruction 10
335-378, 1993
Compared McMaster and McGill students PBL
students generated more elaborated explanations
and were better at integrating new knowledge PBL
students were less accurate than the traditional
students, who did better at pattern recognition
45
Colliver, J. A. Acad Med 75 259-266, 2000
The author reviewed the medical education
literature, starting with three reviews published
in 1993 and moving on to research published from
1992 through 1998. .revealed no convincing
evidence that PBL improves knowledge base and
clinical performance, at least not of the
magnitude expected given the resources required
... The author concludes that the ties between
educational theory and research (both basic and
applied) are loose at best.
46
Problems with PBL in hybrid curricula

• Finding enough tutors - 1 for each 6 students
• Faculty busy with traditional curriculum
• The range of topics which can be discussed is
  a limiting factor - quality control is difficult
• Heavy on library, computer resources, support
• Objective evaluation of PBL is difficult
• Inherent conflict with lectures - waste of time

47
PBL varies markedly from school to school

• The objectives of PBL in a hybrid currriculum
  are substantially different from those of in a
  pure PBL school
• Concern about the adequacy of basic and
  clinical science learning increases as the
  amount of didactic lecturing goes down, in
  spite of PBL
• Exam format has a major steering effect

48
The optimal administration of a PBL component in
a hybrid curriculum requires commitment

• Close interaction between PBL and the
  complementary curriculum
• Tutor training and case-writing workshops,
  briefing/debriefing sessions
• Student workshops
• A constant high level of enthusiasm by tutors
• An administration appreciative of tutors

49
Adequate resources are essential

• dedicated home rooms for tutorials, computer
  access, basic texts, resource materials
• computers, software and support to maintain a
  curriculum database, case objectives
• resources to develop PBL cases to ensure they
  meet the objectives of the curriculum

50
Adequate resources are essential
An Office of Medical Education staffed by
permanent faculty, trained in medical education
51
PBL- A First Year Students Comment
The trouble with PBL is that you have to learn a
whole bunch of stuff that you wont need until
after you graduate
52
THE END
THANK YOU
53
PBL why are you telling us all this?
54
AND NOW. SIGN UP WHILE THERE ARE PBL GROUPS
STILL AVAILABLE!!
55
PBL why should we bother?