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Problem-based learning inMaastricht

Erik Driessen and many others

March 30, 2007 MEDC, Gifu University

Collegezaal rond 1798

Collegezaal rond 1998

A scientific/academic

approach to education in

which an optimal learning

environment is created, which

is based on rationality, theory

and evidence

What are we after?

2

The learning process

Instruction formats

Assessment formats

Management (of change)

Information technology, e-learning

Quality control

………..

And we know a lot………. Three C’s of education

Constructive

Contextual

Collaborative

The case of Maastricht

The case of Maastricht Characteristics of PBL

Problem-oriented

Self-directed

Interdisciplinary

Skills-oriented, early practicecontacts

Assessment tailored to educational

objectives

3

A student’s week

Mon Tue Wed Thu Fri

AM

PM

Attitude &

Communic.

Training

Practical

Tutorial

Group

Tutorial

Group

Lecture

Skills

Training

Health

Practice

Visit

A student’s week

Mon Tue Wed Thu Fri

AM

PM

Attitude &

Communic.

Training

Practical

Tutorial

Group

Tutorial

Group

Lecture

Skills

Training

Health

Practice

Visit

The tutorial group

Composition: - 8-10 students

- 1 chairman

- 1 recorder

- 1 tutor

Duration: - 2 hours

- 1 hour report

- 1 hour new case prep

Frequency: - Twice per week

Sample problemMr. Brown, aged 68, comes to your surgery and

tells you that he has been feeling dizzy recently.He is seriously worried because he has always

been healthy; he has never had any medicalproblems. But the complaints, which he has hadfor a few months, are now getting worse and

worse. The dizziness occurs when he gets out ofbed in the morning, but it can also be provoked by

a sudden movement of his head. "When ithappens, everything swims before my eyes and Ifeel unwell, light in the head and a little queasy.

When I sit down for a moment, the dizziness

slowly disappears."

1) Clarification

of terms

2) Definition of

problem(s)

3) Analysis of

problem(s)

(brainstorm)

4) Structuring

ideas

5) Formulate

learning

objectives

6) Collect new

information

(outside group)

7) Report and

synthesis of

information

The Seven

Jump

4

A student’s week

Mon Tue Wed Thu Fri

AM

PM

Attitude &

Communic.

Training

Practical

Tutorial

Group

Tutorial

Group

Lecture

Skills

Training

Health

Practice

Visit

A student’s week

Mon Tue Wed Thu Fri

AM

PM

Attitude &

Communic.

Training

Practical

Tutorial

Group

Tutorial

Group

Lecture

Skills

Training

Health

Practice

Visit

A student’s week

Mon Tue Wed Thu Fri

AM

PM

Attitude &

Communic.

Training

Practical

Tutorial

Group

Tutorial

Group

Lecture

Skills

Training

Health

Practice

Visit

5

A student’s week

Mon Tue Wed Thu Fri

AM

PM

Attitude &

Communic.

Training

Practical

Tutorial

Group

Tutorial

Group

Lecture

Skills

Training

Health

Practice

Visit

A student’s week

Mon Tue Wed Thu Fri

AM

PM

Attitude &

Communic.

Training

Practical

Tutorial

Group

Tutorial

Group

Lecture

Skills

Training

Health

Practice

Visit

A student’s week

Mon Tue Wed Thu Fri

AM

PM

Attitude &

Communic.

Training

Practical

Tutorial

Group

Tutorial

Group

Lecture

Skills

Training

Health

Practice

Visit

Scheduled educational activities

0

5

10

15

20

25

30

35

40

1.1 1.3 1.5 2.1 2.4 2.6 3.1 3.3 3.5 4.2 4.5 4.7

Curriculum units

Hours per week

11.25 hours on average per week

6

Scheduled educational activities

0

1

2

3

4

5

Year 1

Year 2

Year 3

Year 4

Hours per week

Tutorials Lectures Skills

Training

Practicals Health

Care

Contacts

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Problems identified

PBL too uniform in format

PBL becomes a ritual3 jump

Attendance

Motivation/working hours by students

Tutors less motivated

Mismatch between assessment andcurriculum objectives (particularly block assessments)

Transition to clerkships (the shock of practice)

Contextual

Constructive

Collaborative

What PBL was….

C ontextual

What PBL became….

C onstructive

C ollaborative

Contextual

Constructive

Collaborative

What it needs to become…. How?

More authentic

problems

Increasing

complexity

Real life

projects

Authentic

assessmentContextual

Constructive

Collaborative

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How?

Less direction

Increasing

independent

learning

Portfolio

assessment

Contextual

Constructive

Collaborative

How?

Smaller groups

Group

assignments

More ICT

support

Contextual

Constructive

Collaborative

“New” curriculum structure

Year C o n t e n t

1 EmergencyEmergency care and care and regulatoryregulatory systemssystems

2 Stages of Stages of lifelife and and diagnosticsdiagnostics

3 ChronicChronic disorders disorders

4 TheoryTheory and and practicepractice

5 ClerkshipsClerkships

6 ParticipationParticipation in research and in research and patientpatient care care

Practice Theory

Semi-classic PBL

Patient-based PBL

Guided Work-based

Learning (WBL)

Participatory WBL

Curriculum structure

Curriculum structure

Year 2 Stages of life and diagnostics

Year 5 Clerkships

Year 1-2Preparing for practice

Year 4-5Learning & working in practice

Year 3Transition from theory to practice

Year 6Participation in science (6 months) and Health Care (6 months)

Year 1 and 2

Classic PBL, but including:More authentic (and complex) problems, somethrough videoMore collaborative work through groupassignments or mini-projectsMore comprehensive unit assessment andlongitudinal assessment, including portfolio andprofessional behaviour assessmentEntire curriculum online, digital facilities in all PBLgroups.

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Curriculum structure

Year 2 Stages of life and diagnostics

Year 5 Clerkships

Year 1-2Preparing for practice

Year 4-5Learning & working in practice

Year 3Transition from theory to practice

Year 6Participation in science (6 months) and Health Care (6 months)

Integration theory & practice

Instructional methods

Learner control

Teachers

Patients are starting point for learning

Educational objectives

Variability in instructionalmethods in which students

are required to be active

Active learningCollaborative learning

Self-directed learning

Teachers as coach

The learning cycle

Preparation in

tutorial group

Preparation with

clinical supervisor

Self study

Patient

encounterEvaluation &

Formulation learningobjectives

Self study

Report to

Tutorial group

Patient

vignette/case

Activities

around

patient

encounter

• 10 weak cycle

• n = 10

• 1x per week 4 hours

• presentation and

discussion of

patient problems(3 hours).

• Preparing next

patient encounter(1 hour)

• staff member iscoach

Tutorial group

Patient encounter preparation Patient encounter

10

Report to tutorial group Critical Appraisal of Topic

Final conclusions withrespect to the question

Comments on theusefulnes of the article

Judgement of the article

Motivating the articleused

Search terms used

Resources

Clinical question

Clinical scenario An “evidence-based” approach to answer

relevant and authentic clinical problemsfaced by students

The problems are dealing with

diagnosis

prognosistherapy and contra-indications

assessment of patient management

Criteria

Case report on ethics/health law

Ethics and Law

Make a report and prepare for

discussion about:

• making medical mistakes

• conflicting views

• privacy and confidentiality

• (non) compliance of patients

• informed consent

Family practice visits

Visiting a general practice

• 10-12 times per year

• clinical presentations are

linked to content of the

cluster

• during one day

• clinical presentations are

discussed in tutorial

group

Patient partner program

Visiting and following up

a chronic patient

• 4-6 times a year

• a chronic illness is

dominantly present

• clinical presentation is

discussed in a group

Curriculum structure

Year 2 Stages of life and diagnostics

Year 5 Clerkships

Year 1-2Preparing for practice

Year 4-5Learning & working in practice

Year 3Transition from theory to practice

Year 6Participation in science (6 months) and Health Care (6 months)

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Structure:

• start week: preparatory

(theoretical) learning activities

• Clerkship rotation

• final week: evaluation, reflection,

closure

Year 4-5 clerkships - new developments

Teaching: focus on

• feedback is structured and planned

(several moments per week)

• students themselves are responsible to see a certain

amount of clinical presentations

(navigation plan)

• peer teaching

Year 4-5 clerkships - new developments

Assessment: focus on

• assessment on the work-place

• information for assessment

gathered from different sources during the clerkships

• observation of patient encounters

(weekly)

Year 4-5 clerkships - new developments

Curriculum structure

Year 2 Stages of life and diagnostics

Year 5 Clerkships

Year 1-2Preparing for practice

Year 4-5Learning & working in practice

Year 3Transition from theory to practice

Year 6Participation in science (6 months) and Health Care (6 months)

Year 6

18 weeks of participation in research

18 weeks of participation in health carePreparation through portfolio and mentorMotivated choices for context of research andhealth careSemi-independent participation by studentComputer Supported Collaborative Learning(CSCL)In-training WBL assessment (Mini-CEX,MSF (360 ), portfolio, mentoring)Final assessment through portfolio.

Thank you for your attention!Thank you for your attention!