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PROBLEM-BASED LEARNING

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Title: PROBLEM-BASED LEARNING


1
PROBLEM-BASED LEARNING
  • Presented by
  • Dr. Soha Rashed Aref Mostafa
  • Prof. of Community Medicine
  • Member of Medical Education Department
  • Faculty of Medicine
  • Alexandria University
  • Egypt

2
Traditional Medical Curricula
New-Innovative Curricula
SPICES
? Continuum ?
S
Teacher-centered
Student-centered
Information gathering
Problem-based
P
Discipline-based
Integrated
I
Hospital based
Community-based
C
Standard
Elective
E
Systematic
Apprenticeship-based
S
3
what is it?
4
Definition of PBL
  • An instructional student-centered approach which
    uses carefully constructed clinical problems as a
    context for students to define their learning
    needs, conduct self-directed enquiry, integrate
    theory and practice, and apply knowledge and
    skills to develop a solution to a defined problem.

5
The case serves as a stimulus for learning
6
  • WHAT IS PROBLEM-BASED LEARNING, AND HOW DOES IT
    DIFFER FROM PROBLEM SOLVING?

7
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

8
(Problem Solving)
9
PROBLEM SOLVING PROBLEM-BASED LEARNING
Educational strategy Traditional discipline-based Integrated systems-based
Main characteristics - The focus is on preparatory learning prior to exposure to the problem. - The staff set the problems (case history problems in a primarily lecture- based format), and students attempt to resolve them using previously taught curricular content. - The problem comes first without advance readings, lectures, or preparation. - The problem serves as a stimulus for the need to know. - Based on their own prior knowledge and the identified gaps in that knowledge, students determine the learning issues within their own group. They then identify and use a variety of learning resources to study these issues and return to the group to discuss and share what they have learned.
10
PROBLEM SOLVING PROBLEM-BASED LEARNING
Role of the teacher Content expert Tutor/Facilitator
Learning environment Passive, teacher-centered Learning becomes dependent upon the self-directed efforts of the small group. This method creates a more active, student-centered learning environment
Who is responsible for directing the learning activities Teacher The student decides what he/she needs to learn
11
Rationale for introducing PBL into the
undergraduate curricula
  • Principles of adult learning
  • Adults are motivated by learning that
  • Is perceived as relevant
  • Is based on, and builds on, their previous
    experiences
  • Is participatory and actively involves them
  • Is focused on problems
  • Is designed so that they can take responsibility
    for their own learning
  • Can be immediately applied in practice
  • Involves cycles of action and reflection
  • Is based on mutual trust and respect
  • The rationale for PBL lies in its comparability
    with modern educational principles. Its approach
    is based on principles of adult education and
    self-directed learning.

12
It differs fundamentally from our traditional
curricula, in which students
Preclinical phase (years 1-3) acquire "background" knowledge of the basic sciences
Clinical phase (years 4-6) apply this knowledge to the diagnosis and management of clinical problems
13
This traditional approach has been criticised for
a number of reasons
  • Many existing curricula fail to meet the needs of
    current and future doctors
  • It creates an artificial divide between the basic
    and clinical sciences
  • Time is wasted in acquiring knowledge that is
    subsequently forgotten or found to be irrelevant
    (The acquisition and retention of information
    that has no apparent relevance can be boring and
    even demoralising for students)
  • Application of the acquired knowledge can be
    difficult

14
  • The educational objectives of PBL address many of
    the perceived problems in traditional medical
    curricula
  • 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

15
  • Course material is usually systems- based
    Integration of basic and clinical sciences

16
Integrated Systems-based Curriculum Map
17
Example
  • When studying PBL cases relating to CVS, students
    learn about
  • Normal bodily structure and function
  • The clinical features, diagnosis and management
    of common CVDs
  • Furthermore, they learn to take a relevant
    clinical history and to physically examine the
    CVS

18
  • Knowledge is acquired in context and builds on
    what is already known
  • These facets aid knowledge retention, add
    interest and increase motivation to learn
  • Students continually explore their knowledge,
    identify both their personal learning needs and
    strategies required to address them. This process
    helps to develop skills for life-long learning

19
  • Efficacy and advantages of PBL

20
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21
PBL the claims and the evidence
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23
Too much debates !!
24
  • Although efficacy of PBL is difficult to
    evaluate, the current enthusiasm for PBL seems
    justified and its use is likely to increase
    further.

25
The place of PBL in the curriculum
26
Traditional Medical Curricula
New-Innovative Curricula
SPICES
? Continuum ?
S
Teacher-centered
Student-centered
Information gathering
Problem-based
P
Discipline-based
Integrated
I
Hospital based
Community-based
C
Standard
Elective
E
Systematic
Apprenticeship-based
S
Emphasis on PBL ranges Dominance of the
curriculum
Minor supporting role
27
Clinical Apprenticeship Model
Preclinical phase
Clinical phase
Problem-based learning
Time in the curriculum
28
A PBL-based curriculum is typically organized
into a number of units based on body systems.
Each unit is based on a number of PBL Cases
(casehypothetical patient whose problem requires
analysis and resolution).
29
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30
Hybrid curricula
  • In preclinical phase, PBL can be designed and
    timetabled so as to complement other teaching
    methods such as
  • Lectures
  • Practicals, other laboratory work
  • Computer-assisted learning

31
Example
  • While learning about CVS in PBL tutorials,
    students dissect the heart in anatomy practicals,
    and have lectures on the radiological features of
    heart disease.

32
THE PBL TUTORIAL PROCESS
  • Key steps in the PBL tutorial process
  • Case presentation
  • Identifying key information
  • Generating and ranking hypotheses
  • Generating an enquiry strategy
  • Defining learning objectives
  • Reporting back
  • Integrating new knowledge
  • The PBL process is tightly structured and
    contains a number of key steps
  • The PBL tutorial
  • Typically consists of a small number of students
    (ideally between 6-10)
  • Is facilitated by one or more faculty tutors who
    guide the process without contributing directly
    to the solution of the problem or being the
    primary source of information
  • Meeting two times a week for two or three hours
    per session
  • Completing a case in two or three sessions

33
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35
How does problem-based learning work?
  • What instructors do
  • - Develop real-world, complex and open-ended
    problems such as might be faced in the workplace
    or daily life.
  • - Act as facilitators, making sure students are
    staying on track and finding the resources they
    need.
  • - Raise questions to student groups that deepen
    the connections they make among concepts.
  • - Strike a balance between providing direct
    guidance and encouraging self-directed learning.
  • What students do
  • - Address the problem, identifying what they need
    to learn in order to develop a solution and where
    to look for appropriate learning resources.
  • - Collaborate to gather resources, share and
    synthesize their findings, and pose questions to
    guide further learning tasks for the group.

36
e.g., 6-week Cardiovascular Unit
  • Students might deal with 6 cases in 18 PBL
    tutorials
  • Each case is designed and written by experts with
    specific learning objectives in mind
  • e.g., one of the LO of a case dealing with asthma
    might be to stimulate students to learn about the
    structure and function of the respiratory
    system.
  • Cases are written so as to encourage students
    themselves to identify their own specific
    learning objectives.
  • Learning process is student-directed, and the
    tutor functions more as a facilitator, not a
    didactic teacher.

37
Case presentation
38
How does a case serve as a stimulus for learning?
39
Example PBL tutorial process
  • 1. Case presentation The tutor provides the
    group with some introductory clinical information
    about a hypothetical patient.
  • Mary Smith, a 28-year-old office worker and
    part-time swimming instructor, comes to see her
    GP because of pain in her chest and shortness of
    breath. This has been a recurring problem in
    recent months and seems to be gradually worse. On
    the previous evening, while participating in a
    swimming gala, she became so short of breath that
    she found it difficult to walk.

40
  • Identifying key information
  • Generating and ranking hypotheses
  • e.g., Infection, cardiac problem,
    allergy, asthma, broken rib.
  • Allergy ? cardiac problem
  • Generate an enquiry strategy
  • What additional information is
    required?
  • e.g., Previous medical problems and
    relevant drug, family psychosocial histories,
    physical exam, lab. tests.

discuss, extract, identify, summarize
brainstorm
decide
41
Additional information
  • Further discussion with her GP reveals that Ms
    Smiths chest pain and shortness of breath come
    on following exercise, particularly in a cold
    environment. When she becomes particularly short
    of breath, she starts to wheeze. She sometimes
    has a dry cough and has never had haemoptysis.
    There is no recent history of physical trauma and
    no personal or family history of heart disease.
    She had eczema in childhood but has never had
    asthma. She has smoked for the past 5 years and
    increased her smoking to 40 cigarettes a day
    since she broke up with her intimate friend 3
    months ago. She takes an oral contraceptive pill
    but no other medication.

42
  • New information
  • Revising their hypotheses
  • Discard / Re-rank / Other hypotheses
  • Anxiety attacks with hyperventilation
  • Possible thromboembolic disease due to oral
    contraceptive use
  • Asthma
  • Cardiac problem
  • Broken rib

43
5. Defining learning objectives
  • Once the students have decided on a preferred
    hypothesis (e.g., allergy), they must explain the
    biomedical science mechanisms that link their
    hypothesis to the presenting problems.
  • What students know?
  • What they do not know?
  • What they need to know?
  • to further their understanding of the underlying
    mechanisms, and their ability to solve the
    clinical problem.
  • e.g., Students may identify gaps in their
    knowledge of the mechanics of breathing, anatomy
    of airways, mechanisms of oxygen delivery to
    tissues, or mechanisms of pain perception.

44
5. Defining learning objectives (cont.)
  • The identification of gaps in knowledge helps
    students to define their learning objectives and
    these become the focus of self-directed study in
    the interval between tutorials.
  • Learning objectives should be clear and specific
    and of appropriate scope to be addressed in the
    time available between tutorials (typically 2-3
    days).
  • At each tutorial, the group might identify three
    to five major learning objectives and perhaps an
    equal number of lesser objectives.

45
5. Defining learning objectives (cont.)
  • Although the PBL tutorial is student-centered,
    major learning objectives are identified in
    advance by the case writers as part of the
    overall curriculum design. Tutors may need to
    provide prompts to ensure that major objectives
    are identified and pursued.
  • In PBL, as knowledge is acquired in the context
    of a specific clinical problem (the problem is
    encountered before the student has the knowledge
    to understand it), it is likely to be better
    focused and retained.

46
6. Reporting back
  • In the follow-up tutorial, students reconvene to
    report on their self-directed study and share and
    integrate new knowledge.
  • All students should contribute to the report-back
    and their unique perspectives are incorporated
    into the process of knowledge building. The
    exchange and debate of ideas promotes the
    consolidation and elaboration of new knowledge
    and understanding

47
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48
7. Integrating new knowledge
  • Based on the principle that knowledge is
    consolidated more readily in context, students,
    guided by the tutor/facilitator, should relate
    new biomedical knowledge to the patient's
    problem.
  • Students are required also to extend their
    discussion beyond the biomedical and clinical
    sciences and consider the public health,
    socioeconomic, ethical and legal aspects of the
    case.

49
How do I get started with PBL?
  • Develop problems that
  • - Capture students interest by relating to
    real-world issues.
  • - Draw on students previous learning and
    experience.
  • - Integrate content objectives with
    problem-solving skills.
  • - Require a cooperative, multi-staged method to
    solve.
  • - Necessitate that students do some independent
    research to gather all information relevant to
    the problem.
  • Design assessment tools that
  • - Account for process (e.g. research,
    collaboration) as well as content skills.
  • - Are closely tied to course learning objectives.
  • - Balance individual and group performance.

50
How to create effective PBL scenarios
  • Learning objectives likely to be defined by the
    students after studying the scenario should be
    consistent with the faculty learning objectives
  • Problems should be appropriate to the stage of
    the curriculum and the level of the students'
    understanding
  • Scenarios should have sufficient intrinsic
    interest for the students or relevance to future
    practice
  • Basic science should be presented in the context
    of a clinical scenario to encourage integration
    of knowledge
  • Scenarios should contain cues to stimulate
    discussion and encourage students to seek
    explanations for the issues presented
  • The problem should be sufficiently open, so that
    discussion is not curtailed too early in the
    process
  • Scenarios should promote participation by the
    students in seeking information from various
    learning resources

51
CHECKLIST FOR PROBLEM CONSTRUCTION
  • Is the content of the problem geared to students'
    prior knowledge?
  • Is there a clear connection with one or more of
    the objectives of the block?
  • Is the problem sufficiently complex to offer cues
    for initial discussion and for generating
    learning issues?
  • Is the problem structured in such a way that it
    offers cues for discussion in the group?
  • Has the problem been formulated clearly and, if
    possible, does it offer links with professional
    practice?
  • Is the problem multidisciplinary and is clear to
    students?
  • Does the length of the problem enable inclusion
    of all the relevant information that is needed
    for identifying learning issues and does the
    problem not contain superfluous irrelevant
    information?
  • Is the available time sufficient for studying the
    learning issues?
  • Is there sufficient time available for reporting
    on all the learning issues?
  • Does the block offer sufficient variety in
    learning activities, i.e. does it include
    different types and formats of problems?
  • Is the number of problems geared to the number of
    group meetings in the block? Has a schedule been
    drawn up that specifies which problems are to be
    discussed when?
  • Which problems should be tackled in a specific
    sequence?

52
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