PROBLEM BASED
LEARNINGProfessor S A TabishFRCP (London) FRCP (Edin) FAMS MD
New Horizons in Medical Education
What were the challengesbull Changes in patientrsquos expectationsbull Changes in HC delivery (style of practice of
doctors)bull Changes in medical knowledge
- traditionally the course was structured as a progression from basic sciences to the clinical sciences with little integration
bull Failing to prepare students adequately for the diversity of problems which they will encounter as professionals Studentrsquos expectations of quality of teaching are higher
bull The exponential growth of med knowledge amp the greatly increased content of the scientific aspect of the curriculum has made the selection of appropriate core content and the integration of basic and clinical sciences important aspects of curricular design
Domains of essential Global Requirements of ME
What was the response to these challenges
bull The development of new curricula incorporating new curriculum themes amp different educational strategies
bull The introduction of new learning situations amp the use of new tools amp aids to learning
bull New methods of assessment [OSCE objective structured clinical exam Which can test performance amp competence in a wide diversity of settings Formative Assessment Portfolio assessment Work-based assess]
New Educational Strategies
bull New strategies appropriate for adult learning (instead of spoon-feeding)
bull Self-directed learningbull Problem Based Learningbull Integrated system based approachbull Task Based learningbull Core amp Student-selected
Componentsbull A spiral curriculum
New Tools amp Aids
bull Use of Study Guides
bull Use of Computer Assisted Programs amp Internet
bull Use of Videos to teach Clinical Skillsconsultation techniques
bull Role of Simulators amp Simulations in aspects of physical exam amp practical procedures
PBLbull Problem-based learning (PBL) is a method of
learning in which learners first encounter a problem followed by a systematic learner-centered inquiry and reflection process
bull PBL is a method designed to help students learn the sciences basic to medicine at the same time they develop the reasoning process used by physicians and other health professionals in their clinical practice
bull 1048708 The problem comes first without advance readings lectures or preparation
bull 1048708 The problem serves as a stimulus for the need to know
PBLbullHelps learners build a bridge
between what they already know and what they need to know to reachthe next level
bull Emphasizing active learning which has been shown to be more satisfying than
passive teacher-to-student learning and to enhance retention and recall
bull Emphasizing student-centered learning in which students are actively involved in setting their own learning goals
Advantages
Encourages bull effective amp self-directed learningbull Critical thinkingbull Team workbull understanding rather than
memorizationbull Facility with professional languagebull Both students amp staff enjoy the
process
Advantages
In preparing students for professional practice PBL
bull Encourages independence as students identify amp meet individual learning needs
bull Stimulates reflection amp self-direction for life-long learning
bull Supports ongoing self-assessmentbull Introduces clinical reasoningbull Enhances critical thinking amp evidence-based
decision makingbull Ensures that knowledge is transferred applied
amp retained by providing a relevant integrated context
bull A problem initiates the activitybull The Group is stimulated to explore
basic scientific amp clinical mechanisms together with social psychological ethical or professional issues
bull Problem stimulates students to reason think critically amp weigh evidence they seek out amp share relevant info
PBL
bull Groups do not need prior knowledge to generate lively ideas as they identify areas for further collective amp personal learning
bull Each student brings individual experience amp makes a distinctive contribution
bull the Tutorrsquos role is to manage interactions rather than supply info
bull An effective Group provides a safe environment for sharing amp testing new knowledge
bull Students practice the language of science amp medicine evaluate ideas and receive feedback from peers amp teacher
bull When clinical exposure is introduced concurrently intellectual amp practical skills develop in parallel
Framework for PBL
bull A trigger initiates the problem (papercomputervideo)
bull Groups brainstorm to identify key issues for discussion
bull Broad thinking produces a rich array of mechanisms amp ideas
bull Hypothesis are critically explored through reasoning
bull The need for additional info is identifiedbull A Conclusion is reachedbull Group reviews the process
Framework for PBL - II
bull In Breaks between Tutorials students identfy Learning Issues to be pursued
bull They are encouraged to adot an evidence-based approach
bull When they reconvene they share and review the learning
Characteristics of an effective PBL Group
An Effective Group is Cohesive motivated mutually supportive amp actively engaged in learning
bull The Group understands the process amp energetically pursues its task
bull Members respect each otherrsquos contribution but examine them critically
bull Discussions flow as students cooperate rather than compete
bull The atmosphere is friendly amp good humouredbull Roles are shared all take turns in scribing
leading discussion taking responsibility for acquiring information
Staff Development
bull Basic training is mandatorybull Further development may be a requirementbull Initial training may involve observation amp
practice with a group from the programbull Effective training ensures that necessary
background goals amp local strategies are considered together with info on assessment amp evaluation
bull In addition to materials supplied to students tutors are usually issued with handbooks highlighting issues for each problem
Tutorrsquos Role in Assessment
bull Individual StudentsGroups may be assessed Summatively (determining progression) or formatively (for feedback)
The GROUP
bull At the end of each problem groups review their processes to encourage self-reflection ampenhance their collective performance
Tutorrsquos Role in Assessment
Individual students
bull Tutors should provide formative feedback to each member
bull Ask students to complete a simple self-assessment questionnaire reviewing appropriate behaviors the tutor returns them with comments
bull Students will be a writtenoralclinical tests that will determine their progression amp ultimate graduation
Evaluating PBL Tutorials-II
bull At the end of each problem time is allocated for evaluation
bull Both the process amp learning in PBL can be evaluated against explicit goals
bull The tutorrsquos review of effectiveness of group processes offers insight for the members
bull Students normally evaluate their tutor helpfulness support for clinical reasoning encouragement for independent learning appropriate intervention provision for effective feedback
PBLbull 1048708 Enabling students to learn in the context in which the
information will be used which increases the ability to retrieve and apply information
bull 1048708 Focusing on important concepts which helps learners organize and store new information in a way that facilitates retrieval and application
bull 1048708 Exploring prior knowledge formulating inquiries derived from and defined by the learnersrsquo need to know and actively constructing meaning through dialogue and reflection
bull 1048708 Utilizing problems designed to simulate studentsrsquo perception of their future profession which serves as a powerful stimulus for studentsrsquo intrinsic motivation to learn
bull 1048708 Actively involving students in monitoring their own progress and reflecting on what works and what needs improvement frequently assessing student performance and providing feedback
PBL Starting the casebull After the introductions and discussion
are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it
bull Reading the case aloud keeps the group focused
bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here
PBL Case (contd)
bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session
PBL Case contdbull SECOND deciding which issues everyone will
tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)
bull THIRD deciding what SPECIFIC questions individuals will try to answer
bull FOURTH deciding how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet or consulting an expert)
The Process of PBL
bullWhat are the issues Identify the important issues in the problem
bull How well do you understand the issues
bull Are there any words or terms about which you are unclear
The Process of PBL contd
bull Consider the basic mechanisms that might explain each important aspect of each problem
bull Assess your current understanding of the basic structural andor functional mechanisms that may contribute to the presentation of the problem
bull Use the collective skills and experiences of group members to explore or explain these phenomena Identify current gaps in knowledge or understanding
Learn from each other
bullShare your own knowledge expertise or ability to reason and synthesize information Be receptive and appreciative of the contribution of your small group members
Determine priorities for learning
bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue
bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan
bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge
bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career
PBL
bull The problem comes first without advance readings lectures or preparation
bull The problem serves as a stimulus for the need to know
Learning Issues
bull Learning issues are questions that cannot be answered with studentsrsquo current knowledge and that can be explored and answered through systematic self-directed inquiry
bull The use of learning issues in tutorials prepares students to handle similar challenges in clinical practice and life-long learning
Learning Issues in PBL First Session1 Getting Started (Introductions Ground
Rules Expectations)2 Identifying Problem3 Exploring Pre-Existing Knowledge4 Generating Hypotheses and Explaining
Mechanisms5 Unfolding the Case Incrementally6 Re-EvaluatingReprioritizing Hypotheses
Based on New Information7 AssessmentReflection
PBL Second Session
8 Independent Self-Directed Study of Learning Issues
PBL Third Session
bull 9 Discussion of Learning Issues and Application of New Knowledge to the Case
bull 10 Continued Unfolding of the Case Incrementally
bull 11 AssessmentReflection
During Tutorial Session students will
1048708 Come prepared to discuss the case and learning issues researched since the last tutorial
1048708 Actively participate in group discussions and contribute to the learning process in a manner that allows for the balanced participation of everyone in the group
1048708 Develop learning issues at each session phrase them as full-sentence questions write them on the board and post them on the course web page
1048708 Consider biological population behaviormental health issuesexplanations and questions of professional attitudes values and ethics related to the patientrsquos problem(s) described in the case
Tutorial Session contd1048708 Go to the board to diagram outline draw etc in
explanation of mechanisms relatedto hypotheses1048708 Debate evidence related to the case and avoid
personal attacks on others1048708 Comply with ground rules with regard to how
the group will function and how itsmembers treat one another1048708 Participate in end-of-session reflection and
assessment by giving and receivingconstructive criticism regarding self tutor
student and group performance
Between Tutorial Session
1048708 Research key learning issues using a variety of resources
1048708 Critically evaluate the credibility of sources and the validity of the information they have obtained in their research
1048708 Integrate what they have learned through research lectures labs clinical skills Perspectives in Medicine (PIM) etc into what is discussed in tutorials
1048708 Synthesize what they have learned and be prepared to discuss it without reading directly from their materials as much as possible and apply it to the case at the next tutorial session
Determine priorities for learning
bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue
bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan
bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge
bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career
PBL Starting the casebull After the introductions and discussion
are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it
bull Reading the case aloud keeps the group focused
bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here
Problem-based learning is designed to develop
1048708 Integrated context-specific knowledge base
1048708 Decision-makingcritical thinking process and skills
1048708 Self-directed life-long learning skills 1048708 Interpersonal collaboration and
communication skills 1048708 Constructive self and peer
assessment skills 1048708 Professional ethics and behavior
PBL Case (contd)
bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session
What is problem based learning
bull In PBL students use triggers from the problem case or scenario to define their own learning objectives
bull Subsequently they do independent self directed study before returning to the group to discuss and refine their acquired knowledge
bull Thus PBL is not about problem solving per se but rather it uses appropriate problems to increase knowledge and understanding
bull The process is clearly defined
PBL
bull PBL uses clinical cases as the context for students to study basic and clinical sciences
bull 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
bull Possible disadvantages include higher costs both in resources and staff time
PBL
bull An educational method characterized by the use of patient problems as a context for students to learn problem-solving skills and acquire knowledge about the basic and clinical sciences
bull Students usually meet in small groups two or three times a week for PBL tutorials
bull They are presented with a clinical problem (eg a patient with chest pain) and in a series of steps they discuss possible mechanisms and causes develop hypotheses and strategies to test the hypotheses are presented with further information and use this new information to refine their hypotheses finally reaching a conclusion
bull A tutor usually acts as a facilitator guiding students in this group-learning process
bull In the course of this exercise students identify both their existing levels and gaps in their knowledge These gaps form the basis for independent learning outside the PBL tutorials The identification and pursuit of these so-called learning goals is a key element of the PBL process
Rationale for using PBL bull The PBL approach is based on principles of adult
education20 and cognitive psychology21 It differs fundamentally from traditional curricula in which students acquire background knowledge of the basic sciences in the early years of the course and in the later years apply this knowledge to the diagnosis and management of clinical problems This traditional approach has been criticised for a number of reasons42223
bull It creates an artificial divide between the basic and clinical sciences
bull Time is wasted in acquiring knowledge that is subsequently forgotten or found to be irrelevant
bull Application of the acquired knowledge can be difficult bull The acquisition and retention of information that has no
apparent relevance can be boring and even demoralising for students
The group learning process acquiring
desirable learning skills
Generic Skills amp attitudes
bull Teamwork bull Critical evaluation of literature bull Chairing a group bull Self directed learning and use of
resources bull Listening Presentation skills
Recording bull Cooperation bull Respect for colleagues views
bull Group learning facilitates not only the acquisition of knowledge but also several other desirable attributes such as communication skills teamwork problem solving independent responsibility for learning sharing information and respect for others PBL can therefore be thought of as a small group teaching method that combines the acquisition of knowledge with the development of generic skills and attitudes Presentation of clinical material as the stimulus for learning enables students to understand the relevance of underlying scientific knowledge and principles in clinical practice
bull when PBL is introduced into a curriculum several other issues for curriculum design and implementation need to be tackled PBL is generally introduced in the context of a defined core curriculum and integration of basic and clinical sciences It has implications for staffing and learning resources and demands a different approach to timetabling workload and assessment PBL is often used to deliver core material in non-clinical parts of the curriculum Paper based PBL scenarios form the basis of the core curriculum and ensure that all students are exposed to the same problems Recently modified PBL techniques have been introduced into clinical education with real patients being used as the stimulus for learning Despite the essential ad hoc nature of learning clinical medicine a key cases approach can enable PBL to be used to deliver the core clinical curriculum
Copyright copy2003 BMJ Publishing Group Ltd
Wood D F BMJ 2003326328-330
No CRoles of participants in a PBL tutorial aption Found
What happens in a PBL tutorial bull PBL tutorials are conducted in several ways In
this article the examples are modelled on the Maastricht seven jump process but its format of seven steps may be shortened
bull A typical PBL tutorial consists of a group of students (usually eight to 10) and a tutor who facilitates the session The length of time (number of sessions) that a group stays together with each other and with individual tutors varies between institutions A group needs to be together long enough to allow good group dynamics to develop but may need to be changed occasionally if personality clashes or other dysfunctional behaviour emerges
bull Students elect a chair for each PBL scenario and a scribe to record the discussion The roles are rotated for each scenario Suitable flip charts or a whiteboard should be used for recording the proceedings At the start of the session depending on the trigger material either the student chair reads out the scenario or all students study the material If the trigger is a real patient in a ward clinic or surgery then a student may be asked to take a clinical history or identify an abnormal physical sign before the group moves to a tutorial room For each module students may be given a handbook containing the problem scenarios and suggested learning resources or learning materials may be handed out at appropriate times as the tutorials progress
Examples of trigger material for PBL scenarios bull Paper based clinical scenarios bull Experimental or clinical laboratory data bull Photographs bull Video clips bull Newspaper articles bull All or part of an article from a scientific
journal bull A real or simulated patient bull A family tree showing an inherited
disorder
PBL tutorial process ndash Step 1 Identify and clarify unfamiliar terms presented in the scenario
scribe lists those that remain unexplained after discussion ndash Step 2 Define the problem or problems to be discussed students may
have different views on the issues but all should be considered scribe records a list of agreed problems
ndash Step 3 Brainstorming session to discuss the problem(s) suggestingpossible explanations on basis of prior knowledge students draw on each others knowledge and identify areas of incomplete knowledge scribe records all discussion
ndash Step 4 Review steps 2 and 3 and arrange explanations into tentativesolutions scribe organises the explanations and restructures if necessary
ndash Step 5 Formulate learning objectives group reaches consensus onthe learning objectives tutor ensures learning objectives are focused achievable comprehensive and appropriate
ndash Step 6 Private study (all students gather information related to eachlearning objective)
ndash Step 7 Group shares results of private study (students identify theirlearning resources and share their results) tutor checks learning and may assess the group
bull The role of the tutor is to facilitate the proceedings (helping the chair to maintain group dynamics and moving the group through the task) and to ensure that the group achieves appropriate learning objectives in line with those set by the curriculum design team The tutor may need to take a more active role in step 7 of the process to ensure that all the students have done the appropriate work and to help the chair to suggest a suitable format for group members to use to present the results of their private study The tutor should encourage students to check their understanding of the material He or she can do this by encouraging the students to ask open questions and ask each other to explain topics in their own words or by the use of drawings and diagrams
PBL in curriculum design bull PBL may be used either as the mainstay of an entire
curriculum or for the delivery of individual courses In practice PBL is usually part of an integrated curriculum using a systems based approach with non-clinical material delivered in the context of clinical practice A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge skills and attitudes A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios Sufficient time should be allowed each week for students to do the self directed learning required for PBL
bull
Copyright copy2003 BMJ Publishing Group Ltd
Wood D F BMJ 2003326328-330
No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found
Writing PBL scenarios
bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives
bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after
studying the scenario should be consistent with the faculty learning objectives
bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding
bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice
bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge
bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented
bull The problem should be sufficiently open so that discussion is not curtailed too early in the process
bull Scenarios should promote participation by the students in seeking information from various learning resources
bull Adapted from Dolmans et al Med Teacher 199719185-9
Staff development
bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)
A dysfunctional group a dominant character may
make it difficult for other students to be heard
A dysfunctional group a dominant character may make it difficult for other students to be heard
bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties
Advantages of PBL bull Student centred PBLIt fostersactive learning improved
understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks
Disadvantagesbull Tutors who cant teachTutorsenjoy passing on
their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful
Assessment of PBL
bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods
bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL
Conclusion
bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning
bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL
PBL 5 Easy Steps
bull Read the problem
Mrs Paula Embledon
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
2 Brain storm
bull Brainstorm
bull ndash hypotheses
bull - what do we know in support of the hypothesis
bull - what do we need to know to test the hypothesis
ndash learning issues
Brainstorm
bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)
ndash specific issues (for individuals to look up)
ndash overlapping issues
bull 4 Individual Reading - Research - Preparation
bull 5 Return
bull ndash review case so far ndash report and discuss
ndash assess progress - continue pagenext pagecomplete
ndash self-evaluation - How did things go Any suggestions for next time
ndash next problem
bull 5 Return
THE FIRST GROUP SESSION
bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day
bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session
bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr
bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine
bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise
bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator
bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues
bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know
bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)
bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)
bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)
New Horizons in Medical Education
What were the challengesbull Changes in patientrsquos expectationsbull Changes in HC delivery (style of practice of
doctors)bull Changes in medical knowledge
- traditionally the course was structured as a progression from basic sciences to the clinical sciences with little integration
bull Failing to prepare students adequately for the diversity of problems which they will encounter as professionals Studentrsquos expectations of quality of teaching are higher
bull The exponential growth of med knowledge amp the greatly increased content of the scientific aspect of the curriculum has made the selection of appropriate core content and the integration of basic and clinical sciences important aspects of curricular design
Domains of essential Global Requirements of ME
What was the response to these challenges
bull The development of new curricula incorporating new curriculum themes amp different educational strategies
bull The introduction of new learning situations amp the use of new tools amp aids to learning
bull New methods of assessment [OSCE objective structured clinical exam Which can test performance amp competence in a wide diversity of settings Formative Assessment Portfolio assessment Work-based assess]
New Educational Strategies
bull New strategies appropriate for adult learning (instead of spoon-feeding)
bull Self-directed learningbull Problem Based Learningbull Integrated system based approachbull Task Based learningbull Core amp Student-selected
Componentsbull A spiral curriculum
New Tools amp Aids
bull Use of Study Guides
bull Use of Computer Assisted Programs amp Internet
bull Use of Videos to teach Clinical Skillsconsultation techniques
bull Role of Simulators amp Simulations in aspects of physical exam amp practical procedures
PBLbull Problem-based learning (PBL) is a method of
learning in which learners first encounter a problem followed by a systematic learner-centered inquiry and reflection process
bull PBL is a method designed to help students learn the sciences basic to medicine at the same time they develop the reasoning process used by physicians and other health professionals in their clinical practice
bull 1048708 The problem comes first without advance readings lectures or preparation
bull 1048708 The problem serves as a stimulus for the need to know
PBLbullHelps learners build a bridge
between what they already know and what they need to know to reachthe next level
bull Emphasizing active learning which has been shown to be more satisfying than
passive teacher-to-student learning and to enhance retention and recall
bull Emphasizing student-centered learning in which students are actively involved in setting their own learning goals
Advantages
Encourages bull effective amp self-directed learningbull Critical thinkingbull Team workbull understanding rather than
memorizationbull Facility with professional languagebull Both students amp staff enjoy the
process
Advantages
In preparing students for professional practice PBL
bull Encourages independence as students identify amp meet individual learning needs
bull Stimulates reflection amp self-direction for life-long learning
bull Supports ongoing self-assessmentbull Introduces clinical reasoningbull Enhances critical thinking amp evidence-based
decision makingbull Ensures that knowledge is transferred applied
amp retained by providing a relevant integrated context
bull A problem initiates the activitybull The Group is stimulated to explore
basic scientific amp clinical mechanisms together with social psychological ethical or professional issues
bull Problem stimulates students to reason think critically amp weigh evidence they seek out amp share relevant info
PBL
bull Groups do not need prior knowledge to generate lively ideas as they identify areas for further collective amp personal learning
bull Each student brings individual experience amp makes a distinctive contribution
bull the Tutorrsquos role is to manage interactions rather than supply info
bull An effective Group provides a safe environment for sharing amp testing new knowledge
bull Students practice the language of science amp medicine evaluate ideas and receive feedback from peers amp teacher
bull When clinical exposure is introduced concurrently intellectual amp practical skills develop in parallel
Framework for PBL
bull A trigger initiates the problem (papercomputervideo)
bull Groups brainstorm to identify key issues for discussion
bull Broad thinking produces a rich array of mechanisms amp ideas
bull Hypothesis are critically explored through reasoning
bull The need for additional info is identifiedbull A Conclusion is reachedbull Group reviews the process
Framework for PBL - II
bull In Breaks between Tutorials students identfy Learning Issues to be pursued
bull They are encouraged to adot an evidence-based approach
bull When they reconvene they share and review the learning
Characteristics of an effective PBL Group
An Effective Group is Cohesive motivated mutually supportive amp actively engaged in learning
bull The Group understands the process amp energetically pursues its task
bull Members respect each otherrsquos contribution but examine them critically
bull Discussions flow as students cooperate rather than compete
bull The atmosphere is friendly amp good humouredbull Roles are shared all take turns in scribing
leading discussion taking responsibility for acquiring information
Staff Development
bull Basic training is mandatorybull Further development may be a requirementbull Initial training may involve observation amp
practice with a group from the programbull Effective training ensures that necessary
background goals amp local strategies are considered together with info on assessment amp evaluation
bull In addition to materials supplied to students tutors are usually issued with handbooks highlighting issues for each problem
Tutorrsquos Role in Assessment
bull Individual StudentsGroups may be assessed Summatively (determining progression) or formatively (for feedback)
The GROUP
bull At the end of each problem groups review their processes to encourage self-reflection ampenhance their collective performance
Tutorrsquos Role in Assessment
Individual students
bull Tutors should provide formative feedback to each member
bull Ask students to complete a simple self-assessment questionnaire reviewing appropriate behaviors the tutor returns them with comments
bull Students will be a writtenoralclinical tests that will determine their progression amp ultimate graduation
Evaluating PBL Tutorials-II
bull At the end of each problem time is allocated for evaluation
bull Both the process amp learning in PBL can be evaluated against explicit goals
bull The tutorrsquos review of effectiveness of group processes offers insight for the members
bull Students normally evaluate their tutor helpfulness support for clinical reasoning encouragement for independent learning appropriate intervention provision for effective feedback
PBLbull 1048708 Enabling students to learn in the context in which the
information will be used which increases the ability to retrieve and apply information
bull 1048708 Focusing on important concepts which helps learners organize and store new information in a way that facilitates retrieval and application
bull 1048708 Exploring prior knowledge formulating inquiries derived from and defined by the learnersrsquo need to know and actively constructing meaning through dialogue and reflection
bull 1048708 Utilizing problems designed to simulate studentsrsquo perception of their future profession which serves as a powerful stimulus for studentsrsquo intrinsic motivation to learn
bull 1048708 Actively involving students in monitoring their own progress and reflecting on what works and what needs improvement frequently assessing student performance and providing feedback
PBL Starting the casebull After the introductions and discussion
are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it
bull Reading the case aloud keeps the group focused
bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here
PBL Case (contd)
bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session
PBL Case contdbull SECOND deciding which issues everyone will
tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)
bull THIRD deciding what SPECIFIC questions individuals will try to answer
bull FOURTH deciding how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet or consulting an expert)
The Process of PBL
bullWhat are the issues Identify the important issues in the problem
bull How well do you understand the issues
bull Are there any words or terms about which you are unclear
The Process of PBL contd
bull Consider the basic mechanisms that might explain each important aspect of each problem
bull Assess your current understanding of the basic structural andor functional mechanisms that may contribute to the presentation of the problem
bull Use the collective skills and experiences of group members to explore or explain these phenomena Identify current gaps in knowledge or understanding
Learn from each other
bullShare your own knowledge expertise or ability to reason and synthesize information Be receptive and appreciative of the contribution of your small group members
Determine priorities for learning
bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue
bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan
bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge
bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career
PBL
bull The problem comes first without advance readings lectures or preparation
bull The problem serves as a stimulus for the need to know
Learning Issues
bull Learning issues are questions that cannot be answered with studentsrsquo current knowledge and that can be explored and answered through systematic self-directed inquiry
bull The use of learning issues in tutorials prepares students to handle similar challenges in clinical practice and life-long learning
Learning Issues in PBL First Session1 Getting Started (Introductions Ground
Rules Expectations)2 Identifying Problem3 Exploring Pre-Existing Knowledge4 Generating Hypotheses and Explaining
Mechanisms5 Unfolding the Case Incrementally6 Re-EvaluatingReprioritizing Hypotheses
Based on New Information7 AssessmentReflection
PBL Second Session
8 Independent Self-Directed Study of Learning Issues
PBL Third Session
bull 9 Discussion of Learning Issues and Application of New Knowledge to the Case
bull 10 Continued Unfolding of the Case Incrementally
bull 11 AssessmentReflection
During Tutorial Session students will
1048708 Come prepared to discuss the case and learning issues researched since the last tutorial
1048708 Actively participate in group discussions and contribute to the learning process in a manner that allows for the balanced participation of everyone in the group
1048708 Develop learning issues at each session phrase them as full-sentence questions write them on the board and post them on the course web page
1048708 Consider biological population behaviormental health issuesexplanations and questions of professional attitudes values and ethics related to the patientrsquos problem(s) described in the case
Tutorial Session contd1048708 Go to the board to diagram outline draw etc in
explanation of mechanisms relatedto hypotheses1048708 Debate evidence related to the case and avoid
personal attacks on others1048708 Comply with ground rules with regard to how
the group will function and how itsmembers treat one another1048708 Participate in end-of-session reflection and
assessment by giving and receivingconstructive criticism regarding self tutor
student and group performance
Between Tutorial Session
1048708 Research key learning issues using a variety of resources
1048708 Critically evaluate the credibility of sources and the validity of the information they have obtained in their research
1048708 Integrate what they have learned through research lectures labs clinical skills Perspectives in Medicine (PIM) etc into what is discussed in tutorials
1048708 Synthesize what they have learned and be prepared to discuss it without reading directly from their materials as much as possible and apply it to the case at the next tutorial session
Determine priorities for learning
bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue
bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan
bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge
bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career
PBL Starting the casebull After the introductions and discussion
are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it
bull Reading the case aloud keeps the group focused
bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here
Problem-based learning is designed to develop
1048708 Integrated context-specific knowledge base
1048708 Decision-makingcritical thinking process and skills
1048708 Self-directed life-long learning skills 1048708 Interpersonal collaboration and
communication skills 1048708 Constructive self and peer
assessment skills 1048708 Professional ethics and behavior
PBL Case (contd)
bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session
What is problem based learning
bull In PBL students use triggers from the problem case or scenario to define their own learning objectives
bull Subsequently they do independent self directed study before returning to the group to discuss and refine their acquired knowledge
bull Thus PBL is not about problem solving per se but rather it uses appropriate problems to increase knowledge and understanding
bull The process is clearly defined
PBL
bull PBL uses clinical cases as the context for students to study basic and clinical sciences
bull 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
bull Possible disadvantages include higher costs both in resources and staff time
PBL
bull An educational method characterized by the use of patient problems as a context for students to learn problem-solving skills and acquire knowledge about the basic and clinical sciences
bull Students usually meet in small groups two or three times a week for PBL tutorials
bull They are presented with a clinical problem (eg a patient with chest pain) and in a series of steps they discuss possible mechanisms and causes develop hypotheses and strategies to test the hypotheses are presented with further information and use this new information to refine their hypotheses finally reaching a conclusion
bull A tutor usually acts as a facilitator guiding students in this group-learning process
bull In the course of this exercise students identify both their existing levels and gaps in their knowledge These gaps form the basis for independent learning outside the PBL tutorials The identification and pursuit of these so-called learning goals is a key element of the PBL process
Rationale for using PBL bull The PBL approach is based on principles of adult
education20 and cognitive psychology21 It differs fundamentally from traditional curricula in which students acquire background knowledge of the basic sciences in the early years of the course and in the later years apply this knowledge to the diagnosis and management of clinical problems This traditional approach has been criticised for a number of reasons42223
bull It creates an artificial divide between the basic and clinical sciences
bull Time is wasted in acquiring knowledge that is subsequently forgotten or found to be irrelevant
bull Application of the acquired knowledge can be difficult bull The acquisition and retention of information that has no
apparent relevance can be boring and even demoralising for students
The group learning process acquiring
desirable learning skills
Generic Skills amp attitudes
bull Teamwork bull Critical evaluation of literature bull Chairing a group bull Self directed learning and use of
resources bull Listening Presentation skills
Recording bull Cooperation bull Respect for colleagues views
bull Group learning facilitates not only the acquisition of knowledge but also several other desirable attributes such as communication skills teamwork problem solving independent responsibility for learning sharing information and respect for others PBL can therefore be thought of as a small group teaching method that combines the acquisition of knowledge with the development of generic skills and attitudes Presentation of clinical material as the stimulus for learning enables students to understand the relevance of underlying scientific knowledge and principles in clinical practice
bull when PBL is introduced into a curriculum several other issues for curriculum design and implementation need to be tackled PBL is generally introduced in the context of a defined core curriculum and integration of basic and clinical sciences It has implications for staffing and learning resources and demands a different approach to timetabling workload and assessment PBL is often used to deliver core material in non-clinical parts of the curriculum Paper based PBL scenarios form the basis of the core curriculum and ensure that all students are exposed to the same problems Recently modified PBL techniques have been introduced into clinical education with real patients being used as the stimulus for learning Despite the essential ad hoc nature of learning clinical medicine a key cases approach can enable PBL to be used to deliver the core clinical curriculum
Copyright copy2003 BMJ Publishing Group Ltd
Wood D F BMJ 2003326328-330
No CRoles of participants in a PBL tutorial aption Found
What happens in a PBL tutorial bull PBL tutorials are conducted in several ways In
this article the examples are modelled on the Maastricht seven jump process but its format of seven steps may be shortened
bull A typical PBL tutorial consists of a group of students (usually eight to 10) and a tutor who facilitates the session The length of time (number of sessions) that a group stays together with each other and with individual tutors varies between institutions A group needs to be together long enough to allow good group dynamics to develop but may need to be changed occasionally if personality clashes or other dysfunctional behaviour emerges
bull Students elect a chair for each PBL scenario and a scribe to record the discussion The roles are rotated for each scenario Suitable flip charts or a whiteboard should be used for recording the proceedings At the start of the session depending on the trigger material either the student chair reads out the scenario or all students study the material If the trigger is a real patient in a ward clinic or surgery then a student may be asked to take a clinical history or identify an abnormal physical sign before the group moves to a tutorial room For each module students may be given a handbook containing the problem scenarios and suggested learning resources or learning materials may be handed out at appropriate times as the tutorials progress
Examples of trigger material for PBL scenarios bull Paper based clinical scenarios bull Experimental or clinical laboratory data bull Photographs bull Video clips bull Newspaper articles bull All or part of an article from a scientific
journal bull A real or simulated patient bull A family tree showing an inherited
disorder
PBL tutorial process ndash Step 1 Identify and clarify unfamiliar terms presented in the scenario
scribe lists those that remain unexplained after discussion ndash Step 2 Define the problem or problems to be discussed students may
have different views on the issues but all should be considered scribe records a list of agreed problems
ndash Step 3 Brainstorming session to discuss the problem(s) suggestingpossible explanations on basis of prior knowledge students draw on each others knowledge and identify areas of incomplete knowledge scribe records all discussion
ndash Step 4 Review steps 2 and 3 and arrange explanations into tentativesolutions scribe organises the explanations and restructures if necessary
ndash Step 5 Formulate learning objectives group reaches consensus onthe learning objectives tutor ensures learning objectives are focused achievable comprehensive and appropriate
ndash Step 6 Private study (all students gather information related to eachlearning objective)
ndash Step 7 Group shares results of private study (students identify theirlearning resources and share their results) tutor checks learning and may assess the group
bull The role of the tutor is to facilitate the proceedings (helping the chair to maintain group dynamics and moving the group through the task) and to ensure that the group achieves appropriate learning objectives in line with those set by the curriculum design team The tutor may need to take a more active role in step 7 of the process to ensure that all the students have done the appropriate work and to help the chair to suggest a suitable format for group members to use to present the results of their private study The tutor should encourage students to check their understanding of the material He or she can do this by encouraging the students to ask open questions and ask each other to explain topics in their own words or by the use of drawings and diagrams
PBL in curriculum design bull PBL may be used either as the mainstay of an entire
curriculum or for the delivery of individual courses In practice PBL is usually part of an integrated curriculum using a systems based approach with non-clinical material delivered in the context of clinical practice A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge skills and attitudes A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios Sufficient time should be allowed each week for students to do the self directed learning required for PBL
bull
Copyright copy2003 BMJ Publishing Group Ltd
Wood D F BMJ 2003326328-330
No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found
Writing PBL scenarios
bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives
bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after
studying the scenario should be consistent with the faculty learning objectives
bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding
bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice
bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge
bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented
bull The problem should be sufficiently open so that discussion is not curtailed too early in the process
bull Scenarios should promote participation by the students in seeking information from various learning resources
bull Adapted from Dolmans et al Med Teacher 199719185-9
Staff development
bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)
A dysfunctional group a dominant character may
make it difficult for other students to be heard
A dysfunctional group a dominant character may make it difficult for other students to be heard
bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties
Advantages of PBL bull Student centred PBLIt fostersactive learning improved
understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks
Disadvantagesbull Tutors who cant teachTutorsenjoy passing on
their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful
Assessment of PBL
bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods
bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL
Conclusion
bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning
bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL
PBL 5 Easy Steps
bull Read the problem
Mrs Paula Embledon
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
2 Brain storm
bull Brainstorm
bull ndash hypotheses
bull - what do we know in support of the hypothesis
bull - what do we need to know to test the hypothesis
ndash learning issues
Brainstorm
bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)
ndash specific issues (for individuals to look up)
ndash overlapping issues
bull 4 Individual Reading - Research - Preparation
bull 5 Return
bull ndash review case so far ndash report and discuss
ndash assess progress - continue pagenext pagecomplete
ndash self-evaluation - How did things go Any suggestions for next time
ndash next problem
bull 5 Return
THE FIRST GROUP SESSION
bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day
bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session
bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr
bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine
bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise
bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator
bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues
bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know
bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)
bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)
bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)
bull The exponential growth of med knowledge amp the greatly increased content of the scientific aspect of the curriculum has made the selection of appropriate core content and the integration of basic and clinical sciences important aspects of curricular design
Domains of essential Global Requirements of ME
What was the response to these challenges
bull The development of new curricula incorporating new curriculum themes amp different educational strategies
bull The introduction of new learning situations amp the use of new tools amp aids to learning
bull New methods of assessment [OSCE objective structured clinical exam Which can test performance amp competence in a wide diversity of settings Formative Assessment Portfolio assessment Work-based assess]
New Educational Strategies
bull New strategies appropriate for adult learning (instead of spoon-feeding)
bull Self-directed learningbull Problem Based Learningbull Integrated system based approachbull Task Based learningbull Core amp Student-selected
Componentsbull A spiral curriculum
New Tools amp Aids
bull Use of Study Guides
bull Use of Computer Assisted Programs amp Internet
bull Use of Videos to teach Clinical Skillsconsultation techniques
bull Role of Simulators amp Simulations in aspects of physical exam amp practical procedures
PBLbull Problem-based learning (PBL) is a method of
learning in which learners first encounter a problem followed by a systematic learner-centered inquiry and reflection process
bull PBL is a method designed to help students learn the sciences basic to medicine at the same time they develop the reasoning process used by physicians and other health professionals in their clinical practice
bull 1048708 The problem comes first without advance readings lectures or preparation
bull 1048708 The problem serves as a stimulus for the need to know
PBLbullHelps learners build a bridge
between what they already know and what they need to know to reachthe next level
bull Emphasizing active learning which has been shown to be more satisfying than
passive teacher-to-student learning and to enhance retention and recall
bull Emphasizing student-centered learning in which students are actively involved in setting their own learning goals
Advantages
Encourages bull effective amp self-directed learningbull Critical thinkingbull Team workbull understanding rather than
memorizationbull Facility with professional languagebull Both students amp staff enjoy the
process
Advantages
In preparing students for professional practice PBL
bull Encourages independence as students identify amp meet individual learning needs
bull Stimulates reflection amp self-direction for life-long learning
bull Supports ongoing self-assessmentbull Introduces clinical reasoningbull Enhances critical thinking amp evidence-based
decision makingbull Ensures that knowledge is transferred applied
amp retained by providing a relevant integrated context
bull A problem initiates the activitybull The Group is stimulated to explore
basic scientific amp clinical mechanisms together with social psychological ethical or professional issues
bull Problem stimulates students to reason think critically amp weigh evidence they seek out amp share relevant info
PBL
bull Groups do not need prior knowledge to generate lively ideas as they identify areas for further collective amp personal learning
bull Each student brings individual experience amp makes a distinctive contribution
bull the Tutorrsquos role is to manage interactions rather than supply info
bull An effective Group provides a safe environment for sharing amp testing new knowledge
bull Students practice the language of science amp medicine evaluate ideas and receive feedback from peers amp teacher
bull When clinical exposure is introduced concurrently intellectual amp practical skills develop in parallel
Framework for PBL
bull A trigger initiates the problem (papercomputervideo)
bull Groups brainstorm to identify key issues for discussion
bull Broad thinking produces a rich array of mechanisms amp ideas
bull Hypothesis are critically explored through reasoning
bull The need for additional info is identifiedbull A Conclusion is reachedbull Group reviews the process
Framework for PBL - II
bull In Breaks between Tutorials students identfy Learning Issues to be pursued
bull They are encouraged to adot an evidence-based approach
bull When they reconvene they share and review the learning
Characteristics of an effective PBL Group
An Effective Group is Cohesive motivated mutually supportive amp actively engaged in learning
bull The Group understands the process amp energetically pursues its task
bull Members respect each otherrsquos contribution but examine them critically
bull Discussions flow as students cooperate rather than compete
bull The atmosphere is friendly amp good humouredbull Roles are shared all take turns in scribing
leading discussion taking responsibility for acquiring information
Staff Development
bull Basic training is mandatorybull Further development may be a requirementbull Initial training may involve observation amp
practice with a group from the programbull Effective training ensures that necessary
background goals amp local strategies are considered together with info on assessment amp evaluation
bull In addition to materials supplied to students tutors are usually issued with handbooks highlighting issues for each problem
Tutorrsquos Role in Assessment
bull Individual StudentsGroups may be assessed Summatively (determining progression) or formatively (for feedback)
The GROUP
bull At the end of each problem groups review their processes to encourage self-reflection ampenhance their collective performance
Tutorrsquos Role in Assessment
Individual students
bull Tutors should provide formative feedback to each member
bull Ask students to complete a simple self-assessment questionnaire reviewing appropriate behaviors the tutor returns them with comments
bull Students will be a writtenoralclinical tests that will determine their progression amp ultimate graduation
Evaluating PBL Tutorials-II
bull At the end of each problem time is allocated for evaluation
bull Both the process amp learning in PBL can be evaluated against explicit goals
bull The tutorrsquos review of effectiveness of group processes offers insight for the members
bull Students normally evaluate their tutor helpfulness support for clinical reasoning encouragement for independent learning appropriate intervention provision for effective feedback
PBLbull 1048708 Enabling students to learn in the context in which the
information will be used which increases the ability to retrieve and apply information
bull 1048708 Focusing on important concepts which helps learners organize and store new information in a way that facilitates retrieval and application
bull 1048708 Exploring prior knowledge formulating inquiries derived from and defined by the learnersrsquo need to know and actively constructing meaning through dialogue and reflection
bull 1048708 Utilizing problems designed to simulate studentsrsquo perception of their future profession which serves as a powerful stimulus for studentsrsquo intrinsic motivation to learn
bull 1048708 Actively involving students in monitoring their own progress and reflecting on what works and what needs improvement frequently assessing student performance and providing feedback
PBL Starting the casebull After the introductions and discussion
are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it
bull Reading the case aloud keeps the group focused
bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here
PBL Case (contd)
bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session
PBL Case contdbull SECOND deciding which issues everyone will
tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)
bull THIRD deciding what SPECIFIC questions individuals will try to answer
bull FOURTH deciding how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet or consulting an expert)
The Process of PBL
bullWhat are the issues Identify the important issues in the problem
bull How well do you understand the issues
bull Are there any words or terms about which you are unclear
The Process of PBL contd
bull Consider the basic mechanisms that might explain each important aspect of each problem
bull Assess your current understanding of the basic structural andor functional mechanisms that may contribute to the presentation of the problem
bull Use the collective skills and experiences of group members to explore or explain these phenomena Identify current gaps in knowledge or understanding
Learn from each other
bullShare your own knowledge expertise or ability to reason and synthesize information Be receptive and appreciative of the contribution of your small group members
Determine priorities for learning
bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue
bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan
bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge
bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career
PBL
bull The problem comes first without advance readings lectures or preparation
bull The problem serves as a stimulus for the need to know
Learning Issues
bull Learning issues are questions that cannot be answered with studentsrsquo current knowledge and that can be explored and answered through systematic self-directed inquiry
bull The use of learning issues in tutorials prepares students to handle similar challenges in clinical practice and life-long learning
Learning Issues in PBL First Session1 Getting Started (Introductions Ground
Rules Expectations)2 Identifying Problem3 Exploring Pre-Existing Knowledge4 Generating Hypotheses and Explaining
Mechanisms5 Unfolding the Case Incrementally6 Re-EvaluatingReprioritizing Hypotheses
Based on New Information7 AssessmentReflection
PBL Second Session
8 Independent Self-Directed Study of Learning Issues
PBL Third Session
bull 9 Discussion of Learning Issues and Application of New Knowledge to the Case
bull 10 Continued Unfolding of the Case Incrementally
bull 11 AssessmentReflection
During Tutorial Session students will
1048708 Come prepared to discuss the case and learning issues researched since the last tutorial
1048708 Actively participate in group discussions and contribute to the learning process in a manner that allows for the balanced participation of everyone in the group
1048708 Develop learning issues at each session phrase them as full-sentence questions write them on the board and post them on the course web page
1048708 Consider biological population behaviormental health issuesexplanations and questions of professional attitudes values and ethics related to the patientrsquos problem(s) described in the case
Tutorial Session contd1048708 Go to the board to diagram outline draw etc in
explanation of mechanisms relatedto hypotheses1048708 Debate evidence related to the case and avoid
personal attacks on others1048708 Comply with ground rules with regard to how
the group will function and how itsmembers treat one another1048708 Participate in end-of-session reflection and
assessment by giving and receivingconstructive criticism regarding self tutor
student and group performance
Between Tutorial Session
1048708 Research key learning issues using a variety of resources
1048708 Critically evaluate the credibility of sources and the validity of the information they have obtained in their research
1048708 Integrate what they have learned through research lectures labs clinical skills Perspectives in Medicine (PIM) etc into what is discussed in tutorials
1048708 Synthesize what they have learned and be prepared to discuss it without reading directly from their materials as much as possible and apply it to the case at the next tutorial session
Determine priorities for learning
bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue
bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan
bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge
bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career
PBL Starting the casebull After the introductions and discussion
are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it
bull Reading the case aloud keeps the group focused
bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here
Problem-based learning is designed to develop
1048708 Integrated context-specific knowledge base
1048708 Decision-makingcritical thinking process and skills
1048708 Self-directed life-long learning skills 1048708 Interpersonal collaboration and
communication skills 1048708 Constructive self and peer
assessment skills 1048708 Professional ethics and behavior
PBL Case (contd)
bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session
What is problem based learning
bull In PBL students use triggers from the problem case or scenario to define their own learning objectives
bull Subsequently they do independent self directed study before returning to the group to discuss and refine their acquired knowledge
bull Thus PBL is not about problem solving per se but rather it uses appropriate problems to increase knowledge and understanding
bull The process is clearly defined
PBL
bull PBL uses clinical cases as the context for students to study basic and clinical sciences
bull 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
bull Possible disadvantages include higher costs both in resources and staff time
PBL
bull An educational method characterized by the use of patient problems as a context for students to learn problem-solving skills and acquire knowledge about the basic and clinical sciences
bull Students usually meet in small groups two or three times a week for PBL tutorials
bull They are presented with a clinical problem (eg a patient with chest pain) and in a series of steps they discuss possible mechanisms and causes develop hypotheses and strategies to test the hypotheses are presented with further information and use this new information to refine their hypotheses finally reaching a conclusion
bull A tutor usually acts as a facilitator guiding students in this group-learning process
bull In the course of this exercise students identify both their existing levels and gaps in their knowledge These gaps form the basis for independent learning outside the PBL tutorials The identification and pursuit of these so-called learning goals is a key element of the PBL process
Rationale for using PBL bull The PBL approach is based on principles of adult
education20 and cognitive psychology21 It differs fundamentally from traditional curricula in which students acquire background knowledge of the basic sciences in the early years of the course and in the later years apply this knowledge to the diagnosis and management of clinical problems This traditional approach has been criticised for a number of reasons42223
bull It creates an artificial divide between the basic and clinical sciences
bull Time is wasted in acquiring knowledge that is subsequently forgotten or found to be irrelevant
bull Application of the acquired knowledge can be difficult bull The acquisition and retention of information that has no
apparent relevance can be boring and even demoralising for students
The group learning process acquiring
desirable learning skills
Generic Skills amp attitudes
bull Teamwork bull Critical evaluation of literature bull Chairing a group bull Self directed learning and use of
resources bull Listening Presentation skills
Recording bull Cooperation bull Respect for colleagues views
bull Group learning facilitates not only the acquisition of knowledge but also several other desirable attributes such as communication skills teamwork problem solving independent responsibility for learning sharing information and respect for others PBL can therefore be thought of as a small group teaching method that combines the acquisition of knowledge with the development of generic skills and attitudes Presentation of clinical material as the stimulus for learning enables students to understand the relevance of underlying scientific knowledge and principles in clinical practice
bull when PBL is introduced into a curriculum several other issues for curriculum design and implementation need to be tackled PBL is generally introduced in the context of a defined core curriculum and integration of basic and clinical sciences It has implications for staffing and learning resources and demands a different approach to timetabling workload and assessment PBL is often used to deliver core material in non-clinical parts of the curriculum Paper based PBL scenarios form the basis of the core curriculum and ensure that all students are exposed to the same problems Recently modified PBL techniques have been introduced into clinical education with real patients being used as the stimulus for learning Despite the essential ad hoc nature of learning clinical medicine a key cases approach can enable PBL to be used to deliver the core clinical curriculum
Copyright copy2003 BMJ Publishing Group Ltd
Wood D F BMJ 2003326328-330
No CRoles of participants in a PBL tutorial aption Found
What happens in a PBL tutorial bull PBL tutorials are conducted in several ways In
this article the examples are modelled on the Maastricht seven jump process but its format of seven steps may be shortened
bull A typical PBL tutorial consists of a group of students (usually eight to 10) and a tutor who facilitates the session The length of time (number of sessions) that a group stays together with each other and with individual tutors varies between institutions A group needs to be together long enough to allow good group dynamics to develop but may need to be changed occasionally if personality clashes or other dysfunctional behaviour emerges
bull Students elect a chair for each PBL scenario and a scribe to record the discussion The roles are rotated for each scenario Suitable flip charts or a whiteboard should be used for recording the proceedings At the start of the session depending on the trigger material either the student chair reads out the scenario or all students study the material If the trigger is a real patient in a ward clinic or surgery then a student may be asked to take a clinical history or identify an abnormal physical sign before the group moves to a tutorial room For each module students may be given a handbook containing the problem scenarios and suggested learning resources or learning materials may be handed out at appropriate times as the tutorials progress
Examples of trigger material for PBL scenarios bull Paper based clinical scenarios bull Experimental or clinical laboratory data bull Photographs bull Video clips bull Newspaper articles bull All or part of an article from a scientific
journal bull A real or simulated patient bull A family tree showing an inherited
disorder
PBL tutorial process ndash Step 1 Identify and clarify unfamiliar terms presented in the scenario
scribe lists those that remain unexplained after discussion ndash Step 2 Define the problem or problems to be discussed students may
have different views on the issues but all should be considered scribe records a list of agreed problems
ndash Step 3 Brainstorming session to discuss the problem(s) suggestingpossible explanations on basis of prior knowledge students draw on each others knowledge and identify areas of incomplete knowledge scribe records all discussion
ndash Step 4 Review steps 2 and 3 and arrange explanations into tentativesolutions scribe organises the explanations and restructures if necessary
ndash Step 5 Formulate learning objectives group reaches consensus onthe learning objectives tutor ensures learning objectives are focused achievable comprehensive and appropriate
ndash Step 6 Private study (all students gather information related to eachlearning objective)
ndash Step 7 Group shares results of private study (students identify theirlearning resources and share their results) tutor checks learning and may assess the group
bull The role of the tutor is to facilitate the proceedings (helping the chair to maintain group dynamics and moving the group through the task) and to ensure that the group achieves appropriate learning objectives in line with those set by the curriculum design team The tutor may need to take a more active role in step 7 of the process to ensure that all the students have done the appropriate work and to help the chair to suggest a suitable format for group members to use to present the results of their private study The tutor should encourage students to check their understanding of the material He or she can do this by encouraging the students to ask open questions and ask each other to explain topics in their own words or by the use of drawings and diagrams
PBL in curriculum design bull PBL may be used either as the mainstay of an entire
curriculum or for the delivery of individual courses In practice PBL is usually part of an integrated curriculum using a systems based approach with non-clinical material delivered in the context of clinical practice A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge skills and attitudes A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios Sufficient time should be allowed each week for students to do the self directed learning required for PBL
bull
Copyright copy2003 BMJ Publishing Group Ltd
Wood D F BMJ 2003326328-330
No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found
Writing PBL scenarios
bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives
bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after
studying the scenario should be consistent with the faculty learning objectives
bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding
bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice
bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge
bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented
bull The problem should be sufficiently open so that discussion is not curtailed too early in the process
bull Scenarios should promote participation by the students in seeking information from various learning resources
bull Adapted from Dolmans et al Med Teacher 199719185-9
Staff development
bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)
A dysfunctional group a dominant character may
make it difficult for other students to be heard
A dysfunctional group a dominant character may make it difficult for other students to be heard
bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties
Advantages of PBL bull Student centred PBLIt fostersactive learning improved
understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks
Disadvantagesbull Tutors who cant teachTutorsenjoy passing on
their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful
Assessment of PBL
bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods
bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL
Conclusion
bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning
bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL
PBL 5 Easy Steps
bull Read the problem
Mrs Paula Embledon
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
2 Brain storm
bull Brainstorm
bull ndash hypotheses
bull - what do we know in support of the hypothesis
bull - what do we need to know to test the hypothesis
ndash learning issues
Brainstorm
bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)
ndash specific issues (for individuals to look up)
ndash overlapping issues
bull 4 Individual Reading - Research - Preparation
bull 5 Return
bull ndash review case so far ndash report and discuss
ndash assess progress - continue pagenext pagecomplete
ndash self-evaluation - How did things go Any suggestions for next time
ndash next problem
bull 5 Return
THE FIRST GROUP SESSION
bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day
bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session
bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr
bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine
bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise
bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator
bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues
bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know
bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)
bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)
bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)
Domains of essential Global Requirements of ME
What was the response to these challenges
bull The development of new curricula incorporating new curriculum themes amp different educational strategies
bull The introduction of new learning situations amp the use of new tools amp aids to learning
bull New methods of assessment [OSCE objective structured clinical exam Which can test performance amp competence in a wide diversity of settings Formative Assessment Portfolio assessment Work-based assess]
New Educational Strategies
bull New strategies appropriate for adult learning (instead of spoon-feeding)
bull Self-directed learningbull Problem Based Learningbull Integrated system based approachbull Task Based learningbull Core amp Student-selected
Componentsbull A spiral curriculum
New Tools amp Aids
bull Use of Study Guides
bull Use of Computer Assisted Programs amp Internet
bull Use of Videos to teach Clinical Skillsconsultation techniques
bull Role of Simulators amp Simulations in aspects of physical exam amp practical procedures
PBLbull Problem-based learning (PBL) is a method of
learning in which learners first encounter a problem followed by a systematic learner-centered inquiry and reflection process
bull PBL is a method designed to help students learn the sciences basic to medicine at the same time they develop the reasoning process used by physicians and other health professionals in their clinical practice
bull 1048708 The problem comes first without advance readings lectures or preparation
bull 1048708 The problem serves as a stimulus for the need to know
PBLbullHelps learners build a bridge
between what they already know and what they need to know to reachthe next level
bull Emphasizing active learning which has been shown to be more satisfying than
passive teacher-to-student learning and to enhance retention and recall
bull Emphasizing student-centered learning in which students are actively involved in setting their own learning goals
Advantages
Encourages bull effective amp self-directed learningbull Critical thinkingbull Team workbull understanding rather than
memorizationbull Facility with professional languagebull Both students amp staff enjoy the
process
Advantages
In preparing students for professional practice PBL
bull Encourages independence as students identify amp meet individual learning needs
bull Stimulates reflection amp self-direction for life-long learning
bull Supports ongoing self-assessmentbull Introduces clinical reasoningbull Enhances critical thinking amp evidence-based
decision makingbull Ensures that knowledge is transferred applied
amp retained by providing a relevant integrated context
bull A problem initiates the activitybull The Group is stimulated to explore
basic scientific amp clinical mechanisms together with social psychological ethical or professional issues
bull Problem stimulates students to reason think critically amp weigh evidence they seek out amp share relevant info
PBL
bull Groups do not need prior knowledge to generate lively ideas as they identify areas for further collective amp personal learning
bull Each student brings individual experience amp makes a distinctive contribution
bull the Tutorrsquos role is to manage interactions rather than supply info
bull An effective Group provides a safe environment for sharing amp testing new knowledge
bull Students practice the language of science amp medicine evaluate ideas and receive feedback from peers amp teacher
bull When clinical exposure is introduced concurrently intellectual amp practical skills develop in parallel
Framework for PBL
bull A trigger initiates the problem (papercomputervideo)
bull Groups brainstorm to identify key issues for discussion
bull Broad thinking produces a rich array of mechanisms amp ideas
bull Hypothesis are critically explored through reasoning
bull The need for additional info is identifiedbull A Conclusion is reachedbull Group reviews the process
Framework for PBL - II
bull In Breaks between Tutorials students identfy Learning Issues to be pursued
bull They are encouraged to adot an evidence-based approach
bull When they reconvene they share and review the learning
Characteristics of an effective PBL Group
An Effective Group is Cohesive motivated mutually supportive amp actively engaged in learning
bull The Group understands the process amp energetically pursues its task
bull Members respect each otherrsquos contribution but examine them critically
bull Discussions flow as students cooperate rather than compete
bull The atmosphere is friendly amp good humouredbull Roles are shared all take turns in scribing
leading discussion taking responsibility for acquiring information
Staff Development
bull Basic training is mandatorybull Further development may be a requirementbull Initial training may involve observation amp
practice with a group from the programbull Effective training ensures that necessary
background goals amp local strategies are considered together with info on assessment amp evaluation
bull In addition to materials supplied to students tutors are usually issued with handbooks highlighting issues for each problem
Tutorrsquos Role in Assessment
bull Individual StudentsGroups may be assessed Summatively (determining progression) or formatively (for feedback)
The GROUP
bull At the end of each problem groups review their processes to encourage self-reflection ampenhance their collective performance
Tutorrsquos Role in Assessment
Individual students
bull Tutors should provide formative feedback to each member
bull Ask students to complete a simple self-assessment questionnaire reviewing appropriate behaviors the tutor returns them with comments
bull Students will be a writtenoralclinical tests that will determine their progression amp ultimate graduation
Evaluating PBL Tutorials-II
bull At the end of each problem time is allocated for evaluation
bull Both the process amp learning in PBL can be evaluated against explicit goals
bull The tutorrsquos review of effectiveness of group processes offers insight for the members
bull Students normally evaluate their tutor helpfulness support for clinical reasoning encouragement for independent learning appropriate intervention provision for effective feedback
PBLbull 1048708 Enabling students to learn in the context in which the
information will be used which increases the ability to retrieve and apply information
bull 1048708 Focusing on important concepts which helps learners organize and store new information in a way that facilitates retrieval and application
bull 1048708 Exploring prior knowledge formulating inquiries derived from and defined by the learnersrsquo need to know and actively constructing meaning through dialogue and reflection
bull 1048708 Utilizing problems designed to simulate studentsrsquo perception of their future profession which serves as a powerful stimulus for studentsrsquo intrinsic motivation to learn
bull 1048708 Actively involving students in monitoring their own progress and reflecting on what works and what needs improvement frequently assessing student performance and providing feedback
PBL Starting the casebull After the introductions and discussion
are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it
bull Reading the case aloud keeps the group focused
bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here
PBL Case (contd)
bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session
PBL Case contdbull SECOND deciding which issues everyone will
tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)
bull THIRD deciding what SPECIFIC questions individuals will try to answer
bull FOURTH deciding how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet or consulting an expert)
The Process of PBL
bullWhat are the issues Identify the important issues in the problem
bull How well do you understand the issues
bull Are there any words or terms about which you are unclear
The Process of PBL contd
bull Consider the basic mechanisms that might explain each important aspect of each problem
bull Assess your current understanding of the basic structural andor functional mechanisms that may contribute to the presentation of the problem
bull Use the collective skills and experiences of group members to explore or explain these phenomena Identify current gaps in knowledge or understanding
Learn from each other
bullShare your own knowledge expertise or ability to reason and synthesize information Be receptive and appreciative of the contribution of your small group members
Determine priorities for learning
bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue
bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan
bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge
bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career
PBL
bull The problem comes first without advance readings lectures or preparation
bull The problem serves as a stimulus for the need to know
Learning Issues
bull Learning issues are questions that cannot be answered with studentsrsquo current knowledge and that can be explored and answered through systematic self-directed inquiry
bull The use of learning issues in tutorials prepares students to handle similar challenges in clinical practice and life-long learning
Learning Issues in PBL First Session1 Getting Started (Introductions Ground
Rules Expectations)2 Identifying Problem3 Exploring Pre-Existing Knowledge4 Generating Hypotheses and Explaining
Mechanisms5 Unfolding the Case Incrementally6 Re-EvaluatingReprioritizing Hypotheses
Based on New Information7 AssessmentReflection
PBL Second Session
8 Independent Self-Directed Study of Learning Issues
PBL Third Session
bull 9 Discussion of Learning Issues and Application of New Knowledge to the Case
bull 10 Continued Unfolding of the Case Incrementally
bull 11 AssessmentReflection
During Tutorial Session students will
1048708 Come prepared to discuss the case and learning issues researched since the last tutorial
1048708 Actively participate in group discussions and contribute to the learning process in a manner that allows for the balanced participation of everyone in the group
1048708 Develop learning issues at each session phrase them as full-sentence questions write them on the board and post them on the course web page
1048708 Consider biological population behaviormental health issuesexplanations and questions of professional attitudes values and ethics related to the patientrsquos problem(s) described in the case
Tutorial Session contd1048708 Go to the board to diagram outline draw etc in
explanation of mechanisms relatedto hypotheses1048708 Debate evidence related to the case and avoid
personal attacks on others1048708 Comply with ground rules with regard to how
the group will function and how itsmembers treat one another1048708 Participate in end-of-session reflection and
assessment by giving and receivingconstructive criticism regarding self tutor
student and group performance
Between Tutorial Session
1048708 Research key learning issues using a variety of resources
1048708 Critically evaluate the credibility of sources and the validity of the information they have obtained in their research
1048708 Integrate what they have learned through research lectures labs clinical skills Perspectives in Medicine (PIM) etc into what is discussed in tutorials
1048708 Synthesize what they have learned and be prepared to discuss it without reading directly from their materials as much as possible and apply it to the case at the next tutorial session
Determine priorities for learning
bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue
bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan
bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge
bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career
PBL Starting the casebull After the introductions and discussion
are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it
bull Reading the case aloud keeps the group focused
bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here
Problem-based learning is designed to develop
1048708 Integrated context-specific knowledge base
1048708 Decision-makingcritical thinking process and skills
1048708 Self-directed life-long learning skills 1048708 Interpersonal collaboration and
communication skills 1048708 Constructive self and peer
assessment skills 1048708 Professional ethics and behavior
PBL Case (contd)
bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session
What is problem based learning
bull In PBL students use triggers from the problem case or scenario to define their own learning objectives
bull Subsequently they do independent self directed study before returning to the group to discuss and refine their acquired knowledge
bull Thus PBL is not about problem solving per se but rather it uses appropriate problems to increase knowledge and understanding
bull The process is clearly defined
PBL
bull PBL uses clinical cases as the context for students to study basic and clinical sciences
bull 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
bull Possible disadvantages include higher costs both in resources and staff time
PBL
bull An educational method characterized by the use of patient problems as a context for students to learn problem-solving skills and acquire knowledge about the basic and clinical sciences
bull Students usually meet in small groups two or three times a week for PBL tutorials
bull They are presented with a clinical problem (eg a patient with chest pain) and in a series of steps they discuss possible mechanisms and causes develop hypotheses and strategies to test the hypotheses are presented with further information and use this new information to refine their hypotheses finally reaching a conclusion
bull A tutor usually acts as a facilitator guiding students in this group-learning process
bull In the course of this exercise students identify both their existing levels and gaps in their knowledge These gaps form the basis for independent learning outside the PBL tutorials The identification and pursuit of these so-called learning goals is a key element of the PBL process
Rationale for using PBL bull The PBL approach is based on principles of adult
education20 and cognitive psychology21 It differs fundamentally from traditional curricula in which students acquire background knowledge of the basic sciences in the early years of the course and in the later years apply this knowledge to the diagnosis and management of clinical problems This traditional approach has been criticised for a number of reasons42223
bull It creates an artificial divide between the basic and clinical sciences
bull Time is wasted in acquiring knowledge that is subsequently forgotten or found to be irrelevant
bull Application of the acquired knowledge can be difficult bull The acquisition and retention of information that has no
apparent relevance can be boring and even demoralising for students
The group learning process acquiring
desirable learning skills
Generic Skills amp attitudes
bull Teamwork bull Critical evaluation of literature bull Chairing a group bull Self directed learning and use of
resources bull Listening Presentation skills
Recording bull Cooperation bull Respect for colleagues views
bull Group learning facilitates not only the acquisition of knowledge but also several other desirable attributes such as communication skills teamwork problem solving independent responsibility for learning sharing information and respect for others PBL can therefore be thought of as a small group teaching method that combines the acquisition of knowledge with the development of generic skills and attitudes Presentation of clinical material as the stimulus for learning enables students to understand the relevance of underlying scientific knowledge and principles in clinical practice
bull when PBL is introduced into a curriculum several other issues for curriculum design and implementation need to be tackled PBL is generally introduced in the context of a defined core curriculum and integration of basic and clinical sciences It has implications for staffing and learning resources and demands a different approach to timetabling workload and assessment PBL is often used to deliver core material in non-clinical parts of the curriculum Paper based PBL scenarios form the basis of the core curriculum and ensure that all students are exposed to the same problems Recently modified PBL techniques have been introduced into clinical education with real patients being used as the stimulus for learning Despite the essential ad hoc nature of learning clinical medicine a key cases approach can enable PBL to be used to deliver the core clinical curriculum
Copyright copy2003 BMJ Publishing Group Ltd
Wood D F BMJ 2003326328-330
No CRoles of participants in a PBL tutorial aption Found
What happens in a PBL tutorial bull PBL tutorials are conducted in several ways In
this article the examples are modelled on the Maastricht seven jump process but its format of seven steps may be shortened
bull A typical PBL tutorial consists of a group of students (usually eight to 10) and a tutor who facilitates the session The length of time (number of sessions) that a group stays together with each other and with individual tutors varies between institutions A group needs to be together long enough to allow good group dynamics to develop but may need to be changed occasionally if personality clashes or other dysfunctional behaviour emerges
bull Students elect a chair for each PBL scenario and a scribe to record the discussion The roles are rotated for each scenario Suitable flip charts or a whiteboard should be used for recording the proceedings At the start of the session depending on the trigger material either the student chair reads out the scenario or all students study the material If the trigger is a real patient in a ward clinic or surgery then a student may be asked to take a clinical history or identify an abnormal physical sign before the group moves to a tutorial room For each module students may be given a handbook containing the problem scenarios and suggested learning resources or learning materials may be handed out at appropriate times as the tutorials progress
Examples of trigger material for PBL scenarios bull Paper based clinical scenarios bull Experimental or clinical laboratory data bull Photographs bull Video clips bull Newspaper articles bull All or part of an article from a scientific
journal bull A real or simulated patient bull A family tree showing an inherited
disorder
PBL tutorial process ndash Step 1 Identify and clarify unfamiliar terms presented in the scenario
scribe lists those that remain unexplained after discussion ndash Step 2 Define the problem or problems to be discussed students may
have different views on the issues but all should be considered scribe records a list of agreed problems
ndash Step 3 Brainstorming session to discuss the problem(s) suggestingpossible explanations on basis of prior knowledge students draw on each others knowledge and identify areas of incomplete knowledge scribe records all discussion
ndash Step 4 Review steps 2 and 3 and arrange explanations into tentativesolutions scribe organises the explanations and restructures if necessary
ndash Step 5 Formulate learning objectives group reaches consensus onthe learning objectives tutor ensures learning objectives are focused achievable comprehensive and appropriate
ndash Step 6 Private study (all students gather information related to eachlearning objective)
ndash Step 7 Group shares results of private study (students identify theirlearning resources and share their results) tutor checks learning and may assess the group
bull The role of the tutor is to facilitate the proceedings (helping the chair to maintain group dynamics and moving the group through the task) and to ensure that the group achieves appropriate learning objectives in line with those set by the curriculum design team The tutor may need to take a more active role in step 7 of the process to ensure that all the students have done the appropriate work and to help the chair to suggest a suitable format for group members to use to present the results of their private study The tutor should encourage students to check their understanding of the material He or she can do this by encouraging the students to ask open questions and ask each other to explain topics in their own words or by the use of drawings and diagrams
PBL in curriculum design bull PBL may be used either as the mainstay of an entire
curriculum or for the delivery of individual courses In practice PBL is usually part of an integrated curriculum using a systems based approach with non-clinical material delivered in the context of clinical practice A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge skills and attitudes A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios Sufficient time should be allowed each week for students to do the self directed learning required for PBL
bull
Copyright copy2003 BMJ Publishing Group Ltd
Wood D F BMJ 2003326328-330
No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found
Writing PBL scenarios
bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives
bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after
studying the scenario should be consistent with the faculty learning objectives
bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding
bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice
bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge
bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented
bull The problem should be sufficiently open so that discussion is not curtailed too early in the process
bull Scenarios should promote participation by the students in seeking information from various learning resources
bull Adapted from Dolmans et al Med Teacher 199719185-9
Staff development
bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)
A dysfunctional group a dominant character may
make it difficult for other students to be heard
A dysfunctional group a dominant character may make it difficult for other students to be heard
bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties
Advantages of PBL bull Student centred PBLIt fostersactive learning improved
understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks
Disadvantagesbull Tutors who cant teachTutorsenjoy passing on
their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful
Assessment of PBL
bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods
bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL
Conclusion
bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning
bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL
PBL 5 Easy Steps
bull Read the problem
Mrs Paula Embledon
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
2 Brain storm
bull Brainstorm
bull ndash hypotheses
bull - what do we know in support of the hypothesis
bull - what do we need to know to test the hypothesis
ndash learning issues
Brainstorm
bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)
ndash specific issues (for individuals to look up)
ndash overlapping issues
bull 4 Individual Reading - Research - Preparation
bull 5 Return
bull ndash review case so far ndash report and discuss
ndash assess progress - continue pagenext pagecomplete
ndash self-evaluation - How did things go Any suggestions for next time
ndash next problem
bull 5 Return
THE FIRST GROUP SESSION
bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day
bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session
bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr
bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine
bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise
bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator
bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues
bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know
bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)
bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)
bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)
What was the response to these challenges
bull The development of new curricula incorporating new curriculum themes amp different educational strategies
bull The introduction of new learning situations amp the use of new tools amp aids to learning
bull New methods of assessment [OSCE objective structured clinical exam Which can test performance amp competence in a wide diversity of settings Formative Assessment Portfolio assessment Work-based assess]
New Educational Strategies
bull New strategies appropriate for adult learning (instead of spoon-feeding)
bull Self-directed learningbull Problem Based Learningbull Integrated system based approachbull Task Based learningbull Core amp Student-selected
Componentsbull A spiral curriculum
New Tools amp Aids
bull Use of Study Guides
bull Use of Computer Assisted Programs amp Internet
bull Use of Videos to teach Clinical Skillsconsultation techniques
bull Role of Simulators amp Simulations in aspects of physical exam amp practical procedures
PBLbull Problem-based learning (PBL) is a method of
learning in which learners first encounter a problem followed by a systematic learner-centered inquiry and reflection process
bull PBL is a method designed to help students learn the sciences basic to medicine at the same time they develop the reasoning process used by physicians and other health professionals in their clinical practice
bull 1048708 The problem comes first without advance readings lectures or preparation
bull 1048708 The problem serves as a stimulus for the need to know
PBLbullHelps learners build a bridge
between what they already know and what they need to know to reachthe next level
bull Emphasizing active learning which has been shown to be more satisfying than
passive teacher-to-student learning and to enhance retention and recall
bull Emphasizing student-centered learning in which students are actively involved in setting their own learning goals
Advantages
Encourages bull effective amp self-directed learningbull Critical thinkingbull Team workbull understanding rather than
memorizationbull Facility with professional languagebull Both students amp staff enjoy the
process
Advantages
In preparing students for professional practice PBL
bull Encourages independence as students identify amp meet individual learning needs
bull Stimulates reflection amp self-direction for life-long learning
bull Supports ongoing self-assessmentbull Introduces clinical reasoningbull Enhances critical thinking amp evidence-based
decision makingbull Ensures that knowledge is transferred applied
amp retained by providing a relevant integrated context
bull A problem initiates the activitybull The Group is stimulated to explore
basic scientific amp clinical mechanisms together with social psychological ethical or professional issues
bull Problem stimulates students to reason think critically amp weigh evidence they seek out amp share relevant info
PBL
bull Groups do not need prior knowledge to generate lively ideas as they identify areas for further collective amp personal learning
bull Each student brings individual experience amp makes a distinctive contribution
bull the Tutorrsquos role is to manage interactions rather than supply info
bull An effective Group provides a safe environment for sharing amp testing new knowledge
bull Students practice the language of science amp medicine evaluate ideas and receive feedback from peers amp teacher
bull When clinical exposure is introduced concurrently intellectual amp practical skills develop in parallel
Framework for PBL
bull A trigger initiates the problem (papercomputervideo)
bull Groups brainstorm to identify key issues for discussion
bull Broad thinking produces a rich array of mechanisms amp ideas
bull Hypothesis are critically explored through reasoning
bull The need for additional info is identifiedbull A Conclusion is reachedbull Group reviews the process
Framework for PBL - II
bull In Breaks between Tutorials students identfy Learning Issues to be pursued
bull They are encouraged to adot an evidence-based approach
bull When they reconvene they share and review the learning
Characteristics of an effective PBL Group
An Effective Group is Cohesive motivated mutually supportive amp actively engaged in learning
bull The Group understands the process amp energetically pursues its task
bull Members respect each otherrsquos contribution but examine them critically
bull Discussions flow as students cooperate rather than compete
bull The atmosphere is friendly amp good humouredbull Roles are shared all take turns in scribing
leading discussion taking responsibility for acquiring information
Staff Development
bull Basic training is mandatorybull Further development may be a requirementbull Initial training may involve observation amp
practice with a group from the programbull Effective training ensures that necessary
background goals amp local strategies are considered together with info on assessment amp evaluation
bull In addition to materials supplied to students tutors are usually issued with handbooks highlighting issues for each problem
Tutorrsquos Role in Assessment
bull Individual StudentsGroups may be assessed Summatively (determining progression) or formatively (for feedback)
The GROUP
bull At the end of each problem groups review their processes to encourage self-reflection ampenhance their collective performance
Tutorrsquos Role in Assessment
Individual students
bull Tutors should provide formative feedback to each member
bull Ask students to complete a simple self-assessment questionnaire reviewing appropriate behaviors the tutor returns them with comments
bull Students will be a writtenoralclinical tests that will determine their progression amp ultimate graduation
Evaluating PBL Tutorials-II
bull At the end of each problem time is allocated for evaluation
bull Both the process amp learning in PBL can be evaluated against explicit goals
bull The tutorrsquos review of effectiveness of group processes offers insight for the members
bull Students normally evaluate their tutor helpfulness support for clinical reasoning encouragement for independent learning appropriate intervention provision for effective feedback
PBLbull 1048708 Enabling students to learn in the context in which the
information will be used which increases the ability to retrieve and apply information
bull 1048708 Focusing on important concepts which helps learners organize and store new information in a way that facilitates retrieval and application
bull 1048708 Exploring prior knowledge formulating inquiries derived from and defined by the learnersrsquo need to know and actively constructing meaning through dialogue and reflection
bull 1048708 Utilizing problems designed to simulate studentsrsquo perception of their future profession which serves as a powerful stimulus for studentsrsquo intrinsic motivation to learn
bull 1048708 Actively involving students in monitoring their own progress and reflecting on what works and what needs improvement frequently assessing student performance and providing feedback
PBL Starting the casebull After the introductions and discussion
are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it
bull Reading the case aloud keeps the group focused
bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here
PBL Case (contd)
bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session
PBL Case contdbull SECOND deciding which issues everyone will
tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)
bull THIRD deciding what SPECIFIC questions individuals will try to answer
bull FOURTH deciding how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet or consulting an expert)
The Process of PBL
bullWhat are the issues Identify the important issues in the problem
bull How well do you understand the issues
bull Are there any words or terms about which you are unclear
The Process of PBL contd
bull Consider the basic mechanisms that might explain each important aspect of each problem
bull Assess your current understanding of the basic structural andor functional mechanisms that may contribute to the presentation of the problem
bull Use the collective skills and experiences of group members to explore or explain these phenomena Identify current gaps in knowledge or understanding
Learn from each other
bullShare your own knowledge expertise or ability to reason and synthesize information Be receptive and appreciative of the contribution of your small group members
Determine priorities for learning
bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue
bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan
bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge
bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career
PBL
bull The problem comes first without advance readings lectures or preparation
bull The problem serves as a stimulus for the need to know
Learning Issues
bull Learning issues are questions that cannot be answered with studentsrsquo current knowledge and that can be explored and answered through systematic self-directed inquiry
bull The use of learning issues in tutorials prepares students to handle similar challenges in clinical practice and life-long learning
Learning Issues in PBL First Session1 Getting Started (Introductions Ground
Rules Expectations)2 Identifying Problem3 Exploring Pre-Existing Knowledge4 Generating Hypotheses and Explaining
Mechanisms5 Unfolding the Case Incrementally6 Re-EvaluatingReprioritizing Hypotheses
Based on New Information7 AssessmentReflection
PBL Second Session
8 Independent Self-Directed Study of Learning Issues
PBL Third Session
bull 9 Discussion of Learning Issues and Application of New Knowledge to the Case
bull 10 Continued Unfolding of the Case Incrementally
bull 11 AssessmentReflection
During Tutorial Session students will
1048708 Come prepared to discuss the case and learning issues researched since the last tutorial
1048708 Actively participate in group discussions and contribute to the learning process in a manner that allows for the balanced participation of everyone in the group
1048708 Develop learning issues at each session phrase them as full-sentence questions write them on the board and post them on the course web page
1048708 Consider biological population behaviormental health issuesexplanations and questions of professional attitudes values and ethics related to the patientrsquos problem(s) described in the case
Tutorial Session contd1048708 Go to the board to diagram outline draw etc in
explanation of mechanisms relatedto hypotheses1048708 Debate evidence related to the case and avoid
personal attacks on others1048708 Comply with ground rules with regard to how
the group will function and how itsmembers treat one another1048708 Participate in end-of-session reflection and
assessment by giving and receivingconstructive criticism regarding self tutor
student and group performance
Between Tutorial Session
1048708 Research key learning issues using a variety of resources
1048708 Critically evaluate the credibility of sources and the validity of the information they have obtained in their research
1048708 Integrate what they have learned through research lectures labs clinical skills Perspectives in Medicine (PIM) etc into what is discussed in tutorials
1048708 Synthesize what they have learned and be prepared to discuss it without reading directly from their materials as much as possible and apply it to the case at the next tutorial session
Determine priorities for learning
bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue
bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan
bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge
bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career
PBL Starting the casebull After the introductions and discussion
are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it
bull Reading the case aloud keeps the group focused
bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here
Problem-based learning is designed to develop
1048708 Integrated context-specific knowledge base
1048708 Decision-makingcritical thinking process and skills
1048708 Self-directed life-long learning skills 1048708 Interpersonal collaboration and
communication skills 1048708 Constructive self and peer
assessment skills 1048708 Professional ethics and behavior
PBL Case (contd)
bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session
What is problem based learning
bull In PBL students use triggers from the problem case or scenario to define their own learning objectives
bull Subsequently they do independent self directed study before returning to the group to discuss and refine their acquired knowledge
bull Thus PBL is not about problem solving per se but rather it uses appropriate problems to increase knowledge and understanding
bull The process is clearly defined
PBL
bull PBL uses clinical cases as the context for students to study basic and clinical sciences
bull 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
bull Possible disadvantages include higher costs both in resources and staff time
PBL
bull An educational method characterized by the use of patient problems as a context for students to learn problem-solving skills and acquire knowledge about the basic and clinical sciences
bull Students usually meet in small groups two or three times a week for PBL tutorials
bull They are presented with a clinical problem (eg a patient with chest pain) and in a series of steps they discuss possible mechanisms and causes develop hypotheses and strategies to test the hypotheses are presented with further information and use this new information to refine their hypotheses finally reaching a conclusion
bull A tutor usually acts as a facilitator guiding students in this group-learning process
bull In the course of this exercise students identify both their existing levels and gaps in their knowledge These gaps form the basis for independent learning outside the PBL tutorials The identification and pursuit of these so-called learning goals is a key element of the PBL process
Rationale for using PBL bull The PBL approach is based on principles of adult
education20 and cognitive psychology21 It differs fundamentally from traditional curricula in which students acquire background knowledge of the basic sciences in the early years of the course and in the later years apply this knowledge to the diagnosis and management of clinical problems This traditional approach has been criticised for a number of reasons42223
bull It creates an artificial divide between the basic and clinical sciences
bull Time is wasted in acquiring knowledge that is subsequently forgotten or found to be irrelevant
bull Application of the acquired knowledge can be difficult bull The acquisition and retention of information that has no
apparent relevance can be boring and even demoralising for students
The group learning process acquiring
desirable learning skills
Generic Skills amp attitudes
bull Teamwork bull Critical evaluation of literature bull Chairing a group bull Self directed learning and use of
resources bull Listening Presentation skills
Recording bull Cooperation bull Respect for colleagues views
bull Group learning facilitates not only the acquisition of knowledge but also several other desirable attributes such as communication skills teamwork problem solving independent responsibility for learning sharing information and respect for others PBL can therefore be thought of as a small group teaching method that combines the acquisition of knowledge with the development of generic skills and attitudes Presentation of clinical material as the stimulus for learning enables students to understand the relevance of underlying scientific knowledge and principles in clinical practice
bull when PBL is introduced into a curriculum several other issues for curriculum design and implementation need to be tackled PBL is generally introduced in the context of a defined core curriculum and integration of basic and clinical sciences It has implications for staffing and learning resources and demands a different approach to timetabling workload and assessment PBL is often used to deliver core material in non-clinical parts of the curriculum Paper based PBL scenarios form the basis of the core curriculum and ensure that all students are exposed to the same problems Recently modified PBL techniques have been introduced into clinical education with real patients being used as the stimulus for learning Despite the essential ad hoc nature of learning clinical medicine a key cases approach can enable PBL to be used to deliver the core clinical curriculum
Copyright copy2003 BMJ Publishing Group Ltd
Wood D F BMJ 2003326328-330
No CRoles of participants in a PBL tutorial aption Found
What happens in a PBL tutorial bull PBL tutorials are conducted in several ways In
this article the examples are modelled on the Maastricht seven jump process but its format of seven steps may be shortened
bull A typical PBL tutorial consists of a group of students (usually eight to 10) and a tutor who facilitates the session The length of time (number of sessions) that a group stays together with each other and with individual tutors varies between institutions A group needs to be together long enough to allow good group dynamics to develop but may need to be changed occasionally if personality clashes or other dysfunctional behaviour emerges
bull Students elect a chair for each PBL scenario and a scribe to record the discussion The roles are rotated for each scenario Suitable flip charts or a whiteboard should be used for recording the proceedings At the start of the session depending on the trigger material either the student chair reads out the scenario or all students study the material If the trigger is a real patient in a ward clinic or surgery then a student may be asked to take a clinical history or identify an abnormal physical sign before the group moves to a tutorial room For each module students may be given a handbook containing the problem scenarios and suggested learning resources or learning materials may be handed out at appropriate times as the tutorials progress
Examples of trigger material for PBL scenarios bull Paper based clinical scenarios bull Experimental or clinical laboratory data bull Photographs bull Video clips bull Newspaper articles bull All or part of an article from a scientific
journal bull A real or simulated patient bull A family tree showing an inherited
disorder
PBL tutorial process ndash Step 1 Identify and clarify unfamiliar terms presented in the scenario
scribe lists those that remain unexplained after discussion ndash Step 2 Define the problem or problems to be discussed students may
have different views on the issues but all should be considered scribe records a list of agreed problems
ndash Step 3 Brainstorming session to discuss the problem(s) suggestingpossible explanations on basis of prior knowledge students draw on each others knowledge and identify areas of incomplete knowledge scribe records all discussion
ndash Step 4 Review steps 2 and 3 and arrange explanations into tentativesolutions scribe organises the explanations and restructures if necessary
ndash Step 5 Formulate learning objectives group reaches consensus onthe learning objectives tutor ensures learning objectives are focused achievable comprehensive and appropriate
ndash Step 6 Private study (all students gather information related to eachlearning objective)
ndash Step 7 Group shares results of private study (students identify theirlearning resources and share their results) tutor checks learning and may assess the group
bull The role of the tutor is to facilitate the proceedings (helping the chair to maintain group dynamics and moving the group through the task) and to ensure that the group achieves appropriate learning objectives in line with those set by the curriculum design team The tutor may need to take a more active role in step 7 of the process to ensure that all the students have done the appropriate work and to help the chair to suggest a suitable format for group members to use to present the results of their private study The tutor should encourage students to check their understanding of the material He or she can do this by encouraging the students to ask open questions and ask each other to explain topics in their own words or by the use of drawings and diagrams
PBL in curriculum design bull PBL may be used either as the mainstay of an entire
curriculum or for the delivery of individual courses In practice PBL is usually part of an integrated curriculum using a systems based approach with non-clinical material delivered in the context of clinical practice A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge skills and attitudes A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios Sufficient time should be allowed each week for students to do the self directed learning required for PBL
bull
Copyright copy2003 BMJ Publishing Group Ltd
Wood D F BMJ 2003326328-330
No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found
Writing PBL scenarios
bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives
bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after
studying the scenario should be consistent with the faculty learning objectives
bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding
bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice
bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge
bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented
bull The problem should be sufficiently open so that discussion is not curtailed too early in the process
bull Scenarios should promote participation by the students in seeking information from various learning resources
bull Adapted from Dolmans et al Med Teacher 199719185-9
Staff development
bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)
A dysfunctional group a dominant character may
make it difficult for other students to be heard
A dysfunctional group a dominant character may make it difficult for other students to be heard
bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties
Advantages of PBL bull Student centred PBLIt fostersactive learning improved
understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks
Disadvantagesbull Tutors who cant teachTutorsenjoy passing on
their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful
Assessment of PBL
bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods
bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL
Conclusion
bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning
bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL
PBL 5 Easy Steps
bull Read the problem
Mrs Paula Embledon
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
2 Brain storm
bull Brainstorm
bull ndash hypotheses
bull - what do we know in support of the hypothesis
bull - what do we need to know to test the hypothesis
ndash learning issues
Brainstorm
bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)
ndash specific issues (for individuals to look up)
ndash overlapping issues
bull 4 Individual Reading - Research - Preparation
bull 5 Return
bull ndash review case so far ndash report and discuss
ndash assess progress - continue pagenext pagecomplete
ndash self-evaluation - How did things go Any suggestions for next time
ndash next problem
bull 5 Return
THE FIRST GROUP SESSION
bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day
bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session
bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr
bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine
bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise
bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator
bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues
bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know
bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)
bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)
bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)
New Educational Strategies
bull New strategies appropriate for adult learning (instead of spoon-feeding)
bull Self-directed learningbull Problem Based Learningbull Integrated system based approachbull Task Based learningbull Core amp Student-selected
Componentsbull A spiral curriculum
New Tools amp Aids
bull Use of Study Guides
bull Use of Computer Assisted Programs amp Internet
bull Use of Videos to teach Clinical Skillsconsultation techniques
bull Role of Simulators amp Simulations in aspects of physical exam amp practical procedures
PBLbull Problem-based learning (PBL) is a method of
learning in which learners first encounter a problem followed by a systematic learner-centered inquiry and reflection process
bull PBL is a method designed to help students learn the sciences basic to medicine at the same time they develop the reasoning process used by physicians and other health professionals in their clinical practice
bull 1048708 The problem comes first without advance readings lectures or preparation
bull 1048708 The problem serves as a stimulus for the need to know
PBLbullHelps learners build a bridge
between what they already know and what they need to know to reachthe next level
bull Emphasizing active learning which has been shown to be more satisfying than
passive teacher-to-student learning and to enhance retention and recall
bull Emphasizing student-centered learning in which students are actively involved in setting their own learning goals
Advantages
Encourages bull effective amp self-directed learningbull Critical thinkingbull Team workbull understanding rather than
memorizationbull Facility with professional languagebull Both students amp staff enjoy the
process
Advantages
In preparing students for professional practice PBL
bull Encourages independence as students identify amp meet individual learning needs
bull Stimulates reflection amp self-direction for life-long learning
bull Supports ongoing self-assessmentbull Introduces clinical reasoningbull Enhances critical thinking amp evidence-based
decision makingbull Ensures that knowledge is transferred applied
amp retained by providing a relevant integrated context
bull A problem initiates the activitybull The Group is stimulated to explore
basic scientific amp clinical mechanisms together with social psychological ethical or professional issues
bull Problem stimulates students to reason think critically amp weigh evidence they seek out amp share relevant info
PBL
bull Groups do not need prior knowledge to generate lively ideas as they identify areas for further collective amp personal learning
bull Each student brings individual experience amp makes a distinctive contribution
bull the Tutorrsquos role is to manage interactions rather than supply info
bull An effective Group provides a safe environment for sharing amp testing new knowledge
bull Students practice the language of science amp medicine evaluate ideas and receive feedback from peers amp teacher
bull When clinical exposure is introduced concurrently intellectual amp practical skills develop in parallel
Framework for PBL
bull A trigger initiates the problem (papercomputervideo)
bull Groups brainstorm to identify key issues for discussion
bull Broad thinking produces a rich array of mechanisms amp ideas
bull Hypothesis are critically explored through reasoning
bull The need for additional info is identifiedbull A Conclusion is reachedbull Group reviews the process
Framework for PBL - II
bull In Breaks between Tutorials students identfy Learning Issues to be pursued
bull They are encouraged to adot an evidence-based approach
bull When they reconvene they share and review the learning
Characteristics of an effective PBL Group
An Effective Group is Cohesive motivated mutually supportive amp actively engaged in learning
bull The Group understands the process amp energetically pursues its task
bull Members respect each otherrsquos contribution but examine them critically
bull Discussions flow as students cooperate rather than compete
bull The atmosphere is friendly amp good humouredbull Roles are shared all take turns in scribing
leading discussion taking responsibility for acquiring information
Staff Development
bull Basic training is mandatorybull Further development may be a requirementbull Initial training may involve observation amp
practice with a group from the programbull Effective training ensures that necessary
background goals amp local strategies are considered together with info on assessment amp evaluation
bull In addition to materials supplied to students tutors are usually issued with handbooks highlighting issues for each problem
Tutorrsquos Role in Assessment
bull Individual StudentsGroups may be assessed Summatively (determining progression) or formatively (for feedback)
The GROUP
bull At the end of each problem groups review their processes to encourage self-reflection ampenhance their collective performance
Tutorrsquos Role in Assessment
Individual students
bull Tutors should provide formative feedback to each member
bull Ask students to complete a simple self-assessment questionnaire reviewing appropriate behaviors the tutor returns them with comments
bull Students will be a writtenoralclinical tests that will determine their progression amp ultimate graduation
Evaluating PBL Tutorials-II
bull At the end of each problem time is allocated for evaluation
bull Both the process amp learning in PBL can be evaluated against explicit goals
bull The tutorrsquos review of effectiveness of group processes offers insight for the members
bull Students normally evaluate their tutor helpfulness support for clinical reasoning encouragement for independent learning appropriate intervention provision for effective feedback
PBLbull 1048708 Enabling students to learn in the context in which the
information will be used which increases the ability to retrieve and apply information
bull 1048708 Focusing on important concepts which helps learners organize and store new information in a way that facilitates retrieval and application
bull 1048708 Exploring prior knowledge formulating inquiries derived from and defined by the learnersrsquo need to know and actively constructing meaning through dialogue and reflection
bull 1048708 Utilizing problems designed to simulate studentsrsquo perception of their future profession which serves as a powerful stimulus for studentsrsquo intrinsic motivation to learn
bull 1048708 Actively involving students in monitoring their own progress and reflecting on what works and what needs improvement frequently assessing student performance and providing feedback
PBL Starting the casebull After the introductions and discussion
are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it
bull Reading the case aloud keeps the group focused
bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here
PBL Case (contd)
bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session
PBL Case contdbull SECOND deciding which issues everyone will
tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)
bull THIRD deciding what SPECIFIC questions individuals will try to answer
bull FOURTH deciding how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet or consulting an expert)
The Process of PBL
bullWhat are the issues Identify the important issues in the problem
bull How well do you understand the issues
bull Are there any words or terms about which you are unclear
The Process of PBL contd
bull Consider the basic mechanisms that might explain each important aspect of each problem
bull Assess your current understanding of the basic structural andor functional mechanisms that may contribute to the presentation of the problem
bull Use the collective skills and experiences of group members to explore or explain these phenomena Identify current gaps in knowledge or understanding
Learn from each other
bullShare your own knowledge expertise or ability to reason and synthesize information Be receptive and appreciative of the contribution of your small group members
Determine priorities for learning
bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue
bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan
bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge
bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career
PBL
bull The problem comes first without advance readings lectures or preparation
bull The problem serves as a stimulus for the need to know
Learning Issues
bull Learning issues are questions that cannot be answered with studentsrsquo current knowledge and that can be explored and answered through systematic self-directed inquiry
bull The use of learning issues in tutorials prepares students to handle similar challenges in clinical practice and life-long learning
Learning Issues in PBL First Session1 Getting Started (Introductions Ground
Rules Expectations)2 Identifying Problem3 Exploring Pre-Existing Knowledge4 Generating Hypotheses and Explaining
Mechanisms5 Unfolding the Case Incrementally6 Re-EvaluatingReprioritizing Hypotheses
Based on New Information7 AssessmentReflection
PBL Second Session
8 Independent Self-Directed Study of Learning Issues
PBL Third Session
bull 9 Discussion of Learning Issues and Application of New Knowledge to the Case
bull 10 Continued Unfolding of the Case Incrementally
bull 11 AssessmentReflection
During Tutorial Session students will
1048708 Come prepared to discuss the case and learning issues researched since the last tutorial
1048708 Actively participate in group discussions and contribute to the learning process in a manner that allows for the balanced participation of everyone in the group
1048708 Develop learning issues at each session phrase them as full-sentence questions write them on the board and post them on the course web page
1048708 Consider biological population behaviormental health issuesexplanations and questions of professional attitudes values and ethics related to the patientrsquos problem(s) described in the case
Tutorial Session contd1048708 Go to the board to diagram outline draw etc in
explanation of mechanisms relatedto hypotheses1048708 Debate evidence related to the case and avoid
personal attacks on others1048708 Comply with ground rules with regard to how
the group will function and how itsmembers treat one another1048708 Participate in end-of-session reflection and
assessment by giving and receivingconstructive criticism regarding self tutor
student and group performance
Between Tutorial Session
1048708 Research key learning issues using a variety of resources
1048708 Critically evaluate the credibility of sources and the validity of the information they have obtained in their research
1048708 Integrate what they have learned through research lectures labs clinical skills Perspectives in Medicine (PIM) etc into what is discussed in tutorials
1048708 Synthesize what they have learned and be prepared to discuss it without reading directly from their materials as much as possible and apply it to the case at the next tutorial session
Determine priorities for learning
bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue
bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan
bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge
bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career
PBL Starting the casebull After the introductions and discussion
are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it
bull Reading the case aloud keeps the group focused
bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here
Problem-based learning is designed to develop
1048708 Integrated context-specific knowledge base
1048708 Decision-makingcritical thinking process and skills
1048708 Self-directed life-long learning skills 1048708 Interpersonal collaboration and
communication skills 1048708 Constructive self and peer
assessment skills 1048708 Professional ethics and behavior
PBL Case (contd)
bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session
What is problem based learning
bull In PBL students use triggers from the problem case or scenario to define their own learning objectives
bull Subsequently they do independent self directed study before returning to the group to discuss and refine their acquired knowledge
bull Thus PBL is not about problem solving per se but rather it uses appropriate problems to increase knowledge and understanding
bull The process is clearly defined
PBL
bull PBL uses clinical cases as the context for students to study basic and clinical sciences
bull 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
bull Possible disadvantages include higher costs both in resources and staff time
PBL
bull An educational method characterized by the use of patient problems as a context for students to learn problem-solving skills and acquire knowledge about the basic and clinical sciences
bull Students usually meet in small groups two or three times a week for PBL tutorials
bull They are presented with a clinical problem (eg a patient with chest pain) and in a series of steps they discuss possible mechanisms and causes develop hypotheses and strategies to test the hypotheses are presented with further information and use this new information to refine their hypotheses finally reaching a conclusion
bull A tutor usually acts as a facilitator guiding students in this group-learning process
bull In the course of this exercise students identify both their existing levels and gaps in their knowledge These gaps form the basis for independent learning outside the PBL tutorials The identification and pursuit of these so-called learning goals is a key element of the PBL process
Rationale for using PBL bull The PBL approach is based on principles of adult
education20 and cognitive psychology21 It differs fundamentally from traditional curricula in which students acquire background knowledge of the basic sciences in the early years of the course and in the later years apply this knowledge to the diagnosis and management of clinical problems This traditional approach has been criticised for a number of reasons42223
bull It creates an artificial divide between the basic and clinical sciences
bull Time is wasted in acquiring knowledge that is subsequently forgotten or found to be irrelevant
bull Application of the acquired knowledge can be difficult bull The acquisition and retention of information that has no
apparent relevance can be boring and even demoralising for students
The group learning process acquiring
desirable learning skills
Generic Skills amp attitudes
bull Teamwork bull Critical evaluation of literature bull Chairing a group bull Self directed learning and use of
resources bull Listening Presentation skills
Recording bull Cooperation bull Respect for colleagues views
bull Group learning facilitates not only the acquisition of knowledge but also several other desirable attributes such as communication skills teamwork problem solving independent responsibility for learning sharing information and respect for others PBL can therefore be thought of as a small group teaching method that combines the acquisition of knowledge with the development of generic skills and attitudes Presentation of clinical material as the stimulus for learning enables students to understand the relevance of underlying scientific knowledge and principles in clinical practice
bull when PBL is introduced into a curriculum several other issues for curriculum design and implementation need to be tackled PBL is generally introduced in the context of a defined core curriculum and integration of basic and clinical sciences It has implications for staffing and learning resources and demands a different approach to timetabling workload and assessment PBL is often used to deliver core material in non-clinical parts of the curriculum Paper based PBL scenarios form the basis of the core curriculum and ensure that all students are exposed to the same problems Recently modified PBL techniques have been introduced into clinical education with real patients being used as the stimulus for learning Despite the essential ad hoc nature of learning clinical medicine a key cases approach can enable PBL to be used to deliver the core clinical curriculum
Copyright copy2003 BMJ Publishing Group Ltd
Wood D F BMJ 2003326328-330
No CRoles of participants in a PBL tutorial aption Found
What happens in a PBL tutorial bull PBL tutorials are conducted in several ways In
this article the examples are modelled on the Maastricht seven jump process but its format of seven steps may be shortened
bull A typical PBL tutorial consists of a group of students (usually eight to 10) and a tutor who facilitates the session The length of time (number of sessions) that a group stays together with each other and with individual tutors varies between institutions A group needs to be together long enough to allow good group dynamics to develop but may need to be changed occasionally if personality clashes or other dysfunctional behaviour emerges
bull Students elect a chair for each PBL scenario and a scribe to record the discussion The roles are rotated for each scenario Suitable flip charts or a whiteboard should be used for recording the proceedings At the start of the session depending on the trigger material either the student chair reads out the scenario or all students study the material If the trigger is a real patient in a ward clinic or surgery then a student may be asked to take a clinical history or identify an abnormal physical sign before the group moves to a tutorial room For each module students may be given a handbook containing the problem scenarios and suggested learning resources or learning materials may be handed out at appropriate times as the tutorials progress
Examples of trigger material for PBL scenarios bull Paper based clinical scenarios bull Experimental or clinical laboratory data bull Photographs bull Video clips bull Newspaper articles bull All or part of an article from a scientific
journal bull A real or simulated patient bull A family tree showing an inherited
disorder
PBL tutorial process ndash Step 1 Identify and clarify unfamiliar terms presented in the scenario
scribe lists those that remain unexplained after discussion ndash Step 2 Define the problem or problems to be discussed students may
have different views on the issues but all should be considered scribe records a list of agreed problems
ndash Step 3 Brainstorming session to discuss the problem(s) suggestingpossible explanations on basis of prior knowledge students draw on each others knowledge and identify areas of incomplete knowledge scribe records all discussion
ndash Step 4 Review steps 2 and 3 and arrange explanations into tentativesolutions scribe organises the explanations and restructures if necessary
ndash Step 5 Formulate learning objectives group reaches consensus onthe learning objectives tutor ensures learning objectives are focused achievable comprehensive and appropriate
ndash Step 6 Private study (all students gather information related to eachlearning objective)
ndash Step 7 Group shares results of private study (students identify theirlearning resources and share their results) tutor checks learning and may assess the group
bull The role of the tutor is to facilitate the proceedings (helping the chair to maintain group dynamics and moving the group through the task) and to ensure that the group achieves appropriate learning objectives in line with those set by the curriculum design team The tutor may need to take a more active role in step 7 of the process to ensure that all the students have done the appropriate work and to help the chair to suggest a suitable format for group members to use to present the results of their private study The tutor should encourage students to check their understanding of the material He or she can do this by encouraging the students to ask open questions and ask each other to explain topics in their own words or by the use of drawings and diagrams
PBL in curriculum design bull PBL may be used either as the mainstay of an entire
curriculum or for the delivery of individual courses In practice PBL is usually part of an integrated curriculum using a systems based approach with non-clinical material delivered in the context of clinical practice A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge skills and attitudes A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios Sufficient time should be allowed each week for students to do the self directed learning required for PBL
bull
Copyright copy2003 BMJ Publishing Group Ltd
Wood D F BMJ 2003326328-330
No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found
Writing PBL scenarios
bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives
bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after
studying the scenario should be consistent with the faculty learning objectives
bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding
bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice
bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge
bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented
bull The problem should be sufficiently open so that discussion is not curtailed too early in the process
bull Scenarios should promote participation by the students in seeking information from various learning resources
bull Adapted from Dolmans et al Med Teacher 199719185-9
Staff development
bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)
A dysfunctional group a dominant character may
make it difficult for other students to be heard
A dysfunctional group a dominant character may make it difficult for other students to be heard
bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties
Advantages of PBL bull Student centred PBLIt fostersactive learning improved
understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks
Disadvantagesbull Tutors who cant teachTutorsenjoy passing on
their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful
Assessment of PBL
bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods
bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL
Conclusion
bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning
bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL
PBL 5 Easy Steps
bull Read the problem
Mrs Paula Embledon
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
2 Brain storm
bull Brainstorm
bull ndash hypotheses
bull - what do we know in support of the hypothesis
bull - what do we need to know to test the hypothesis
ndash learning issues
Brainstorm
bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)
ndash specific issues (for individuals to look up)
ndash overlapping issues
bull 4 Individual Reading - Research - Preparation
bull 5 Return
bull ndash review case so far ndash report and discuss
ndash assess progress - continue pagenext pagecomplete
ndash self-evaluation - How did things go Any suggestions for next time
ndash next problem
bull 5 Return
THE FIRST GROUP SESSION
bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day
bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session
bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr
bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine
bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise
bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator
bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues
bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know
bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)
bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)
bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)
New Tools amp Aids
bull Use of Study Guides
bull Use of Computer Assisted Programs amp Internet
bull Use of Videos to teach Clinical Skillsconsultation techniques
bull Role of Simulators amp Simulations in aspects of physical exam amp practical procedures
PBLbull Problem-based learning (PBL) is a method of
learning in which learners first encounter a problem followed by a systematic learner-centered inquiry and reflection process
bull PBL is a method designed to help students learn the sciences basic to medicine at the same time they develop the reasoning process used by physicians and other health professionals in their clinical practice
bull 1048708 The problem comes first without advance readings lectures or preparation
bull 1048708 The problem serves as a stimulus for the need to know
PBLbullHelps learners build a bridge
between what they already know and what they need to know to reachthe next level
bull Emphasizing active learning which has been shown to be more satisfying than
passive teacher-to-student learning and to enhance retention and recall
bull Emphasizing student-centered learning in which students are actively involved in setting their own learning goals
Advantages
Encourages bull effective amp self-directed learningbull Critical thinkingbull Team workbull understanding rather than
memorizationbull Facility with professional languagebull Both students amp staff enjoy the
process
Advantages
In preparing students for professional practice PBL
bull Encourages independence as students identify amp meet individual learning needs
bull Stimulates reflection amp self-direction for life-long learning
bull Supports ongoing self-assessmentbull Introduces clinical reasoningbull Enhances critical thinking amp evidence-based
decision makingbull Ensures that knowledge is transferred applied
amp retained by providing a relevant integrated context
bull A problem initiates the activitybull The Group is stimulated to explore
basic scientific amp clinical mechanisms together with social psychological ethical or professional issues
bull Problem stimulates students to reason think critically amp weigh evidence they seek out amp share relevant info
PBL
bull Groups do not need prior knowledge to generate lively ideas as they identify areas for further collective amp personal learning
bull Each student brings individual experience amp makes a distinctive contribution
bull the Tutorrsquos role is to manage interactions rather than supply info
bull An effective Group provides a safe environment for sharing amp testing new knowledge
bull Students practice the language of science amp medicine evaluate ideas and receive feedback from peers amp teacher
bull When clinical exposure is introduced concurrently intellectual amp practical skills develop in parallel
Framework for PBL
bull A trigger initiates the problem (papercomputervideo)
bull Groups brainstorm to identify key issues for discussion
bull Broad thinking produces a rich array of mechanisms amp ideas
bull Hypothesis are critically explored through reasoning
bull The need for additional info is identifiedbull A Conclusion is reachedbull Group reviews the process
Framework for PBL - II
bull In Breaks between Tutorials students identfy Learning Issues to be pursued
bull They are encouraged to adot an evidence-based approach
bull When they reconvene they share and review the learning
Characteristics of an effective PBL Group
An Effective Group is Cohesive motivated mutually supportive amp actively engaged in learning
bull The Group understands the process amp energetically pursues its task
bull Members respect each otherrsquos contribution but examine them critically
bull Discussions flow as students cooperate rather than compete
bull The atmosphere is friendly amp good humouredbull Roles are shared all take turns in scribing
leading discussion taking responsibility for acquiring information
Staff Development
bull Basic training is mandatorybull Further development may be a requirementbull Initial training may involve observation amp
practice with a group from the programbull Effective training ensures that necessary
background goals amp local strategies are considered together with info on assessment amp evaluation
bull In addition to materials supplied to students tutors are usually issued with handbooks highlighting issues for each problem
Tutorrsquos Role in Assessment
bull Individual StudentsGroups may be assessed Summatively (determining progression) or formatively (for feedback)
The GROUP
bull At the end of each problem groups review their processes to encourage self-reflection ampenhance their collective performance
Tutorrsquos Role in Assessment
Individual students
bull Tutors should provide formative feedback to each member
bull Ask students to complete a simple self-assessment questionnaire reviewing appropriate behaviors the tutor returns them with comments
bull Students will be a writtenoralclinical tests that will determine their progression amp ultimate graduation
Evaluating PBL Tutorials-II
bull At the end of each problem time is allocated for evaluation
bull Both the process amp learning in PBL can be evaluated against explicit goals
bull The tutorrsquos review of effectiveness of group processes offers insight for the members
bull Students normally evaluate their tutor helpfulness support for clinical reasoning encouragement for independent learning appropriate intervention provision for effective feedback
PBLbull 1048708 Enabling students to learn in the context in which the
information will be used which increases the ability to retrieve and apply information
bull 1048708 Focusing on important concepts which helps learners organize and store new information in a way that facilitates retrieval and application
bull 1048708 Exploring prior knowledge formulating inquiries derived from and defined by the learnersrsquo need to know and actively constructing meaning through dialogue and reflection
bull 1048708 Utilizing problems designed to simulate studentsrsquo perception of their future profession which serves as a powerful stimulus for studentsrsquo intrinsic motivation to learn
bull 1048708 Actively involving students in monitoring their own progress and reflecting on what works and what needs improvement frequently assessing student performance and providing feedback
PBL Starting the casebull After the introductions and discussion
are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it
bull Reading the case aloud keeps the group focused
bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here
PBL Case (contd)
bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session
PBL Case contdbull SECOND deciding which issues everyone will
tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)
bull THIRD deciding what SPECIFIC questions individuals will try to answer
bull FOURTH deciding how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet or consulting an expert)
The Process of PBL
bullWhat are the issues Identify the important issues in the problem
bull How well do you understand the issues
bull Are there any words or terms about which you are unclear
The Process of PBL contd
bull Consider the basic mechanisms that might explain each important aspect of each problem
bull Assess your current understanding of the basic structural andor functional mechanisms that may contribute to the presentation of the problem
bull Use the collective skills and experiences of group members to explore or explain these phenomena Identify current gaps in knowledge or understanding
Learn from each other
bullShare your own knowledge expertise or ability to reason and synthesize information Be receptive and appreciative of the contribution of your small group members
Determine priorities for learning
bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue
bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan
bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge
bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career
PBL
bull The problem comes first without advance readings lectures or preparation
bull The problem serves as a stimulus for the need to know
Learning Issues
bull Learning issues are questions that cannot be answered with studentsrsquo current knowledge and that can be explored and answered through systematic self-directed inquiry
bull The use of learning issues in tutorials prepares students to handle similar challenges in clinical practice and life-long learning
Learning Issues in PBL First Session1 Getting Started (Introductions Ground
Rules Expectations)2 Identifying Problem3 Exploring Pre-Existing Knowledge4 Generating Hypotheses and Explaining
Mechanisms5 Unfolding the Case Incrementally6 Re-EvaluatingReprioritizing Hypotheses
Based on New Information7 AssessmentReflection
PBL Second Session
8 Independent Self-Directed Study of Learning Issues
PBL Third Session
bull 9 Discussion of Learning Issues and Application of New Knowledge to the Case
bull 10 Continued Unfolding of the Case Incrementally
bull 11 AssessmentReflection
During Tutorial Session students will
1048708 Come prepared to discuss the case and learning issues researched since the last tutorial
1048708 Actively participate in group discussions and contribute to the learning process in a manner that allows for the balanced participation of everyone in the group
1048708 Develop learning issues at each session phrase them as full-sentence questions write them on the board and post them on the course web page
1048708 Consider biological population behaviormental health issuesexplanations and questions of professional attitudes values and ethics related to the patientrsquos problem(s) described in the case
Tutorial Session contd1048708 Go to the board to diagram outline draw etc in
explanation of mechanisms relatedto hypotheses1048708 Debate evidence related to the case and avoid
personal attacks on others1048708 Comply with ground rules with regard to how
the group will function and how itsmembers treat one another1048708 Participate in end-of-session reflection and
assessment by giving and receivingconstructive criticism regarding self tutor
student and group performance
Between Tutorial Session
1048708 Research key learning issues using a variety of resources
1048708 Critically evaluate the credibility of sources and the validity of the information they have obtained in their research
1048708 Integrate what they have learned through research lectures labs clinical skills Perspectives in Medicine (PIM) etc into what is discussed in tutorials
1048708 Synthesize what they have learned and be prepared to discuss it without reading directly from their materials as much as possible and apply it to the case at the next tutorial session
Determine priorities for learning
bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue
bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan
bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge
bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career
PBL Starting the casebull After the introductions and discussion
are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it
bull Reading the case aloud keeps the group focused
bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here
Problem-based learning is designed to develop
1048708 Integrated context-specific knowledge base
1048708 Decision-makingcritical thinking process and skills
1048708 Self-directed life-long learning skills 1048708 Interpersonal collaboration and
communication skills 1048708 Constructive self and peer
assessment skills 1048708 Professional ethics and behavior
PBL Case (contd)
bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session
What is problem based learning
bull In PBL students use triggers from the problem case or scenario to define their own learning objectives
bull Subsequently they do independent self directed study before returning to the group to discuss and refine their acquired knowledge
bull Thus PBL is not about problem solving per se but rather it uses appropriate problems to increase knowledge and understanding
bull The process is clearly defined
PBL
bull PBL uses clinical cases as the context for students to study basic and clinical sciences
bull 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
bull Possible disadvantages include higher costs both in resources and staff time
PBL
bull An educational method characterized by the use of patient problems as a context for students to learn problem-solving skills and acquire knowledge about the basic and clinical sciences
bull Students usually meet in small groups two or three times a week for PBL tutorials
bull They are presented with a clinical problem (eg a patient with chest pain) and in a series of steps they discuss possible mechanisms and causes develop hypotheses and strategies to test the hypotheses are presented with further information and use this new information to refine their hypotheses finally reaching a conclusion
bull A tutor usually acts as a facilitator guiding students in this group-learning process
bull In the course of this exercise students identify both their existing levels and gaps in their knowledge These gaps form the basis for independent learning outside the PBL tutorials The identification and pursuit of these so-called learning goals is a key element of the PBL process
Rationale for using PBL bull The PBL approach is based on principles of adult
education20 and cognitive psychology21 It differs fundamentally from traditional curricula in which students acquire background knowledge of the basic sciences in the early years of the course and in the later years apply this knowledge to the diagnosis and management of clinical problems This traditional approach has been criticised for a number of reasons42223
bull It creates an artificial divide between the basic and clinical sciences
bull Time is wasted in acquiring knowledge that is subsequently forgotten or found to be irrelevant
bull Application of the acquired knowledge can be difficult bull The acquisition and retention of information that has no
apparent relevance can be boring and even demoralising for students
The group learning process acquiring
desirable learning skills
Generic Skills amp attitudes
bull Teamwork bull Critical evaluation of literature bull Chairing a group bull Self directed learning and use of
resources bull Listening Presentation skills
Recording bull Cooperation bull Respect for colleagues views
bull Group learning facilitates not only the acquisition of knowledge but also several other desirable attributes such as communication skills teamwork problem solving independent responsibility for learning sharing information and respect for others PBL can therefore be thought of as a small group teaching method that combines the acquisition of knowledge with the development of generic skills and attitudes Presentation of clinical material as the stimulus for learning enables students to understand the relevance of underlying scientific knowledge and principles in clinical practice
bull when PBL is introduced into a curriculum several other issues for curriculum design and implementation need to be tackled PBL is generally introduced in the context of a defined core curriculum and integration of basic and clinical sciences It has implications for staffing and learning resources and demands a different approach to timetabling workload and assessment PBL is often used to deliver core material in non-clinical parts of the curriculum Paper based PBL scenarios form the basis of the core curriculum and ensure that all students are exposed to the same problems Recently modified PBL techniques have been introduced into clinical education with real patients being used as the stimulus for learning Despite the essential ad hoc nature of learning clinical medicine a key cases approach can enable PBL to be used to deliver the core clinical curriculum
Copyright copy2003 BMJ Publishing Group Ltd
Wood D F BMJ 2003326328-330
No CRoles of participants in a PBL tutorial aption Found
What happens in a PBL tutorial bull PBL tutorials are conducted in several ways In
this article the examples are modelled on the Maastricht seven jump process but its format of seven steps may be shortened
bull A typical PBL tutorial consists of a group of students (usually eight to 10) and a tutor who facilitates the session The length of time (number of sessions) that a group stays together with each other and with individual tutors varies between institutions A group needs to be together long enough to allow good group dynamics to develop but may need to be changed occasionally if personality clashes or other dysfunctional behaviour emerges
bull Students elect a chair for each PBL scenario and a scribe to record the discussion The roles are rotated for each scenario Suitable flip charts or a whiteboard should be used for recording the proceedings At the start of the session depending on the trigger material either the student chair reads out the scenario or all students study the material If the trigger is a real patient in a ward clinic or surgery then a student may be asked to take a clinical history or identify an abnormal physical sign before the group moves to a tutorial room For each module students may be given a handbook containing the problem scenarios and suggested learning resources or learning materials may be handed out at appropriate times as the tutorials progress
Examples of trigger material for PBL scenarios bull Paper based clinical scenarios bull Experimental or clinical laboratory data bull Photographs bull Video clips bull Newspaper articles bull All or part of an article from a scientific
journal bull A real or simulated patient bull A family tree showing an inherited
disorder
PBL tutorial process ndash Step 1 Identify and clarify unfamiliar terms presented in the scenario
scribe lists those that remain unexplained after discussion ndash Step 2 Define the problem or problems to be discussed students may
have different views on the issues but all should be considered scribe records a list of agreed problems
ndash Step 3 Brainstorming session to discuss the problem(s) suggestingpossible explanations on basis of prior knowledge students draw on each others knowledge and identify areas of incomplete knowledge scribe records all discussion
ndash Step 4 Review steps 2 and 3 and arrange explanations into tentativesolutions scribe organises the explanations and restructures if necessary
ndash Step 5 Formulate learning objectives group reaches consensus onthe learning objectives tutor ensures learning objectives are focused achievable comprehensive and appropriate
ndash Step 6 Private study (all students gather information related to eachlearning objective)
ndash Step 7 Group shares results of private study (students identify theirlearning resources and share their results) tutor checks learning and may assess the group
bull The role of the tutor is to facilitate the proceedings (helping the chair to maintain group dynamics and moving the group through the task) and to ensure that the group achieves appropriate learning objectives in line with those set by the curriculum design team The tutor may need to take a more active role in step 7 of the process to ensure that all the students have done the appropriate work and to help the chair to suggest a suitable format for group members to use to present the results of their private study The tutor should encourage students to check their understanding of the material He or she can do this by encouraging the students to ask open questions and ask each other to explain topics in their own words or by the use of drawings and diagrams
PBL in curriculum design bull PBL may be used either as the mainstay of an entire
curriculum or for the delivery of individual courses In practice PBL is usually part of an integrated curriculum using a systems based approach with non-clinical material delivered in the context of clinical practice A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge skills and attitudes A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios Sufficient time should be allowed each week for students to do the self directed learning required for PBL
bull
Copyright copy2003 BMJ Publishing Group Ltd
Wood D F BMJ 2003326328-330
No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found
Writing PBL scenarios
bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives
bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after
studying the scenario should be consistent with the faculty learning objectives
bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding
bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice
bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge
bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented
bull The problem should be sufficiently open so that discussion is not curtailed too early in the process
bull Scenarios should promote participation by the students in seeking information from various learning resources
bull Adapted from Dolmans et al Med Teacher 199719185-9
Staff development
bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)
A dysfunctional group a dominant character may
make it difficult for other students to be heard
A dysfunctional group a dominant character may make it difficult for other students to be heard
bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties
Advantages of PBL bull Student centred PBLIt fostersactive learning improved
understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks
Disadvantagesbull Tutors who cant teachTutorsenjoy passing on
their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful
Assessment of PBL
bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods
bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL
Conclusion
bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning
bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL
PBL 5 Easy Steps
bull Read the problem
Mrs Paula Embledon
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
2 Brain storm
bull Brainstorm
bull ndash hypotheses
bull - what do we know in support of the hypothesis
bull - what do we need to know to test the hypothesis
ndash learning issues
Brainstorm
bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)
ndash specific issues (for individuals to look up)
ndash overlapping issues
bull 4 Individual Reading - Research - Preparation
bull 5 Return
bull ndash review case so far ndash report and discuss
ndash assess progress - continue pagenext pagecomplete
ndash self-evaluation - How did things go Any suggestions for next time
ndash next problem
bull 5 Return
THE FIRST GROUP SESSION
bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day
bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session
bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr
bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine
bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise
bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator
bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues
bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know
bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)
bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)
bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)
PBLbull Problem-based learning (PBL) is a method of
learning in which learners first encounter a problem followed by a systematic learner-centered inquiry and reflection process
bull PBL is a method designed to help students learn the sciences basic to medicine at the same time they develop the reasoning process used by physicians and other health professionals in their clinical practice
bull 1048708 The problem comes first without advance readings lectures or preparation
bull 1048708 The problem serves as a stimulus for the need to know
PBLbullHelps learners build a bridge
between what they already know and what they need to know to reachthe next level
bull Emphasizing active learning which has been shown to be more satisfying than
passive teacher-to-student learning and to enhance retention and recall
bull Emphasizing student-centered learning in which students are actively involved in setting their own learning goals
Advantages
Encourages bull effective amp self-directed learningbull Critical thinkingbull Team workbull understanding rather than
memorizationbull Facility with professional languagebull Both students amp staff enjoy the
process
Advantages
In preparing students for professional practice PBL
bull Encourages independence as students identify amp meet individual learning needs
bull Stimulates reflection amp self-direction for life-long learning
bull Supports ongoing self-assessmentbull Introduces clinical reasoningbull Enhances critical thinking amp evidence-based
decision makingbull Ensures that knowledge is transferred applied
amp retained by providing a relevant integrated context
bull A problem initiates the activitybull The Group is stimulated to explore
basic scientific amp clinical mechanisms together with social psychological ethical or professional issues
bull Problem stimulates students to reason think critically amp weigh evidence they seek out amp share relevant info
PBL
bull Groups do not need prior knowledge to generate lively ideas as they identify areas for further collective amp personal learning
bull Each student brings individual experience amp makes a distinctive contribution
bull the Tutorrsquos role is to manage interactions rather than supply info
bull An effective Group provides a safe environment for sharing amp testing new knowledge
bull Students practice the language of science amp medicine evaluate ideas and receive feedback from peers amp teacher
bull When clinical exposure is introduced concurrently intellectual amp practical skills develop in parallel
Framework for PBL
bull A trigger initiates the problem (papercomputervideo)
bull Groups brainstorm to identify key issues for discussion
bull Broad thinking produces a rich array of mechanisms amp ideas
bull Hypothesis are critically explored through reasoning
bull The need for additional info is identifiedbull A Conclusion is reachedbull Group reviews the process
Framework for PBL - II
bull In Breaks between Tutorials students identfy Learning Issues to be pursued
bull They are encouraged to adot an evidence-based approach
bull When they reconvene they share and review the learning
Characteristics of an effective PBL Group
An Effective Group is Cohesive motivated mutually supportive amp actively engaged in learning
bull The Group understands the process amp energetically pursues its task
bull Members respect each otherrsquos contribution but examine them critically
bull Discussions flow as students cooperate rather than compete
bull The atmosphere is friendly amp good humouredbull Roles are shared all take turns in scribing
leading discussion taking responsibility for acquiring information
Staff Development
bull Basic training is mandatorybull Further development may be a requirementbull Initial training may involve observation amp
practice with a group from the programbull Effective training ensures that necessary
background goals amp local strategies are considered together with info on assessment amp evaluation
bull In addition to materials supplied to students tutors are usually issued with handbooks highlighting issues for each problem
Tutorrsquos Role in Assessment
bull Individual StudentsGroups may be assessed Summatively (determining progression) or formatively (for feedback)
The GROUP
bull At the end of each problem groups review their processes to encourage self-reflection ampenhance their collective performance
Tutorrsquos Role in Assessment
Individual students
bull Tutors should provide formative feedback to each member
bull Ask students to complete a simple self-assessment questionnaire reviewing appropriate behaviors the tutor returns them with comments
bull Students will be a writtenoralclinical tests that will determine their progression amp ultimate graduation
Evaluating PBL Tutorials-II
bull At the end of each problem time is allocated for evaluation
bull Both the process amp learning in PBL can be evaluated against explicit goals
bull The tutorrsquos review of effectiveness of group processes offers insight for the members
bull Students normally evaluate their tutor helpfulness support for clinical reasoning encouragement for independent learning appropriate intervention provision for effective feedback
PBLbull 1048708 Enabling students to learn in the context in which the
information will be used which increases the ability to retrieve and apply information
bull 1048708 Focusing on important concepts which helps learners organize and store new information in a way that facilitates retrieval and application
bull 1048708 Exploring prior knowledge formulating inquiries derived from and defined by the learnersrsquo need to know and actively constructing meaning through dialogue and reflection
bull 1048708 Utilizing problems designed to simulate studentsrsquo perception of their future profession which serves as a powerful stimulus for studentsrsquo intrinsic motivation to learn
bull 1048708 Actively involving students in monitoring their own progress and reflecting on what works and what needs improvement frequently assessing student performance and providing feedback
PBL Starting the casebull After the introductions and discussion
are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it
bull Reading the case aloud keeps the group focused
bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here
PBL Case (contd)
bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session
PBL Case contdbull SECOND deciding which issues everyone will
tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)
bull THIRD deciding what SPECIFIC questions individuals will try to answer
bull FOURTH deciding how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet or consulting an expert)
The Process of PBL
bullWhat are the issues Identify the important issues in the problem
bull How well do you understand the issues
bull Are there any words or terms about which you are unclear
The Process of PBL contd
bull Consider the basic mechanisms that might explain each important aspect of each problem
bull Assess your current understanding of the basic structural andor functional mechanisms that may contribute to the presentation of the problem
bull Use the collective skills and experiences of group members to explore or explain these phenomena Identify current gaps in knowledge or understanding
Learn from each other
bullShare your own knowledge expertise or ability to reason and synthesize information Be receptive and appreciative of the contribution of your small group members
Determine priorities for learning
bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue
bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan
bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge
bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career
PBL
bull The problem comes first without advance readings lectures or preparation
bull The problem serves as a stimulus for the need to know
Learning Issues
bull Learning issues are questions that cannot be answered with studentsrsquo current knowledge and that can be explored and answered through systematic self-directed inquiry
bull The use of learning issues in tutorials prepares students to handle similar challenges in clinical practice and life-long learning
Learning Issues in PBL First Session1 Getting Started (Introductions Ground
Rules Expectations)2 Identifying Problem3 Exploring Pre-Existing Knowledge4 Generating Hypotheses and Explaining
Mechanisms5 Unfolding the Case Incrementally6 Re-EvaluatingReprioritizing Hypotheses
Based on New Information7 AssessmentReflection
PBL Second Session
8 Independent Self-Directed Study of Learning Issues
PBL Third Session
bull 9 Discussion of Learning Issues and Application of New Knowledge to the Case
bull 10 Continued Unfolding of the Case Incrementally
bull 11 AssessmentReflection
During Tutorial Session students will
1048708 Come prepared to discuss the case and learning issues researched since the last tutorial
1048708 Actively participate in group discussions and contribute to the learning process in a manner that allows for the balanced participation of everyone in the group
1048708 Develop learning issues at each session phrase them as full-sentence questions write them on the board and post them on the course web page
1048708 Consider biological population behaviormental health issuesexplanations and questions of professional attitudes values and ethics related to the patientrsquos problem(s) described in the case
Tutorial Session contd1048708 Go to the board to diagram outline draw etc in
explanation of mechanisms relatedto hypotheses1048708 Debate evidence related to the case and avoid
personal attacks on others1048708 Comply with ground rules with regard to how
the group will function and how itsmembers treat one another1048708 Participate in end-of-session reflection and
assessment by giving and receivingconstructive criticism regarding self tutor
student and group performance
Between Tutorial Session
1048708 Research key learning issues using a variety of resources
1048708 Critically evaluate the credibility of sources and the validity of the information they have obtained in their research
1048708 Integrate what they have learned through research lectures labs clinical skills Perspectives in Medicine (PIM) etc into what is discussed in tutorials
1048708 Synthesize what they have learned and be prepared to discuss it without reading directly from their materials as much as possible and apply it to the case at the next tutorial session
Determine priorities for learning
bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue
bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan
bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge
bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career
PBL Starting the casebull After the introductions and discussion
are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it
bull Reading the case aloud keeps the group focused
bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here
Problem-based learning is designed to develop
1048708 Integrated context-specific knowledge base
1048708 Decision-makingcritical thinking process and skills
1048708 Self-directed life-long learning skills 1048708 Interpersonal collaboration and
communication skills 1048708 Constructive self and peer
assessment skills 1048708 Professional ethics and behavior
PBL Case (contd)
bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session
What is problem based learning
bull In PBL students use triggers from the problem case or scenario to define their own learning objectives
bull Subsequently they do independent self directed study before returning to the group to discuss and refine their acquired knowledge
bull Thus PBL is not about problem solving per se but rather it uses appropriate problems to increase knowledge and understanding
bull The process is clearly defined
PBL
bull PBL uses clinical cases as the context for students to study basic and clinical sciences
bull 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
bull Possible disadvantages include higher costs both in resources and staff time
PBL
bull An educational method characterized by the use of patient problems as a context for students to learn problem-solving skills and acquire knowledge about the basic and clinical sciences
bull Students usually meet in small groups two or three times a week for PBL tutorials
bull They are presented with a clinical problem (eg a patient with chest pain) and in a series of steps they discuss possible mechanisms and causes develop hypotheses and strategies to test the hypotheses are presented with further information and use this new information to refine their hypotheses finally reaching a conclusion
bull A tutor usually acts as a facilitator guiding students in this group-learning process
bull In the course of this exercise students identify both their existing levels and gaps in their knowledge These gaps form the basis for independent learning outside the PBL tutorials The identification and pursuit of these so-called learning goals is a key element of the PBL process
Rationale for using PBL bull The PBL approach is based on principles of adult
education20 and cognitive psychology21 It differs fundamentally from traditional curricula in which students acquire background knowledge of the basic sciences in the early years of the course and in the later years apply this knowledge to the diagnosis and management of clinical problems This traditional approach has been criticised for a number of reasons42223
bull It creates an artificial divide between the basic and clinical sciences
bull Time is wasted in acquiring knowledge that is subsequently forgotten or found to be irrelevant
bull Application of the acquired knowledge can be difficult bull The acquisition and retention of information that has no
apparent relevance can be boring and even demoralising for students
The group learning process acquiring
desirable learning skills
Generic Skills amp attitudes
bull Teamwork bull Critical evaluation of literature bull Chairing a group bull Self directed learning and use of
resources bull Listening Presentation skills
Recording bull Cooperation bull Respect for colleagues views
bull Group learning facilitates not only the acquisition of knowledge but also several other desirable attributes such as communication skills teamwork problem solving independent responsibility for learning sharing information and respect for others PBL can therefore be thought of as a small group teaching method that combines the acquisition of knowledge with the development of generic skills and attitudes Presentation of clinical material as the stimulus for learning enables students to understand the relevance of underlying scientific knowledge and principles in clinical practice
bull when PBL is introduced into a curriculum several other issues for curriculum design and implementation need to be tackled PBL is generally introduced in the context of a defined core curriculum and integration of basic and clinical sciences It has implications for staffing and learning resources and demands a different approach to timetabling workload and assessment PBL is often used to deliver core material in non-clinical parts of the curriculum Paper based PBL scenarios form the basis of the core curriculum and ensure that all students are exposed to the same problems Recently modified PBL techniques have been introduced into clinical education with real patients being used as the stimulus for learning Despite the essential ad hoc nature of learning clinical medicine a key cases approach can enable PBL to be used to deliver the core clinical curriculum
Copyright copy2003 BMJ Publishing Group Ltd
Wood D F BMJ 2003326328-330
No CRoles of participants in a PBL tutorial aption Found
What happens in a PBL tutorial bull PBL tutorials are conducted in several ways In
this article the examples are modelled on the Maastricht seven jump process but its format of seven steps may be shortened
bull A typical PBL tutorial consists of a group of students (usually eight to 10) and a tutor who facilitates the session The length of time (number of sessions) that a group stays together with each other and with individual tutors varies between institutions A group needs to be together long enough to allow good group dynamics to develop but may need to be changed occasionally if personality clashes or other dysfunctional behaviour emerges
bull Students elect a chair for each PBL scenario and a scribe to record the discussion The roles are rotated for each scenario Suitable flip charts or a whiteboard should be used for recording the proceedings At the start of the session depending on the trigger material either the student chair reads out the scenario or all students study the material If the trigger is a real patient in a ward clinic or surgery then a student may be asked to take a clinical history or identify an abnormal physical sign before the group moves to a tutorial room For each module students may be given a handbook containing the problem scenarios and suggested learning resources or learning materials may be handed out at appropriate times as the tutorials progress
Examples of trigger material for PBL scenarios bull Paper based clinical scenarios bull Experimental or clinical laboratory data bull Photographs bull Video clips bull Newspaper articles bull All or part of an article from a scientific
journal bull A real or simulated patient bull A family tree showing an inherited
disorder
PBL tutorial process ndash Step 1 Identify and clarify unfamiliar terms presented in the scenario
scribe lists those that remain unexplained after discussion ndash Step 2 Define the problem or problems to be discussed students may
have different views on the issues but all should be considered scribe records a list of agreed problems
ndash Step 3 Brainstorming session to discuss the problem(s) suggestingpossible explanations on basis of prior knowledge students draw on each others knowledge and identify areas of incomplete knowledge scribe records all discussion
ndash Step 4 Review steps 2 and 3 and arrange explanations into tentativesolutions scribe organises the explanations and restructures if necessary
ndash Step 5 Formulate learning objectives group reaches consensus onthe learning objectives tutor ensures learning objectives are focused achievable comprehensive and appropriate
ndash Step 6 Private study (all students gather information related to eachlearning objective)
ndash Step 7 Group shares results of private study (students identify theirlearning resources and share their results) tutor checks learning and may assess the group
bull The role of the tutor is to facilitate the proceedings (helping the chair to maintain group dynamics and moving the group through the task) and to ensure that the group achieves appropriate learning objectives in line with those set by the curriculum design team The tutor may need to take a more active role in step 7 of the process to ensure that all the students have done the appropriate work and to help the chair to suggest a suitable format for group members to use to present the results of their private study The tutor should encourage students to check their understanding of the material He or she can do this by encouraging the students to ask open questions and ask each other to explain topics in their own words or by the use of drawings and diagrams
PBL in curriculum design bull PBL may be used either as the mainstay of an entire
curriculum or for the delivery of individual courses In practice PBL is usually part of an integrated curriculum using a systems based approach with non-clinical material delivered in the context of clinical practice A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge skills and attitudes A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios Sufficient time should be allowed each week for students to do the self directed learning required for PBL
bull
Copyright copy2003 BMJ Publishing Group Ltd
Wood D F BMJ 2003326328-330
No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found
Writing PBL scenarios
bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives
bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after
studying the scenario should be consistent with the faculty learning objectives
bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding
bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice
bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge
bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented
bull The problem should be sufficiently open so that discussion is not curtailed too early in the process
bull Scenarios should promote participation by the students in seeking information from various learning resources
bull Adapted from Dolmans et al Med Teacher 199719185-9
Staff development
bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)
A dysfunctional group a dominant character may
make it difficult for other students to be heard
A dysfunctional group a dominant character may make it difficult for other students to be heard
bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties
Advantages of PBL bull Student centred PBLIt fostersactive learning improved
understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks
Disadvantagesbull Tutors who cant teachTutorsenjoy passing on
their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful
Assessment of PBL
bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods
bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL
Conclusion
bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning
bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL
PBL 5 Easy Steps
bull Read the problem
Mrs Paula Embledon
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
2 Brain storm
bull Brainstorm
bull ndash hypotheses
bull - what do we know in support of the hypothesis
bull - what do we need to know to test the hypothesis
ndash learning issues
Brainstorm
bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)
ndash specific issues (for individuals to look up)
ndash overlapping issues
bull 4 Individual Reading - Research - Preparation
bull 5 Return
bull ndash review case so far ndash report and discuss
ndash assess progress - continue pagenext pagecomplete
ndash self-evaluation - How did things go Any suggestions for next time
ndash next problem
bull 5 Return
THE FIRST GROUP SESSION
bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day
bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session
bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr
bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine
bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise
bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator
bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues
bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know
bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)
bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)
bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)
PBLbullHelps learners build a bridge
between what they already know and what they need to know to reachthe next level
bull Emphasizing active learning which has been shown to be more satisfying than
passive teacher-to-student learning and to enhance retention and recall
bull Emphasizing student-centered learning in which students are actively involved in setting their own learning goals
Advantages
Encourages bull effective amp self-directed learningbull Critical thinkingbull Team workbull understanding rather than
memorizationbull Facility with professional languagebull Both students amp staff enjoy the
process
Advantages
In preparing students for professional practice PBL
bull Encourages independence as students identify amp meet individual learning needs
bull Stimulates reflection amp self-direction for life-long learning
bull Supports ongoing self-assessmentbull Introduces clinical reasoningbull Enhances critical thinking amp evidence-based
decision makingbull Ensures that knowledge is transferred applied
amp retained by providing a relevant integrated context
bull A problem initiates the activitybull The Group is stimulated to explore
basic scientific amp clinical mechanisms together with social psychological ethical or professional issues
bull Problem stimulates students to reason think critically amp weigh evidence they seek out amp share relevant info
PBL
bull Groups do not need prior knowledge to generate lively ideas as they identify areas for further collective amp personal learning
bull Each student brings individual experience amp makes a distinctive contribution
bull the Tutorrsquos role is to manage interactions rather than supply info
bull An effective Group provides a safe environment for sharing amp testing new knowledge
bull Students practice the language of science amp medicine evaluate ideas and receive feedback from peers amp teacher
bull When clinical exposure is introduced concurrently intellectual amp practical skills develop in parallel
Framework for PBL
bull A trigger initiates the problem (papercomputervideo)
bull Groups brainstorm to identify key issues for discussion
bull Broad thinking produces a rich array of mechanisms amp ideas
bull Hypothesis are critically explored through reasoning
bull The need for additional info is identifiedbull A Conclusion is reachedbull Group reviews the process
Framework for PBL - II
bull In Breaks between Tutorials students identfy Learning Issues to be pursued
bull They are encouraged to adot an evidence-based approach
bull When they reconvene they share and review the learning
Characteristics of an effective PBL Group
An Effective Group is Cohesive motivated mutually supportive amp actively engaged in learning
bull The Group understands the process amp energetically pursues its task
bull Members respect each otherrsquos contribution but examine them critically
bull Discussions flow as students cooperate rather than compete
bull The atmosphere is friendly amp good humouredbull Roles are shared all take turns in scribing
leading discussion taking responsibility for acquiring information
Staff Development
bull Basic training is mandatorybull Further development may be a requirementbull Initial training may involve observation amp
practice with a group from the programbull Effective training ensures that necessary
background goals amp local strategies are considered together with info on assessment amp evaluation
bull In addition to materials supplied to students tutors are usually issued with handbooks highlighting issues for each problem
Tutorrsquos Role in Assessment
bull Individual StudentsGroups may be assessed Summatively (determining progression) or formatively (for feedback)
The GROUP
bull At the end of each problem groups review their processes to encourage self-reflection ampenhance their collective performance
Tutorrsquos Role in Assessment
Individual students
bull Tutors should provide formative feedback to each member
bull Ask students to complete a simple self-assessment questionnaire reviewing appropriate behaviors the tutor returns them with comments
bull Students will be a writtenoralclinical tests that will determine their progression amp ultimate graduation
Evaluating PBL Tutorials-II
bull At the end of each problem time is allocated for evaluation
bull Both the process amp learning in PBL can be evaluated against explicit goals
bull The tutorrsquos review of effectiveness of group processes offers insight for the members
bull Students normally evaluate their tutor helpfulness support for clinical reasoning encouragement for independent learning appropriate intervention provision for effective feedback
PBLbull 1048708 Enabling students to learn in the context in which the
information will be used which increases the ability to retrieve and apply information
bull 1048708 Focusing on important concepts which helps learners organize and store new information in a way that facilitates retrieval and application
bull 1048708 Exploring prior knowledge formulating inquiries derived from and defined by the learnersrsquo need to know and actively constructing meaning through dialogue and reflection
bull 1048708 Utilizing problems designed to simulate studentsrsquo perception of their future profession which serves as a powerful stimulus for studentsrsquo intrinsic motivation to learn
bull 1048708 Actively involving students in monitoring their own progress and reflecting on what works and what needs improvement frequently assessing student performance and providing feedback
PBL Starting the casebull After the introductions and discussion
are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it
bull Reading the case aloud keeps the group focused
bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here
PBL Case (contd)
bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session
PBL Case contdbull SECOND deciding which issues everyone will
tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)
bull THIRD deciding what SPECIFIC questions individuals will try to answer
bull FOURTH deciding how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet or consulting an expert)
The Process of PBL
bullWhat are the issues Identify the important issues in the problem
bull How well do you understand the issues
bull Are there any words or terms about which you are unclear
The Process of PBL contd
bull Consider the basic mechanisms that might explain each important aspect of each problem
bull Assess your current understanding of the basic structural andor functional mechanisms that may contribute to the presentation of the problem
bull Use the collective skills and experiences of group members to explore or explain these phenomena Identify current gaps in knowledge or understanding
Learn from each other
bullShare your own knowledge expertise or ability to reason and synthesize information Be receptive and appreciative of the contribution of your small group members
Determine priorities for learning
bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue
bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan
bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge
bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career
PBL
bull The problem comes first without advance readings lectures or preparation
bull The problem serves as a stimulus for the need to know
Learning Issues
bull Learning issues are questions that cannot be answered with studentsrsquo current knowledge and that can be explored and answered through systematic self-directed inquiry
bull The use of learning issues in tutorials prepares students to handle similar challenges in clinical practice and life-long learning
Learning Issues in PBL First Session1 Getting Started (Introductions Ground
Rules Expectations)2 Identifying Problem3 Exploring Pre-Existing Knowledge4 Generating Hypotheses and Explaining
Mechanisms5 Unfolding the Case Incrementally6 Re-EvaluatingReprioritizing Hypotheses
Based on New Information7 AssessmentReflection
PBL Second Session
8 Independent Self-Directed Study of Learning Issues
PBL Third Session
bull 9 Discussion of Learning Issues and Application of New Knowledge to the Case
bull 10 Continued Unfolding of the Case Incrementally
bull 11 AssessmentReflection
During Tutorial Session students will
1048708 Come prepared to discuss the case and learning issues researched since the last tutorial
1048708 Actively participate in group discussions and contribute to the learning process in a manner that allows for the balanced participation of everyone in the group
1048708 Develop learning issues at each session phrase them as full-sentence questions write them on the board and post them on the course web page
1048708 Consider biological population behaviormental health issuesexplanations and questions of professional attitudes values and ethics related to the patientrsquos problem(s) described in the case
Tutorial Session contd1048708 Go to the board to diagram outline draw etc in
explanation of mechanisms relatedto hypotheses1048708 Debate evidence related to the case and avoid
personal attacks on others1048708 Comply with ground rules with regard to how
the group will function and how itsmembers treat one another1048708 Participate in end-of-session reflection and
assessment by giving and receivingconstructive criticism regarding self tutor
student and group performance
Between Tutorial Session
1048708 Research key learning issues using a variety of resources
1048708 Critically evaluate the credibility of sources and the validity of the information they have obtained in their research
1048708 Integrate what they have learned through research lectures labs clinical skills Perspectives in Medicine (PIM) etc into what is discussed in tutorials
1048708 Synthesize what they have learned and be prepared to discuss it without reading directly from their materials as much as possible and apply it to the case at the next tutorial session
Determine priorities for learning
bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue
bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan
bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge
bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career
PBL Starting the casebull After the introductions and discussion
are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it
bull Reading the case aloud keeps the group focused
bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here
Problem-based learning is designed to develop
1048708 Integrated context-specific knowledge base
1048708 Decision-makingcritical thinking process and skills
1048708 Self-directed life-long learning skills 1048708 Interpersonal collaboration and
communication skills 1048708 Constructive self and peer
assessment skills 1048708 Professional ethics and behavior
PBL Case (contd)
bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session
What is problem based learning
bull In PBL students use triggers from the problem case or scenario to define their own learning objectives
bull Subsequently they do independent self directed study before returning to the group to discuss and refine their acquired knowledge
bull Thus PBL is not about problem solving per se but rather it uses appropriate problems to increase knowledge and understanding
bull The process is clearly defined
PBL
bull PBL uses clinical cases as the context for students to study basic and clinical sciences
bull 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
bull Possible disadvantages include higher costs both in resources and staff time
PBL
bull An educational method characterized by the use of patient problems as a context for students to learn problem-solving skills and acquire knowledge about the basic and clinical sciences
bull Students usually meet in small groups two or three times a week for PBL tutorials
bull They are presented with a clinical problem (eg a patient with chest pain) and in a series of steps they discuss possible mechanisms and causes develop hypotheses and strategies to test the hypotheses are presented with further information and use this new information to refine their hypotheses finally reaching a conclusion
bull A tutor usually acts as a facilitator guiding students in this group-learning process
bull In the course of this exercise students identify both their existing levels and gaps in their knowledge These gaps form the basis for independent learning outside the PBL tutorials The identification and pursuit of these so-called learning goals is a key element of the PBL process
Rationale for using PBL bull The PBL approach is based on principles of adult
education20 and cognitive psychology21 It differs fundamentally from traditional curricula in which students acquire background knowledge of the basic sciences in the early years of the course and in the later years apply this knowledge to the diagnosis and management of clinical problems This traditional approach has been criticised for a number of reasons42223
bull It creates an artificial divide between the basic and clinical sciences
bull Time is wasted in acquiring knowledge that is subsequently forgotten or found to be irrelevant
bull Application of the acquired knowledge can be difficult bull The acquisition and retention of information that has no
apparent relevance can be boring and even demoralising for students
The group learning process acquiring
desirable learning skills
Generic Skills amp attitudes
bull Teamwork bull Critical evaluation of literature bull Chairing a group bull Self directed learning and use of
resources bull Listening Presentation skills
Recording bull Cooperation bull Respect for colleagues views
bull Group learning facilitates not only the acquisition of knowledge but also several other desirable attributes such as communication skills teamwork problem solving independent responsibility for learning sharing information and respect for others PBL can therefore be thought of as a small group teaching method that combines the acquisition of knowledge with the development of generic skills and attitudes Presentation of clinical material as the stimulus for learning enables students to understand the relevance of underlying scientific knowledge and principles in clinical practice
bull when PBL is introduced into a curriculum several other issues for curriculum design and implementation need to be tackled PBL is generally introduced in the context of a defined core curriculum and integration of basic and clinical sciences It has implications for staffing and learning resources and demands a different approach to timetabling workload and assessment PBL is often used to deliver core material in non-clinical parts of the curriculum Paper based PBL scenarios form the basis of the core curriculum and ensure that all students are exposed to the same problems Recently modified PBL techniques have been introduced into clinical education with real patients being used as the stimulus for learning Despite the essential ad hoc nature of learning clinical medicine a key cases approach can enable PBL to be used to deliver the core clinical curriculum
Copyright copy2003 BMJ Publishing Group Ltd
Wood D F BMJ 2003326328-330
No CRoles of participants in a PBL tutorial aption Found
What happens in a PBL tutorial bull PBL tutorials are conducted in several ways In
this article the examples are modelled on the Maastricht seven jump process but its format of seven steps may be shortened
bull A typical PBL tutorial consists of a group of students (usually eight to 10) and a tutor who facilitates the session The length of time (number of sessions) that a group stays together with each other and with individual tutors varies between institutions A group needs to be together long enough to allow good group dynamics to develop but may need to be changed occasionally if personality clashes or other dysfunctional behaviour emerges
bull Students elect a chair for each PBL scenario and a scribe to record the discussion The roles are rotated for each scenario Suitable flip charts or a whiteboard should be used for recording the proceedings At the start of the session depending on the trigger material either the student chair reads out the scenario or all students study the material If the trigger is a real patient in a ward clinic or surgery then a student may be asked to take a clinical history or identify an abnormal physical sign before the group moves to a tutorial room For each module students may be given a handbook containing the problem scenarios and suggested learning resources or learning materials may be handed out at appropriate times as the tutorials progress
Examples of trigger material for PBL scenarios bull Paper based clinical scenarios bull Experimental or clinical laboratory data bull Photographs bull Video clips bull Newspaper articles bull All or part of an article from a scientific
journal bull A real or simulated patient bull A family tree showing an inherited
disorder
PBL tutorial process ndash Step 1 Identify and clarify unfamiliar terms presented in the scenario
scribe lists those that remain unexplained after discussion ndash Step 2 Define the problem or problems to be discussed students may
have different views on the issues but all should be considered scribe records a list of agreed problems
ndash Step 3 Brainstorming session to discuss the problem(s) suggestingpossible explanations on basis of prior knowledge students draw on each others knowledge and identify areas of incomplete knowledge scribe records all discussion
ndash Step 4 Review steps 2 and 3 and arrange explanations into tentativesolutions scribe organises the explanations and restructures if necessary
ndash Step 5 Formulate learning objectives group reaches consensus onthe learning objectives tutor ensures learning objectives are focused achievable comprehensive and appropriate
ndash Step 6 Private study (all students gather information related to eachlearning objective)
ndash Step 7 Group shares results of private study (students identify theirlearning resources and share their results) tutor checks learning and may assess the group
bull The role of the tutor is to facilitate the proceedings (helping the chair to maintain group dynamics and moving the group through the task) and to ensure that the group achieves appropriate learning objectives in line with those set by the curriculum design team The tutor may need to take a more active role in step 7 of the process to ensure that all the students have done the appropriate work and to help the chair to suggest a suitable format for group members to use to present the results of their private study The tutor should encourage students to check their understanding of the material He or she can do this by encouraging the students to ask open questions and ask each other to explain topics in their own words or by the use of drawings and diagrams
PBL in curriculum design bull PBL may be used either as the mainstay of an entire
curriculum or for the delivery of individual courses In practice PBL is usually part of an integrated curriculum using a systems based approach with non-clinical material delivered in the context of clinical practice A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge skills and attitudes A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios Sufficient time should be allowed each week for students to do the self directed learning required for PBL
bull
Copyright copy2003 BMJ Publishing Group Ltd
Wood D F BMJ 2003326328-330
No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found
Writing PBL scenarios
bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives
bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after
studying the scenario should be consistent with the faculty learning objectives
bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding
bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice
bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge
bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented
bull The problem should be sufficiently open so that discussion is not curtailed too early in the process
bull Scenarios should promote participation by the students in seeking information from various learning resources
bull Adapted from Dolmans et al Med Teacher 199719185-9
Staff development
bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)
A dysfunctional group a dominant character may
make it difficult for other students to be heard
A dysfunctional group a dominant character may make it difficult for other students to be heard
bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties
Advantages of PBL bull Student centred PBLIt fostersactive learning improved
understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks
Disadvantagesbull Tutors who cant teachTutorsenjoy passing on
their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful
Assessment of PBL
bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods
bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL
Conclusion
bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning
bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL
PBL 5 Easy Steps
bull Read the problem
Mrs Paula Embledon
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
2 Brain storm
bull Brainstorm
bull ndash hypotheses
bull - what do we know in support of the hypothesis
bull - what do we need to know to test the hypothesis
ndash learning issues
Brainstorm
bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)
ndash specific issues (for individuals to look up)
ndash overlapping issues
bull 4 Individual Reading - Research - Preparation
bull 5 Return
bull ndash review case so far ndash report and discuss
ndash assess progress - continue pagenext pagecomplete
ndash self-evaluation - How did things go Any suggestions for next time
ndash next problem
bull 5 Return
THE FIRST GROUP SESSION
bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day
bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session
bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr
bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine
bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise
bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator
bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues
bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know
bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)
bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)
bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)
Advantages
Encourages bull effective amp self-directed learningbull Critical thinkingbull Team workbull understanding rather than
memorizationbull Facility with professional languagebull Both students amp staff enjoy the
process
Advantages
In preparing students for professional practice PBL
bull Encourages independence as students identify amp meet individual learning needs
bull Stimulates reflection amp self-direction for life-long learning
bull Supports ongoing self-assessmentbull Introduces clinical reasoningbull Enhances critical thinking amp evidence-based
decision makingbull Ensures that knowledge is transferred applied
amp retained by providing a relevant integrated context
bull A problem initiates the activitybull The Group is stimulated to explore
basic scientific amp clinical mechanisms together with social psychological ethical or professional issues
bull Problem stimulates students to reason think critically amp weigh evidence they seek out amp share relevant info
PBL
bull Groups do not need prior knowledge to generate lively ideas as they identify areas for further collective amp personal learning
bull Each student brings individual experience amp makes a distinctive contribution
bull the Tutorrsquos role is to manage interactions rather than supply info
bull An effective Group provides a safe environment for sharing amp testing new knowledge
bull Students practice the language of science amp medicine evaluate ideas and receive feedback from peers amp teacher
bull When clinical exposure is introduced concurrently intellectual amp practical skills develop in parallel
Framework for PBL
bull A trigger initiates the problem (papercomputervideo)
bull Groups brainstorm to identify key issues for discussion
bull Broad thinking produces a rich array of mechanisms amp ideas
bull Hypothesis are critically explored through reasoning
bull The need for additional info is identifiedbull A Conclusion is reachedbull Group reviews the process
Framework for PBL - II
bull In Breaks between Tutorials students identfy Learning Issues to be pursued
bull They are encouraged to adot an evidence-based approach
bull When they reconvene they share and review the learning
Characteristics of an effective PBL Group
An Effective Group is Cohesive motivated mutually supportive amp actively engaged in learning
bull The Group understands the process amp energetically pursues its task
bull Members respect each otherrsquos contribution but examine them critically
bull Discussions flow as students cooperate rather than compete
bull The atmosphere is friendly amp good humouredbull Roles are shared all take turns in scribing
leading discussion taking responsibility for acquiring information
Staff Development
bull Basic training is mandatorybull Further development may be a requirementbull Initial training may involve observation amp
practice with a group from the programbull Effective training ensures that necessary
background goals amp local strategies are considered together with info on assessment amp evaluation
bull In addition to materials supplied to students tutors are usually issued with handbooks highlighting issues for each problem
Tutorrsquos Role in Assessment
bull Individual StudentsGroups may be assessed Summatively (determining progression) or formatively (for feedback)
The GROUP
bull At the end of each problem groups review their processes to encourage self-reflection ampenhance their collective performance
Tutorrsquos Role in Assessment
Individual students
bull Tutors should provide formative feedback to each member
bull Ask students to complete a simple self-assessment questionnaire reviewing appropriate behaviors the tutor returns them with comments
bull Students will be a writtenoralclinical tests that will determine their progression amp ultimate graduation
Evaluating PBL Tutorials-II
bull At the end of each problem time is allocated for evaluation
bull Both the process amp learning in PBL can be evaluated against explicit goals
bull The tutorrsquos review of effectiveness of group processes offers insight for the members
bull Students normally evaluate their tutor helpfulness support for clinical reasoning encouragement for independent learning appropriate intervention provision for effective feedback
PBLbull 1048708 Enabling students to learn in the context in which the
information will be used which increases the ability to retrieve and apply information
bull 1048708 Focusing on important concepts which helps learners organize and store new information in a way that facilitates retrieval and application
bull 1048708 Exploring prior knowledge formulating inquiries derived from and defined by the learnersrsquo need to know and actively constructing meaning through dialogue and reflection
bull 1048708 Utilizing problems designed to simulate studentsrsquo perception of their future profession which serves as a powerful stimulus for studentsrsquo intrinsic motivation to learn
bull 1048708 Actively involving students in monitoring their own progress and reflecting on what works and what needs improvement frequently assessing student performance and providing feedback
PBL Starting the casebull After the introductions and discussion
are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it
bull Reading the case aloud keeps the group focused
bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here
PBL Case (contd)
bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session
PBL Case contdbull SECOND deciding which issues everyone will
tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)
bull THIRD deciding what SPECIFIC questions individuals will try to answer
bull FOURTH deciding how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet or consulting an expert)
The Process of PBL
bullWhat are the issues Identify the important issues in the problem
bull How well do you understand the issues
bull Are there any words or terms about which you are unclear
The Process of PBL contd
bull Consider the basic mechanisms that might explain each important aspect of each problem
bull Assess your current understanding of the basic structural andor functional mechanisms that may contribute to the presentation of the problem
bull Use the collective skills and experiences of group members to explore or explain these phenomena Identify current gaps in knowledge or understanding
Learn from each other
bullShare your own knowledge expertise or ability to reason and synthesize information Be receptive and appreciative of the contribution of your small group members
Determine priorities for learning
bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue
bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan
bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge
bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career
PBL
bull The problem comes first without advance readings lectures or preparation
bull The problem serves as a stimulus for the need to know
Learning Issues
bull Learning issues are questions that cannot be answered with studentsrsquo current knowledge and that can be explored and answered through systematic self-directed inquiry
bull The use of learning issues in tutorials prepares students to handle similar challenges in clinical practice and life-long learning
Learning Issues in PBL First Session1 Getting Started (Introductions Ground
Rules Expectations)2 Identifying Problem3 Exploring Pre-Existing Knowledge4 Generating Hypotheses and Explaining
Mechanisms5 Unfolding the Case Incrementally6 Re-EvaluatingReprioritizing Hypotheses
Based on New Information7 AssessmentReflection
PBL Second Session
8 Independent Self-Directed Study of Learning Issues
PBL Third Session
bull 9 Discussion of Learning Issues and Application of New Knowledge to the Case
bull 10 Continued Unfolding of the Case Incrementally
bull 11 AssessmentReflection
During Tutorial Session students will
1048708 Come prepared to discuss the case and learning issues researched since the last tutorial
1048708 Actively participate in group discussions and contribute to the learning process in a manner that allows for the balanced participation of everyone in the group
1048708 Develop learning issues at each session phrase them as full-sentence questions write them on the board and post them on the course web page
1048708 Consider biological population behaviormental health issuesexplanations and questions of professional attitudes values and ethics related to the patientrsquos problem(s) described in the case
Tutorial Session contd1048708 Go to the board to diagram outline draw etc in
explanation of mechanisms relatedto hypotheses1048708 Debate evidence related to the case and avoid
personal attacks on others1048708 Comply with ground rules with regard to how
the group will function and how itsmembers treat one another1048708 Participate in end-of-session reflection and
assessment by giving and receivingconstructive criticism regarding self tutor
student and group performance
Between Tutorial Session
1048708 Research key learning issues using a variety of resources
1048708 Critically evaluate the credibility of sources and the validity of the information they have obtained in their research
1048708 Integrate what they have learned through research lectures labs clinical skills Perspectives in Medicine (PIM) etc into what is discussed in tutorials
1048708 Synthesize what they have learned and be prepared to discuss it without reading directly from their materials as much as possible and apply it to the case at the next tutorial session
Determine priorities for learning
bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue
bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan
bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge
bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career
PBL Starting the casebull After the introductions and discussion
are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it
bull Reading the case aloud keeps the group focused
bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here
Problem-based learning is designed to develop
1048708 Integrated context-specific knowledge base
1048708 Decision-makingcritical thinking process and skills
1048708 Self-directed life-long learning skills 1048708 Interpersonal collaboration and
communication skills 1048708 Constructive self and peer
assessment skills 1048708 Professional ethics and behavior
PBL Case (contd)
bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session
What is problem based learning
bull In PBL students use triggers from the problem case or scenario to define their own learning objectives
bull Subsequently they do independent self directed study before returning to the group to discuss and refine their acquired knowledge
bull Thus PBL is not about problem solving per se but rather it uses appropriate problems to increase knowledge and understanding
bull The process is clearly defined
PBL
bull PBL uses clinical cases as the context for students to study basic and clinical sciences
bull 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
bull Possible disadvantages include higher costs both in resources and staff time
PBL
bull An educational method characterized by the use of patient problems as a context for students to learn problem-solving skills and acquire knowledge about the basic and clinical sciences
bull Students usually meet in small groups two or three times a week for PBL tutorials
bull They are presented with a clinical problem (eg a patient with chest pain) and in a series of steps they discuss possible mechanisms and causes develop hypotheses and strategies to test the hypotheses are presented with further information and use this new information to refine their hypotheses finally reaching a conclusion
bull A tutor usually acts as a facilitator guiding students in this group-learning process
bull In the course of this exercise students identify both their existing levels and gaps in their knowledge These gaps form the basis for independent learning outside the PBL tutorials The identification and pursuit of these so-called learning goals is a key element of the PBL process
Rationale for using PBL bull The PBL approach is based on principles of adult
education20 and cognitive psychology21 It differs fundamentally from traditional curricula in which students acquire background knowledge of the basic sciences in the early years of the course and in the later years apply this knowledge to the diagnosis and management of clinical problems This traditional approach has been criticised for a number of reasons42223
bull It creates an artificial divide between the basic and clinical sciences
bull Time is wasted in acquiring knowledge that is subsequently forgotten or found to be irrelevant
bull Application of the acquired knowledge can be difficult bull The acquisition and retention of information that has no
apparent relevance can be boring and even demoralising for students
The group learning process acquiring
desirable learning skills
Generic Skills amp attitudes
bull Teamwork bull Critical evaluation of literature bull Chairing a group bull Self directed learning and use of
resources bull Listening Presentation skills
Recording bull Cooperation bull Respect for colleagues views
bull Group learning facilitates not only the acquisition of knowledge but also several other desirable attributes such as communication skills teamwork problem solving independent responsibility for learning sharing information and respect for others PBL can therefore be thought of as a small group teaching method that combines the acquisition of knowledge with the development of generic skills and attitudes Presentation of clinical material as the stimulus for learning enables students to understand the relevance of underlying scientific knowledge and principles in clinical practice
bull when PBL is introduced into a curriculum several other issues for curriculum design and implementation need to be tackled PBL is generally introduced in the context of a defined core curriculum and integration of basic and clinical sciences It has implications for staffing and learning resources and demands a different approach to timetabling workload and assessment PBL is often used to deliver core material in non-clinical parts of the curriculum Paper based PBL scenarios form the basis of the core curriculum and ensure that all students are exposed to the same problems Recently modified PBL techniques have been introduced into clinical education with real patients being used as the stimulus for learning Despite the essential ad hoc nature of learning clinical medicine a key cases approach can enable PBL to be used to deliver the core clinical curriculum
Copyright copy2003 BMJ Publishing Group Ltd
Wood D F BMJ 2003326328-330
No CRoles of participants in a PBL tutorial aption Found
What happens in a PBL tutorial bull PBL tutorials are conducted in several ways In
this article the examples are modelled on the Maastricht seven jump process but its format of seven steps may be shortened
bull A typical PBL tutorial consists of a group of students (usually eight to 10) and a tutor who facilitates the session The length of time (number of sessions) that a group stays together with each other and with individual tutors varies between institutions A group needs to be together long enough to allow good group dynamics to develop but may need to be changed occasionally if personality clashes or other dysfunctional behaviour emerges
bull Students elect a chair for each PBL scenario and a scribe to record the discussion The roles are rotated for each scenario Suitable flip charts or a whiteboard should be used for recording the proceedings At the start of the session depending on the trigger material either the student chair reads out the scenario or all students study the material If the trigger is a real patient in a ward clinic or surgery then a student may be asked to take a clinical history or identify an abnormal physical sign before the group moves to a tutorial room For each module students may be given a handbook containing the problem scenarios and suggested learning resources or learning materials may be handed out at appropriate times as the tutorials progress
Examples of trigger material for PBL scenarios bull Paper based clinical scenarios bull Experimental or clinical laboratory data bull Photographs bull Video clips bull Newspaper articles bull All or part of an article from a scientific
journal bull A real or simulated patient bull A family tree showing an inherited
disorder
PBL tutorial process ndash Step 1 Identify and clarify unfamiliar terms presented in the scenario
scribe lists those that remain unexplained after discussion ndash Step 2 Define the problem or problems to be discussed students may
have different views on the issues but all should be considered scribe records a list of agreed problems
ndash Step 3 Brainstorming session to discuss the problem(s) suggestingpossible explanations on basis of prior knowledge students draw on each others knowledge and identify areas of incomplete knowledge scribe records all discussion
ndash Step 4 Review steps 2 and 3 and arrange explanations into tentativesolutions scribe organises the explanations and restructures if necessary
ndash Step 5 Formulate learning objectives group reaches consensus onthe learning objectives tutor ensures learning objectives are focused achievable comprehensive and appropriate
ndash Step 6 Private study (all students gather information related to eachlearning objective)
ndash Step 7 Group shares results of private study (students identify theirlearning resources and share their results) tutor checks learning and may assess the group
bull The role of the tutor is to facilitate the proceedings (helping the chair to maintain group dynamics and moving the group through the task) and to ensure that the group achieves appropriate learning objectives in line with those set by the curriculum design team The tutor may need to take a more active role in step 7 of the process to ensure that all the students have done the appropriate work and to help the chair to suggest a suitable format for group members to use to present the results of their private study The tutor should encourage students to check their understanding of the material He or she can do this by encouraging the students to ask open questions and ask each other to explain topics in their own words or by the use of drawings and diagrams
PBL in curriculum design bull PBL may be used either as the mainstay of an entire
curriculum or for the delivery of individual courses In practice PBL is usually part of an integrated curriculum using a systems based approach with non-clinical material delivered in the context of clinical practice A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge skills and attitudes A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios Sufficient time should be allowed each week for students to do the self directed learning required for PBL
bull
Copyright copy2003 BMJ Publishing Group Ltd
Wood D F BMJ 2003326328-330
No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found
Writing PBL scenarios
bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives
bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after
studying the scenario should be consistent with the faculty learning objectives
bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding
bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice
bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge
bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented
bull The problem should be sufficiently open so that discussion is not curtailed too early in the process
bull Scenarios should promote participation by the students in seeking information from various learning resources
bull Adapted from Dolmans et al Med Teacher 199719185-9
Staff development
bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)
A dysfunctional group a dominant character may
make it difficult for other students to be heard
A dysfunctional group a dominant character may make it difficult for other students to be heard
bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties
Advantages of PBL bull Student centred PBLIt fostersactive learning improved
understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks
Disadvantagesbull Tutors who cant teachTutorsenjoy passing on
their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful
Assessment of PBL
bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods
bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL
Conclusion
bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning
bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL
PBL 5 Easy Steps
bull Read the problem
Mrs Paula Embledon
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
2 Brain storm
bull Brainstorm
bull ndash hypotheses
bull - what do we know in support of the hypothesis
bull - what do we need to know to test the hypothesis
ndash learning issues
Brainstorm
bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)
ndash specific issues (for individuals to look up)
ndash overlapping issues
bull 4 Individual Reading - Research - Preparation
bull 5 Return
bull ndash review case so far ndash report and discuss
ndash assess progress - continue pagenext pagecomplete
ndash self-evaluation - How did things go Any suggestions for next time
ndash next problem
bull 5 Return
THE FIRST GROUP SESSION
bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day
bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session
bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr
bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine
bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise
bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator
bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues
bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know
bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)
bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)
bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)
Advantages
In preparing students for professional practice PBL
bull Encourages independence as students identify amp meet individual learning needs
bull Stimulates reflection amp self-direction for life-long learning
bull Supports ongoing self-assessmentbull Introduces clinical reasoningbull Enhances critical thinking amp evidence-based
decision makingbull Ensures that knowledge is transferred applied
amp retained by providing a relevant integrated context
bull A problem initiates the activitybull The Group is stimulated to explore
basic scientific amp clinical mechanisms together with social psychological ethical or professional issues
bull Problem stimulates students to reason think critically amp weigh evidence they seek out amp share relevant info
PBL
bull Groups do not need prior knowledge to generate lively ideas as they identify areas for further collective amp personal learning
bull Each student brings individual experience amp makes a distinctive contribution
bull the Tutorrsquos role is to manage interactions rather than supply info
bull An effective Group provides a safe environment for sharing amp testing new knowledge
bull Students practice the language of science amp medicine evaluate ideas and receive feedback from peers amp teacher
bull When clinical exposure is introduced concurrently intellectual amp practical skills develop in parallel
Framework for PBL
bull A trigger initiates the problem (papercomputervideo)
bull Groups brainstorm to identify key issues for discussion
bull Broad thinking produces a rich array of mechanisms amp ideas
bull Hypothesis are critically explored through reasoning
bull The need for additional info is identifiedbull A Conclusion is reachedbull Group reviews the process
Framework for PBL - II
bull In Breaks between Tutorials students identfy Learning Issues to be pursued
bull They are encouraged to adot an evidence-based approach
bull When they reconvene they share and review the learning
Characteristics of an effective PBL Group
An Effective Group is Cohesive motivated mutually supportive amp actively engaged in learning
bull The Group understands the process amp energetically pursues its task
bull Members respect each otherrsquos contribution but examine them critically
bull Discussions flow as students cooperate rather than compete
bull The atmosphere is friendly amp good humouredbull Roles are shared all take turns in scribing
leading discussion taking responsibility for acquiring information
Staff Development
bull Basic training is mandatorybull Further development may be a requirementbull Initial training may involve observation amp
practice with a group from the programbull Effective training ensures that necessary
background goals amp local strategies are considered together with info on assessment amp evaluation
bull In addition to materials supplied to students tutors are usually issued with handbooks highlighting issues for each problem
Tutorrsquos Role in Assessment
bull Individual StudentsGroups may be assessed Summatively (determining progression) or formatively (for feedback)
The GROUP
bull At the end of each problem groups review their processes to encourage self-reflection ampenhance their collective performance
Tutorrsquos Role in Assessment
Individual students
bull Tutors should provide formative feedback to each member
bull Ask students to complete a simple self-assessment questionnaire reviewing appropriate behaviors the tutor returns them with comments
bull Students will be a writtenoralclinical tests that will determine their progression amp ultimate graduation
Evaluating PBL Tutorials-II
bull At the end of each problem time is allocated for evaluation
bull Both the process amp learning in PBL can be evaluated against explicit goals
bull The tutorrsquos review of effectiveness of group processes offers insight for the members
bull Students normally evaluate their tutor helpfulness support for clinical reasoning encouragement for independent learning appropriate intervention provision for effective feedback
PBLbull 1048708 Enabling students to learn in the context in which the
information will be used which increases the ability to retrieve and apply information
bull 1048708 Focusing on important concepts which helps learners organize and store new information in a way that facilitates retrieval and application
bull 1048708 Exploring prior knowledge formulating inquiries derived from and defined by the learnersrsquo need to know and actively constructing meaning through dialogue and reflection
bull 1048708 Utilizing problems designed to simulate studentsrsquo perception of their future profession which serves as a powerful stimulus for studentsrsquo intrinsic motivation to learn
bull 1048708 Actively involving students in monitoring their own progress and reflecting on what works and what needs improvement frequently assessing student performance and providing feedback
PBL Starting the casebull After the introductions and discussion
are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it
bull Reading the case aloud keeps the group focused
bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here
PBL Case (contd)
bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session
PBL Case contdbull SECOND deciding which issues everyone will
tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)
bull THIRD deciding what SPECIFIC questions individuals will try to answer
bull FOURTH deciding how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet or consulting an expert)
The Process of PBL
bullWhat are the issues Identify the important issues in the problem
bull How well do you understand the issues
bull Are there any words or terms about which you are unclear
The Process of PBL contd
bull Consider the basic mechanisms that might explain each important aspect of each problem
bull Assess your current understanding of the basic structural andor functional mechanisms that may contribute to the presentation of the problem
bull Use the collective skills and experiences of group members to explore or explain these phenomena Identify current gaps in knowledge or understanding
Learn from each other
bullShare your own knowledge expertise or ability to reason and synthesize information Be receptive and appreciative of the contribution of your small group members
Determine priorities for learning
bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue
bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan
bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge
bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career
PBL
bull The problem comes first without advance readings lectures or preparation
bull The problem serves as a stimulus for the need to know
Learning Issues
bull Learning issues are questions that cannot be answered with studentsrsquo current knowledge and that can be explored and answered through systematic self-directed inquiry
bull The use of learning issues in tutorials prepares students to handle similar challenges in clinical practice and life-long learning
Learning Issues in PBL First Session1 Getting Started (Introductions Ground
Rules Expectations)2 Identifying Problem3 Exploring Pre-Existing Knowledge4 Generating Hypotheses and Explaining
Mechanisms5 Unfolding the Case Incrementally6 Re-EvaluatingReprioritizing Hypotheses
Based on New Information7 AssessmentReflection
PBL Second Session
8 Independent Self-Directed Study of Learning Issues
PBL Third Session
bull 9 Discussion of Learning Issues and Application of New Knowledge to the Case
bull 10 Continued Unfolding of the Case Incrementally
bull 11 AssessmentReflection
During Tutorial Session students will
1048708 Come prepared to discuss the case and learning issues researched since the last tutorial
1048708 Actively participate in group discussions and contribute to the learning process in a manner that allows for the balanced participation of everyone in the group
1048708 Develop learning issues at each session phrase them as full-sentence questions write them on the board and post them on the course web page
1048708 Consider biological population behaviormental health issuesexplanations and questions of professional attitudes values and ethics related to the patientrsquos problem(s) described in the case
Tutorial Session contd1048708 Go to the board to diagram outline draw etc in
explanation of mechanisms relatedto hypotheses1048708 Debate evidence related to the case and avoid
personal attacks on others1048708 Comply with ground rules with regard to how
the group will function and how itsmembers treat one another1048708 Participate in end-of-session reflection and
assessment by giving and receivingconstructive criticism regarding self tutor
student and group performance
Between Tutorial Session
1048708 Research key learning issues using a variety of resources
1048708 Critically evaluate the credibility of sources and the validity of the information they have obtained in their research
1048708 Integrate what they have learned through research lectures labs clinical skills Perspectives in Medicine (PIM) etc into what is discussed in tutorials
1048708 Synthesize what they have learned and be prepared to discuss it without reading directly from their materials as much as possible and apply it to the case at the next tutorial session
Determine priorities for learning
bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue
bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan
bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge
bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career
PBL Starting the casebull After the introductions and discussion
are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it
bull Reading the case aloud keeps the group focused
bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here
Problem-based learning is designed to develop
1048708 Integrated context-specific knowledge base
1048708 Decision-makingcritical thinking process and skills
1048708 Self-directed life-long learning skills 1048708 Interpersonal collaboration and
communication skills 1048708 Constructive self and peer
assessment skills 1048708 Professional ethics and behavior
PBL Case (contd)
bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session
What is problem based learning
bull In PBL students use triggers from the problem case or scenario to define their own learning objectives
bull Subsequently they do independent self directed study before returning to the group to discuss and refine their acquired knowledge
bull Thus PBL is not about problem solving per se but rather it uses appropriate problems to increase knowledge and understanding
bull The process is clearly defined
PBL
bull PBL uses clinical cases as the context for students to study basic and clinical sciences
bull 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
bull Possible disadvantages include higher costs both in resources and staff time
PBL
bull An educational method characterized by the use of patient problems as a context for students to learn problem-solving skills and acquire knowledge about the basic and clinical sciences
bull Students usually meet in small groups two or three times a week for PBL tutorials
bull They are presented with a clinical problem (eg a patient with chest pain) and in a series of steps they discuss possible mechanisms and causes develop hypotheses and strategies to test the hypotheses are presented with further information and use this new information to refine their hypotheses finally reaching a conclusion
bull A tutor usually acts as a facilitator guiding students in this group-learning process
bull In the course of this exercise students identify both their existing levels and gaps in their knowledge These gaps form the basis for independent learning outside the PBL tutorials The identification and pursuit of these so-called learning goals is a key element of the PBL process
Rationale for using PBL bull The PBL approach is based on principles of adult
education20 and cognitive psychology21 It differs fundamentally from traditional curricula in which students acquire background knowledge of the basic sciences in the early years of the course and in the later years apply this knowledge to the diagnosis and management of clinical problems This traditional approach has been criticised for a number of reasons42223
bull It creates an artificial divide between the basic and clinical sciences
bull Time is wasted in acquiring knowledge that is subsequently forgotten or found to be irrelevant
bull Application of the acquired knowledge can be difficult bull The acquisition and retention of information that has no
apparent relevance can be boring and even demoralising for students
The group learning process acquiring
desirable learning skills
Generic Skills amp attitudes
bull Teamwork bull Critical evaluation of literature bull Chairing a group bull Self directed learning and use of
resources bull Listening Presentation skills
Recording bull Cooperation bull Respect for colleagues views
bull Group learning facilitates not only the acquisition of knowledge but also several other desirable attributes such as communication skills teamwork problem solving independent responsibility for learning sharing information and respect for others PBL can therefore be thought of as a small group teaching method that combines the acquisition of knowledge with the development of generic skills and attitudes Presentation of clinical material as the stimulus for learning enables students to understand the relevance of underlying scientific knowledge and principles in clinical practice
bull when PBL is introduced into a curriculum several other issues for curriculum design and implementation need to be tackled PBL is generally introduced in the context of a defined core curriculum and integration of basic and clinical sciences It has implications for staffing and learning resources and demands a different approach to timetabling workload and assessment PBL is often used to deliver core material in non-clinical parts of the curriculum Paper based PBL scenarios form the basis of the core curriculum and ensure that all students are exposed to the same problems Recently modified PBL techniques have been introduced into clinical education with real patients being used as the stimulus for learning Despite the essential ad hoc nature of learning clinical medicine a key cases approach can enable PBL to be used to deliver the core clinical curriculum
Copyright copy2003 BMJ Publishing Group Ltd
Wood D F BMJ 2003326328-330
No CRoles of participants in a PBL tutorial aption Found
What happens in a PBL tutorial bull PBL tutorials are conducted in several ways In
this article the examples are modelled on the Maastricht seven jump process but its format of seven steps may be shortened
bull A typical PBL tutorial consists of a group of students (usually eight to 10) and a tutor who facilitates the session The length of time (number of sessions) that a group stays together with each other and with individual tutors varies between institutions A group needs to be together long enough to allow good group dynamics to develop but may need to be changed occasionally if personality clashes or other dysfunctional behaviour emerges
bull Students elect a chair for each PBL scenario and a scribe to record the discussion The roles are rotated for each scenario Suitable flip charts or a whiteboard should be used for recording the proceedings At the start of the session depending on the trigger material either the student chair reads out the scenario or all students study the material If the trigger is a real patient in a ward clinic or surgery then a student may be asked to take a clinical history or identify an abnormal physical sign before the group moves to a tutorial room For each module students may be given a handbook containing the problem scenarios and suggested learning resources or learning materials may be handed out at appropriate times as the tutorials progress
Examples of trigger material for PBL scenarios bull Paper based clinical scenarios bull Experimental or clinical laboratory data bull Photographs bull Video clips bull Newspaper articles bull All or part of an article from a scientific
journal bull A real or simulated patient bull A family tree showing an inherited
disorder
PBL tutorial process ndash Step 1 Identify and clarify unfamiliar terms presented in the scenario
scribe lists those that remain unexplained after discussion ndash Step 2 Define the problem or problems to be discussed students may
have different views on the issues but all should be considered scribe records a list of agreed problems
ndash Step 3 Brainstorming session to discuss the problem(s) suggestingpossible explanations on basis of prior knowledge students draw on each others knowledge and identify areas of incomplete knowledge scribe records all discussion
ndash Step 4 Review steps 2 and 3 and arrange explanations into tentativesolutions scribe organises the explanations and restructures if necessary
ndash Step 5 Formulate learning objectives group reaches consensus onthe learning objectives tutor ensures learning objectives are focused achievable comprehensive and appropriate
ndash Step 6 Private study (all students gather information related to eachlearning objective)
ndash Step 7 Group shares results of private study (students identify theirlearning resources and share their results) tutor checks learning and may assess the group
bull The role of the tutor is to facilitate the proceedings (helping the chair to maintain group dynamics and moving the group through the task) and to ensure that the group achieves appropriate learning objectives in line with those set by the curriculum design team The tutor may need to take a more active role in step 7 of the process to ensure that all the students have done the appropriate work and to help the chair to suggest a suitable format for group members to use to present the results of their private study The tutor should encourage students to check their understanding of the material He or she can do this by encouraging the students to ask open questions and ask each other to explain topics in their own words or by the use of drawings and diagrams
PBL in curriculum design bull PBL may be used either as the mainstay of an entire
curriculum or for the delivery of individual courses In practice PBL is usually part of an integrated curriculum using a systems based approach with non-clinical material delivered in the context of clinical practice A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge skills and attitudes A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios Sufficient time should be allowed each week for students to do the self directed learning required for PBL
bull
Copyright copy2003 BMJ Publishing Group Ltd
Wood D F BMJ 2003326328-330
No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found
Writing PBL scenarios
bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives
bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after
studying the scenario should be consistent with the faculty learning objectives
bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding
bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice
bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge
bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented
bull The problem should be sufficiently open so that discussion is not curtailed too early in the process
bull Scenarios should promote participation by the students in seeking information from various learning resources
bull Adapted from Dolmans et al Med Teacher 199719185-9
Staff development
bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)
A dysfunctional group a dominant character may
make it difficult for other students to be heard
A dysfunctional group a dominant character may make it difficult for other students to be heard
bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties
Advantages of PBL bull Student centred PBLIt fostersactive learning improved
understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks
Disadvantagesbull Tutors who cant teachTutorsenjoy passing on
their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful
Assessment of PBL
bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods
bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL
Conclusion
bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning
bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL
PBL 5 Easy Steps
bull Read the problem
Mrs Paula Embledon
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
2 Brain storm
bull Brainstorm
bull ndash hypotheses
bull - what do we know in support of the hypothesis
bull - what do we need to know to test the hypothesis
ndash learning issues
Brainstorm
bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)
ndash specific issues (for individuals to look up)
ndash overlapping issues
bull 4 Individual Reading - Research - Preparation
bull 5 Return
bull ndash review case so far ndash report and discuss
ndash assess progress - continue pagenext pagecomplete
ndash self-evaluation - How did things go Any suggestions for next time
ndash next problem
bull 5 Return
THE FIRST GROUP SESSION
bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day
bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session
bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr
bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine
bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise
bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator
bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues
bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know
bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)
bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)
bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)
bull A problem initiates the activitybull The Group is stimulated to explore
basic scientific amp clinical mechanisms together with social psychological ethical or professional issues
bull Problem stimulates students to reason think critically amp weigh evidence they seek out amp share relevant info
PBL
bull Groups do not need prior knowledge to generate lively ideas as they identify areas for further collective amp personal learning
bull Each student brings individual experience amp makes a distinctive contribution
bull the Tutorrsquos role is to manage interactions rather than supply info
bull An effective Group provides a safe environment for sharing amp testing new knowledge
bull Students practice the language of science amp medicine evaluate ideas and receive feedback from peers amp teacher
bull When clinical exposure is introduced concurrently intellectual amp practical skills develop in parallel
Framework for PBL
bull A trigger initiates the problem (papercomputervideo)
bull Groups brainstorm to identify key issues for discussion
bull Broad thinking produces a rich array of mechanisms amp ideas
bull Hypothesis are critically explored through reasoning
bull The need for additional info is identifiedbull A Conclusion is reachedbull Group reviews the process
Framework for PBL - II
bull In Breaks between Tutorials students identfy Learning Issues to be pursued
bull They are encouraged to adot an evidence-based approach
bull When they reconvene they share and review the learning
Characteristics of an effective PBL Group
An Effective Group is Cohesive motivated mutually supportive amp actively engaged in learning
bull The Group understands the process amp energetically pursues its task
bull Members respect each otherrsquos contribution but examine them critically
bull Discussions flow as students cooperate rather than compete
bull The atmosphere is friendly amp good humouredbull Roles are shared all take turns in scribing
leading discussion taking responsibility for acquiring information
Staff Development
bull Basic training is mandatorybull Further development may be a requirementbull Initial training may involve observation amp
practice with a group from the programbull Effective training ensures that necessary
background goals amp local strategies are considered together with info on assessment amp evaluation
bull In addition to materials supplied to students tutors are usually issued with handbooks highlighting issues for each problem
Tutorrsquos Role in Assessment
bull Individual StudentsGroups may be assessed Summatively (determining progression) or formatively (for feedback)
The GROUP
bull At the end of each problem groups review their processes to encourage self-reflection ampenhance their collective performance
Tutorrsquos Role in Assessment
Individual students
bull Tutors should provide formative feedback to each member
bull Ask students to complete a simple self-assessment questionnaire reviewing appropriate behaviors the tutor returns them with comments
bull Students will be a writtenoralclinical tests that will determine their progression amp ultimate graduation
Evaluating PBL Tutorials-II
bull At the end of each problem time is allocated for evaluation
bull Both the process amp learning in PBL can be evaluated against explicit goals
bull The tutorrsquos review of effectiveness of group processes offers insight for the members
bull Students normally evaluate their tutor helpfulness support for clinical reasoning encouragement for independent learning appropriate intervention provision for effective feedback
PBLbull 1048708 Enabling students to learn in the context in which the
information will be used which increases the ability to retrieve and apply information
bull 1048708 Focusing on important concepts which helps learners organize and store new information in a way that facilitates retrieval and application
bull 1048708 Exploring prior knowledge formulating inquiries derived from and defined by the learnersrsquo need to know and actively constructing meaning through dialogue and reflection
bull 1048708 Utilizing problems designed to simulate studentsrsquo perception of their future profession which serves as a powerful stimulus for studentsrsquo intrinsic motivation to learn
bull 1048708 Actively involving students in monitoring their own progress and reflecting on what works and what needs improvement frequently assessing student performance and providing feedback
PBL Starting the casebull After the introductions and discussion
are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it
bull Reading the case aloud keeps the group focused
bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here
PBL Case (contd)
bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session
PBL Case contdbull SECOND deciding which issues everyone will
tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)
bull THIRD deciding what SPECIFIC questions individuals will try to answer
bull FOURTH deciding how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet or consulting an expert)
The Process of PBL
bullWhat are the issues Identify the important issues in the problem
bull How well do you understand the issues
bull Are there any words or terms about which you are unclear
The Process of PBL contd
bull Consider the basic mechanisms that might explain each important aspect of each problem
bull Assess your current understanding of the basic structural andor functional mechanisms that may contribute to the presentation of the problem
bull Use the collective skills and experiences of group members to explore or explain these phenomena Identify current gaps in knowledge or understanding
Learn from each other
bullShare your own knowledge expertise or ability to reason and synthesize information Be receptive and appreciative of the contribution of your small group members
Determine priorities for learning
bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue
bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan
bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge
bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career
PBL
bull The problem comes first without advance readings lectures or preparation
bull The problem serves as a stimulus for the need to know
Learning Issues
bull Learning issues are questions that cannot be answered with studentsrsquo current knowledge and that can be explored and answered through systematic self-directed inquiry
bull The use of learning issues in tutorials prepares students to handle similar challenges in clinical practice and life-long learning
Learning Issues in PBL First Session1 Getting Started (Introductions Ground
Rules Expectations)2 Identifying Problem3 Exploring Pre-Existing Knowledge4 Generating Hypotheses and Explaining
Mechanisms5 Unfolding the Case Incrementally6 Re-EvaluatingReprioritizing Hypotheses
Based on New Information7 AssessmentReflection
PBL Second Session
8 Independent Self-Directed Study of Learning Issues
PBL Third Session
bull 9 Discussion of Learning Issues and Application of New Knowledge to the Case
bull 10 Continued Unfolding of the Case Incrementally
bull 11 AssessmentReflection
During Tutorial Session students will
1048708 Come prepared to discuss the case and learning issues researched since the last tutorial
1048708 Actively participate in group discussions and contribute to the learning process in a manner that allows for the balanced participation of everyone in the group
1048708 Develop learning issues at each session phrase them as full-sentence questions write them on the board and post them on the course web page
1048708 Consider biological population behaviormental health issuesexplanations and questions of professional attitudes values and ethics related to the patientrsquos problem(s) described in the case
Tutorial Session contd1048708 Go to the board to diagram outline draw etc in
explanation of mechanisms relatedto hypotheses1048708 Debate evidence related to the case and avoid
personal attacks on others1048708 Comply with ground rules with regard to how
the group will function and how itsmembers treat one another1048708 Participate in end-of-session reflection and
assessment by giving and receivingconstructive criticism regarding self tutor
student and group performance
Between Tutorial Session
1048708 Research key learning issues using a variety of resources
1048708 Critically evaluate the credibility of sources and the validity of the information they have obtained in their research
1048708 Integrate what they have learned through research lectures labs clinical skills Perspectives in Medicine (PIM) etc into what is discussed in tutorials
1048708 Synthesize what they have learned and be prepared to discuss it without reading directly from their materials as much as possible and apply it to the case at the next tutorial session
Determine priorities for learning
bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue
bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan
bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge
bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career
PBL Starting the casebull After the introductions and discussion
are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it
bull Reading the case aloud keeps the group focused
bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here
Problem-based learning is designed to develop
1048708 Integrated context-specific knowledge base
1048708 Decision-makingcritical thinking process and skills
1048708 Self-directed life-long learning skills 1048708 Interpersonal collaboration and
communication skills 1048708 Constructive self and peer
assessment skills 1048708 Professional ethics and behavior
PBL Case (contd)
bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session
What is problem based learning
bull In PBL students use triggers from the problem case or scenario to define their own learning objectives
bull Subsequently they do independent self directed study before returning to the group to discuss and refine their acquired knowledge
bull Thus PBL is not about problem solving per se but rather it uses appropriate problems to increase knowledge and understanding
bull The process is clearly defined
PBL
bull PBL uses clinical cases as the context for students to study basic and clinical sciences
bull 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
bull Possible disadvantages include higher costs both in resources and staff time
PBL
bull An educational method characterized by the use of patient problems as a context for students to learn problem-solving skills and acquire knowledge about the basic and clinical sciences
bull Students usually meet in small groups two or three times a week for PBL tutorials
bull They are presented with a clinical problem (eg a patient with chest pain) and in a series of steps they discuss possible mechanisms and causes develop hypotheses and strategies to test the hypotheses are presented with further information and use this new information to refine their hypotheses finally reaching a conclusion
bull A tutor usually acts as a facilitator guiding students in this group-learning process
bull In the course of this exercise students identify both their existing levels and gaps in their knowledge These gaps form the basis for independent learning outside the PBL tutorials The identification and pursuit of these so-called learning goals is a key element of the PBL process
Rationale for using PBL bull The PBL approach is based on principles of adult
education20 and cognitive psychology21 It differs fundamentally from traditional curricula in which students acquire background knowledge of the basic sciences in the early years of the course and in the later years apply this knowledge to the diagnosis and management of clinical problems This traditional approach has been criticised for a number of reasons42223
bull It creates an artificial divide between the basic and clinical sciences
bull Time is wasted in acquiring knowledge that is subsequently forgotten or found to be irrelevant
bull Application of the acquired knowledge can be difficult bull The acquisition and retention of information that has no
apparent relevance can be boring and even demoralising for students
The group learning process acquiring
desirable learning skills
Generic Skills amp attitudes
bull Teamwork bull Critical evaluation of literature bull Chairing a group bull Self directed learning and use of
resources bull Listening Presentation skills
Recording bull Cooperation bull Respect for colleagues views
bull Group learning facilitates not only the acquisition of knowledge but also several other desirable attributes such as communication skills teamwork problem solving independent responsibility for learning sharing information and respect for others PBL can therefore be thought of as a small group teaching method that combines the acquisition of knowledge with the development of generic skills and attitudes Presentation of clinical material as the stimulus for learning enables students to understand the relevance of underlying scientific knowledge and principles in clinical practice
bull when PBL is introduced into a curriculum several other issues for curriculum design and implementation need to be tackled PBL is generally introduced in the context of a defined core curriculum and integration of basic and clinical sciences It has implications for staffing and learning resources and demands a different approach to timetabling workload and assessment PBL is often used to deliver core material in non-clinical parts of the curriculum Paper based PBL scenarios form the basis of the core curriculum and ensure that all students are exposed to the same problems Recently modified PBL techniques have been introduced into clinical education with real patients being used as the stimulus for learning Despite the essential ad hoc nature of learning clinical medicine a key cases approach can enable PBL to be used to deliver the core clinical curriculum
Copyright copy2003 BMJ Publishing Group Ltd
Wood D F BMJ 2003326328-330
No CRoles of participants in a PBL tutorial aption Found
What happens in a PBL tutorial bull PBL tutorials are conducted in several ways In
this article the examples are modelled on the Maastricht seven jump process but its format of seven steps may be shortened
bull A typical PBL tutorial consists of a group of students (usually eight to 10) and a tutor who facilitates the session The length of time (number of sessions) that a group stays together with each other and with individual tutors varies between institutions A group needs to be together long enough to allow good group dynamics to develop but may need to be changed occasionally if personality clashes or other dysfunctional behaviour emerges
bull Students elect a chair for each PBL scenario and a scribe to record the discussion The roles are rotated for each scenario Suitable flip charts or a whiteboard should be used for recording the proceedings At the start of the session depending on the trigger material either the student chair reads out the scenario or all students study the material If the trigger is a real patient in a ward clinic or surgery then a student may be asked to take a clinical history or identify an abnormal physical sign before the group moves to a tutorial room For each module students may be given a handbook containing the problem scenarios and suggested learning resources or learning materials may be handed out at appropriate times as the tutorials progress
Examples of trigger material for PBL scenarios bull Paper based clinical scenarios bull Experimental or clinical laboratory data bull Photographs bull Video clips bull Newspaper articles bull All or part of an article from a scientific
journal bull A real or simulated patient bull A family tree showing an inherited
disorder
PBL tutorial process ndash Step 1 Identify and clarify unfamiliar terms presented in the scenario
scribe lists those that remain unexplained after discussion ndash Step 2 Define the problem or problems to be discussed students may
have different views on the issues but all should be considered scribe records a list of agreed problems
ndash Step 3 Brainstorming session to discuss the problem(s) suggestingpossible explanations on basis of prior knowledge students draw on each others knowledge and identify areas of incomplete knowledge scribe records all discussion
ndash Step 4 Review steps 2 and 3 and arrange explanations into tentativesolutions scribe organises the explanations and restructures if necessary
ndash Step 5 Formulate learning objectives group reaches consensus onthe learning objectives tutor ensures learning objectives are focused achievable comprehensive and appropriate
ndash Step 6 Private study (all students gather information related to eachlearning objective)
ndash Step 7 Group shares results of private study (students identify theirlearning resources and share their results) tutor checks learning and may assess the group
bull The role of the tutor is to facilitate the proceedings (helping the chair to maintain group dynamics and moving the group through the task) and to ensure that the group achieves appropriate learning objectives in line with those set by the curriculum design team The tutor may need to take a more active role in step 7 of the process to ensure that all the students have done the appropriate work and to help the chair to suggest a suitable format for group members to use to present the results of their private study The tutor should encourage students to check their understanding of the material He or she can do this by encouraging the students to ask open questions and ask each other to explain topics in their own words or by the use of drawings and diagrams
PBL in curriculum design bull PBL may be used either as the mainstay of an entire
curriculum or for the delivery of individual courses In practice PBL is usually part of an integrated curriculum using a systems based approach with non-clinical material delivered in the context of clinical practice A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge skills and attitudes A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios Sufficient time should be allowed each week for students to do the self directed learning required for PBL
bull
Copyright copy2003 BMJ Publishing Group Ltd
Wood D F BMJ 2003326328-330
No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found
Writing PBL scenarios
bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives
bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after
studying the scenario should be consistent with the faculty learning objectives
bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding
bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice
bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge
bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented
bull The problem should be sufficiently open so that discussion is not curtailed too early in the process
bull Scenarios should promote participation by the students in seeking information from various learning resources
bull Adapted from Dolmans et al Med Teacher 199719185-9
Staff development
bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)
A dysfunctional group a dominant character may
make it difficult for other students to be heard
A dysfunctional group a dominant character may make it difficult for other students to be heard
bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties
Advantages of PBL bull Student centred PBLIt fostersactive learning improved
understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks
Disadvantagesbull Tutors who cant teachTutorsenjoy passing on
their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful
Assessment of PBL
bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods
bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL
Conclusion
bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning
bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL
PBL 5 Easy Steps
bull Read the problem
Mrs Paula Embledon
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
2 Brain storm
bull Brainstorm
bull ndash hypotheses
bull - what do we know in support of the hypothesis
bull - what do we need to know to test the hypothesis
ndash learning issues
Brainstorm
bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)
ndash specific issues (for individuals to look up)
ndash overlapping issues
bull 4 Individual Reading - Research - Preparation
bull 5 Return
bull ndash review case so far ndash report and discuss
ndash assess progress - continue pagenext pagecomplete
ndash self-evaluation - How did things go Any suggestions for next time
ndash next problem
bull 5 Return
THE FIRST GROUP SESSION
bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day
bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session
bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr
bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine
bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise
bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator
bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues
bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know
bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)
bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)
bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)
PBL
bull Groups do not need prior knowledge to generate lively ideas as they identify areas for further collective amp personal learning
bull Each student brings individual experience amp makes a distinctive contribution
bull the Tutorrsquos role is to manage interactions rather than supply info
bull An effective Group provides a safe environment for sharing amp testing new knowledge
bull Students practice the language of science amp medicine evaluate ideas and receive feedback from peers amp teacher
bull When clinical exposure is introduced concurrently intellectual amp practical skills develop in parallel
Framework for PBL
bull A trigger initiates the problem (papercomputervideo)
bull Groups brainstorm to identify key issues for discussion
bull Broad thinking produces a rich array of mechanisms amp ideas
bull Hypothesis are critically explored through reasoning
bull The need for additional info is identifiedbull A Conclusion is reachedbull Group reviews the process
Framework for PBL - II
bull In Breaks between Tutorials students identfy Learning Issues to be pursued
bull They are encouraged to adot an evidence-based approach
bull When they reconvene they share and review the learning
Characteristics of an effective PBL Group
An Effective Group is Cohesive motivated mutually supportive amp actively engaged in learning
bull The Group understands the process amp energetically pursues its task
bull Members respect each otherrsquos contribution but examine them critically
bull Discussions flow as students cooperate rather than compete
bull The atmosphere is friendly amp good humouredbull Roles are shared all take turns in scribing
leading discussion taking responsibility for acquiring information
Staff Development
bull Basic training is mandatorybull Further development may be a requirementbull Initial training may involve observation amp
practice with a group from the programbull Effective training ensures that necessary
background goals amp local strategies are considered together with info on assessment amp evaluation
bull In addition to materials supplied to students tutors are usually issued with handbooks highlighting issues for each problem
Tutorrsquos Role in Assessment
bull Individual StudentsGroups may be assessed Summatively (determining progression) or formatively (for feedback)
The GROUP
bull At the end of each problem groups review their processes to encourage self-reflection ampenhance their collective performance
Tutorrsquos Role in Assessment
Individual students
bull Tutors should provide formative feedback to each member
bull Ask students to complete a simple self-assessment questionnaire reviewing appropriate behaviors the tutor returns them with comments
bull Students will be a writtenoralclinical tests that will determine their progression amp ultimate graduation
Evaluating PBL Tutorials-II
bull At the end of each problem time is allocated for evaluation
bull Both the process amp learning in PBL can be evaluated against explicit goals
bull The tutorrsquos review of effectiveness of group processes offers insight for the members
bull Students normally evaluate their tutor helpfulness support for clinical reasoning encouragement for independent learning appropriate intervention provision for effective feedback
PBLbull 1048708 Enabling students to learn in the context in which the
information will be used which increases the ability to retrieve and apply information
bull 1048708 Focusing on important concepts which helps learners organize and store new information in a way that facilitates retrieval and application
bull 1048708 Exploring prior knowledge formulating inquiries derived from and defined by the learnersrsquo need to know and actively constructing meaning through dialogue and reflection
bull 1048708 Utilizing problems designed to simulate studentsrsquo perception of their future profession which serves as a powerful stimulus for studentsrsquo intrinsic motivation to learn
bull 1048708 Actively involving students in monitoring their own progress and reflecting on what works and what needs improvement frequently assessing student performance and providing feedback
PBL Starting the casebull After the introductions and discussion
are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it
bull Reading the case aloud keeps the group focused
bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here
PBL Case (contd)
bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session
PBL Case contdbull SECOND deciding which issues everyone will
tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)
bull THIRD deciding what SPECIFIC questions individuals will try to answer
bull FOURTH deciding how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet or consulting an expert)
The Process of PBL
bullWhat are the issues Identify the important issues in the problem
bull How well do you understand the issues
bull Are there any words or terms about which you are unclear
The Process of PBL contd
bull Consider the basic mechanisms that might explain each important aspect of each problem
bull Assess your current understanding of the basic structural andor functional mechanisms that may contribute to the presentation of the problem
bull Use the collective skills and experiences of group members to explore or explain these phenomena Identify current gaps in knowledge or understanding
Learn from each other
bullShare your own knowledge expertise or ability to reason and synthesize information Be receptive and appreciative of the contribution of your small group members
Determine priorities for learning
bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue
bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan
bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge
bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career
PBL
bull The problem comes first without advance readings lectures or preparation
bull The problem serves as a stimulus for the need to know
Learning Issues
bull Learning issues are questions that cannot be answered with studentsrsquo current knowledge and that can be explored and answered through systematic self-directed inquiry
bull The use of learning issues in tutorials prepares students to handle similar challenges in clinical practice and life-long learning
Learning Issues in PBL First Session1 Getting Started (Introductions Ground
Rules Expectations)2 Identifying Problem3 Exploring Pre-Existing Knowledge4 Generating Hypotheses and Explaining
Mechanisms5 Unfolding the Case Incrementally6 Re-EvaluatingReprioritizing Hypotheses
Based on New Information7 AssessmentReflection
PBL Second Session
8 Independent Self-Directed Study of Learning Issues
PBL Third Session
bull 9 Discussion of Learning Issues and Application of New Knowledge to the Case
bull 10 Continued Unfolding of the Case Incrementally
bull 11 AssessmentReflection
During Tutorial Session students will
1048708 Come prepared to discuss the case and learning issues researched since the last tutorial
1048708 Actively participate in group discussions and contribute to the learning process in a manner that allows for the balanced participation of everyone in the group
1048708 Develop learning issues at each session phrase them as full-sentence questions write them on the board and post them on the course web page
1048708 Consider biological population behaviormental health issuesexplanations and questions of professional attitudes values and ethics related to the patientrsquos problem(s) described in the case
Tutorial Session contd1048708 Go to the board to diagram outline draw etc in
explanation of mechanisms relatedto hypotheses1048708 Debate evidence related to the case and avoid
personal attacks on others1048708 Comply with ground rules with regard to how
the group will function and how itsmembers treat one another1048708 Participate in end-of-session reflection and
assessment by giving and receivingconstructive criticism regarding self tutor
student and group performance
Between Tutorial Session
1048708 Research key learning issues using a variety of resources
1048708 Critically evaluate the credibility of sources and the validity of the information they have obtained in their research
1048708 Integrate what they have learned through research lectures labs clinical skills Perspectives in Medicine (PIM) etc into what is discussed in tutorials
1048708 Synthesize what they have learned and be prepared to discuss it without reading directly from their materials as much as possible and apply it to the case at the next tutorial session
Determine priorities for learning
bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue
bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan
bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge
bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career
PBL Starting the casebull After the introductions and discussion
are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it
bull Reading the case aloud keeps the group focused
bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here
Problem-based learning is designed to develop
1048708 Integrated context-specific knowledge base
1048708 Decision-makingcritical thinking process and skills
1048708 Self-directed life-long learning skills 1048708 Interpersonal collaboration and
communication skills 1048708 Constructive self and peer
assessment skills 1048708 Professional ethics and behavior
PBL Case (contd)
bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session
What is problem based learning
bull In PBL students use triggers from the problem case or scenario to define their own learning objectives
bull Subsequently they do independent self directed study before returning to the group to discuss and refine their acquired knowledge
bull Thus PBL is not about problem solving per se but rather it uses appropriate problems to increase knowledge and understanding
bull The process is clearly defined
PBL
bull PBL uses clinical cases as the context for students to study basic and clinical sciences
bull 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
bull Possible disadvantages include higher costs both in resources and staff time
PBL
bull An educational method characterized by the use of patient problems as a context for students to learn problem-solving skills and acquire knowledge about the basic and clinical sciences
bull Students usually meet in small groups two or three times a week for PBL tutorials
bull They are presented with a clinical problem (eg a patient with chest pain) and in a series of steps they discuss possible mechanisms and causes develop hypotheses and strategies to test the hypotheses are presented with further information and use this new information to refine their hypotheses finally reaching a conclusion
bull A tutor usually acts as a facilitator guiding students in this group-learning process
bull In the course of this exercise students identify both their existing levels and gaps in their knowledge These gaps form the basis for independent learning outside the PBL tutorials The identification and pursuit of these so-called learning goals is a key element of the PBL process
Rationale for using PBL bull The PBL approach is based on principles of adult
education20 and cognitive psychology21 It differs fundamentally from traditional curricula in which students acquire background knowledge of the basic sciences in the early years of the course and in the later years apply this knowledge to the diagnosis and management of clinical problems This traditional approach has been criticised for a number of reasons42223
bull It creates an artificial divide between the basic and clinical sciences
bull Time is wasted in acquiring knowledge that is subsequently forgotten or found to be irrelevant
bull Application of the acquired knowledge can be difficult bull The acquisition and retention of information that has no
apparent relevance can be boring and even demoralising for students
The group learning process acquiring
desirable learning skills
Generic Skills amp attitudes
bull Teamwork bull Critical evaluation of literature bull Chairing a group bull Self directed learning and use of
resources bull Listening Presentation skills
Recording bull Cooperation bull Respect for colleagues views
bull Group learning facilitates not only the acquisition of knowledge but also several other desirable attributes such as communication skills teamwork problem solving independent responsibility for learning sharing information and respect for others PBL can therefore be thought of as a small group teaching method that combines the acquisition of knowledge with the development of generic skills and attitudes Presentation of clinical material as the stimulus for learning enables students to understand the relevance of underlying scientific knowledge and principles in clinical practice
bull when PBL is introduced into a curriculum several other issues for curriculum design and implementation need to be tackled PBL is generally introduced in the context of a defined core curriculum and integration of basic and clinical sciences It has implications for staffing and learning resources and demands a different approach to timetabling workload and assessment PBL is often used to deliver core material in non-clinical parts of the curriculum Paper based PBL scenarios form the basis of the core curriculum and ensure that all students are exposed to the same problems Recently modified PBL techniques have been introduced into clinical education with real patients being used as the stimulus for learning Despite the essential ad hoc nature of learning clinical medicine a key cases approach can enable PBL to be used to deliver the core clinical curriculum
Copyright copy2003 BMJ Publishing Group Ltd
Wood D F BMJ 2003326328-330
No CRoles of participants in a PBL tutorial aption Found
What happens in a PBL tutorial bull PBL tutorials are conducted in several ways In
this article the examples are modelled on the Maastricht seven jump process but its format of seven steps may be shortened
bull A typical PBL tutorial consists of a group of students (usually eight to 10) and a tutor who facilitates the session The length of time (number of sessions) that a group stays together with each other and with individual tutors varies between institutions A group needs to be together long enough to allow good group dynamics to develop but may need to be changed occasionally if personality clashes or other dysfunctional behaviour emerges
bull Students elect a chair for each PBL scenario and a scribe to record the discussion The roles are rotated for each scenario Suitable flip charts or a whiteboard should be used for recording the proceedings At the start of the session depending on the trigger material either the student chair reads out the scenario or all students study the material If the trigger is a real patient in a ward clinic or surgery then a student may be asked to take a clinical history or identify an abnormal physical sign before the group moves to a tutorial room For each module students may be given a handbook containing the problem scenarios and suggested learning resources or learning materials may be handed out at appropriate times as the tutorials progress
Examples of trigger material for PBL scenarios bull Paper based clinical scenarios bull Experimental or clinical laboratory data bull Photographs bull Video clips bull Newspaper articles bull All or part of an article from a scientific
journal bull A real or simulated patient bull A family tree showing an inherited
disorder
PBL tutorial process ndash Step 1 Identify and clarify unfamiliar terms presented in the scenario
scribe lists those that remain unexplained after discussion ndash Step 2 Define the problem or problems to be discussed students may
have different views on the issues but all should be considered scribe records a list of agreed problems
ndash Step 3 Brainstorming session to discuss the problem(s) suggestingpossible explanations on basis of prior knowledge students draw on each others knowledge and identify areas of incomplete knowledge scribe records all discussion
ndash Step 4 Review steps 2 and 3 and arrange explanations into tentativesolutions scribe organises the explanations and restructures if necessary
ndash Step 5 Formulate learning objectives group reaches consensus onthe learning objectives tutor ensures learning objectives are focused achievable comprehensive and appropriate
ndash Step 6 Private study (all students gather information related to eachlearning objective)
ndash Step 7 Group shares results of private study (students identify theirlearning resources and share their results) tutor checks learning and may assess the group
bull The role of the tutor is to facilitate the proceedings (helping the chair to maintain group dynamics and moving the group through the task) and to ensure that the group achieves appropriate learning objectives in line with those set by the curriculum design team The tutor may need to take a more active role in step 7 of the process to ensure that all the students have done the appropriate work and to help the chair to suggest a suitable format for group members to use to present the results of their private study The tutor should encourage students to check their understanding of the material He or she can do this by encouraging the students to ask open questions and ask each other to explain topics in their own words or by the use of drawings and diagrams
PBL in curriculum design bull PBL may be used either as the mainstay of an entire
curriculum or for the delivery of individual courses In practice PBL is usually part of an integrated curriculum using a systems based approach with non-clinical material delivered in the context of clinical practice A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge skills and attitudes A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios Sufficient time should be allowed each week for students to do the self directed learning required for PBL
bull
Copyright copy2003 BMJ Publishing Group Ltd
Wood D F BMJ 2003326328-330
No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found
Writing PBL scenarios
bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives
bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after
studying the scenario should be consistent with the faculty learning objectives
bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding
bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice
bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge
bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented
bull The problem should be sufficiently open so that discussion is not curtailed too early in the process
bull Scenarios should promote participation by the students in seeking information from various learning resources
bull Adapted from Dolmans et al Med Teacher 199719185-9
Staff development
bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)
A dysfunctional group a dominant character may
make it difficult for other students to be heard
A dysfunctional group a dominant character may make it difficult for other students to be heard
bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties
Advantages of PBL bull Student centred PBLIt fostersactive learning improved
understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks
Disadvantagesbull Tutors who cant teachTutorsenjoy passing on
their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful
Assessment of PBL
bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods
bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL
Conclusion
bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning
bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL
PBL 5 Easy Steps
bull Read the problem
Mrs Paula Embledon
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
2 Brain storm
bull Brainstorm
bull ndash hypotheses
bull - what do we know in support of the hypothesis
bull - what do we need to know to test the hypothesis
ndash learning issues
Brainstorm
bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)
ndash specific issues (for individuals to look up)
ndash overlapping issues
bull 4 Individual Reading - Research - Preparation
bull 5 Return
bull ndash review case so far ndash report and discuss
ndash assess progress - continue pagenext pagecomplete
ndash self-evaluation - How did things go Any suggestions for next time
ndash next problem
bull 5 Return
THE FIRST GROUP SESSION
bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day
bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session
bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr
bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine
bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise
bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator
bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues
bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know
bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)
bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)
bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)
bull An effective Group provides a safe environment for sharing amp testing new knowledge
bull Students practice the language of science amp medicine evaluate ideas and receive feedback from peers amp teacher
bull When clinical exposure is introduced concurrently intellectual amp practical skills develop in parallel
Framework for PBL
bull A trigger initiates the problem (papercomputervideo)
bull Groups brainstorm to identify key issues for discussion
bull Broad thinking produces a rich array of mechanisms amp ideas
bull Hypothesis are critically explored through reasoning
bull The need for additional info is identifiedbull A Conclusion is reachedbull Group reviews the process
Framework for PBL - II
bull In Breaks between Tutorials students identfy Learning Issues to be pursued
bull They are encouraged to adot an evidence-based approach
bull When they reconvene they share and review the learning
Characteristics of an effective PBL Group
An Effective Group is Cohesive motivated mutually supportive amp actively engaged in learning
bull The Group understands the process amp energetically pursues its task
bull Members respect each otherrsquos contribution but examine them critically
bull Discussions flow as students cooperate rather than compete
bull The atmosphere is friendly amp good humouredbull Roles are shared all take turns in scribing
leading discussion taking responsibility for acquiring information
Staff Development
bull Basic training is mandatorybull Further development may be a requirementbull Initial training may involve observation amp
practice with a group from the programbull Effective training ensures that necessary
background goals amp local strategies are considered together with info on assessment amp evaluation
bull In addition to materials supplied to students tutors are usually issued with handbooks highlighting issues for each problem
Tutorrsquos Role in Assessment
bull Individual StudentsGroups may be assessed Summatively (determining progression) or formatively (for feedback)
The GROUP
bull At the end of each problem groups review their processes to encourage self-reflection ampenhance their collective performance
Tutorrsquos Role in Assessment
Individual students
bull Tutors should provide formative feedback to each member
bull Ask students to complete a simple self-assessment questionnaire reviewing appropriate behaviors the tutor returns them with comments
bull Students will be a writtenoralclinical tests that will determine their progression amp ultimate graduation
Evaluating PBL Tutorials-II
bull At the end of each problem time is allocated for evaluation
bull Both the process amp learning in PBL can be evaluated against explicit goals
bull The tutorrsquos review of effectiveness of group processes offers insight for the members
bull Students normally evaluate their tutor helpfulness support for clinical reasoning encouragement for independent learning appropriate intervention provision for effective feedback
PBLbull 1048708 Enabling students to learn in the context in which the
information will be used which increases the ability to retrieve and apply information
bull 1048708 Focusing on important concepts which helps learners organize and store new information in a way that facilitates retrieval and application
bull 1048708 Exploring prior knowledge formulating inquiries derived from and defined by the learnersrsquo need to know and actively constructing meaning through dialogue and reflection
bull 1048708 Utilizing problems designed to simulate studentsrsquo perception of their future profession which serves as a powerful stimulus for studentsrsquo intrinsic motivation to learn
bull 1048708 Actively involving students in monitoring their own progress and reflecting on what works and what needs improvement frequently assessing student performance and providing feedback
PBL Starting the casebull After the introductions and discussion
are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it
bull Reading the case aloud keeps the group focused
bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here
PBL Case (contd)
bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session
PBL Case contdbull SECOND deciding which issues everyone will
tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)
bull THIRD deciding what SPECIFIC questions individuals will try to answer
bull FOURTH deciding how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet or consulting an expert)
The Process of PBL
bullWhat are the issues Identify the important issues in the problem
bull How well do you understand the issues
bull Are there any words or terms about which you are unclear
The Process of PBL contd
bull Consider the basic mechanisms that might explain each important aspect of each problem
bull Assess your current understanding of the basic structural andor functional mechanisms that may contribute to the presentation of the problem
bull Use the collective skills and experiences of group members to explore or explain these phenomena Identify current gaps in knowledge or understanding
Learn from each other
bullShare your own knowledge expertise or ability to reason and synthesize information Be receptive and appreciative of the contribution of your small group members
Determine priorities for learning
bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue
bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan
bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge
bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career
PBL
bull The problem comes first without advance readings lectures or preparation
bull The problem serves as a stimulus for the need to know
Learning Issues
bull Learning issues are questions that cannot be answered with studentsrsquo current knowledge and that can be explored and answered through systematic self-directed inquiry
bull The use of learning issues in tutorials prepares students to handle similar challenges in clinical practice and life-long learning
Learning Issues in PBL First Session1 Getting Started (Introductions Ground
Rules Expectations)2 Identifying Problem3 Exploring Pre-Existing Knowledge4 Generating Hypotheses and Explaining
Mechanisms5 Unfolding the Case Incrementally6 Re-EvaluatingReprioritizing Hypotheses
Based on New Information7 AssessmentReflection
PBL Second Session
8 Independent Self-Directed Study of Learning Issues
PBL Third Session
bull 9 Discussion of Learning Issues and Application of New Knowledge to the Case
bull 10 Continued Unfolding of the Case Incrementally
bull 11 AssessmentReflection
During Tutorial Session students will
1048708 Come prepared to discuss the case and learning issues researched since the last tutorial
1048708 Actively participate in group discussions and contribute to the learning process in a manner that allows for the balanced participation of everyone in the group
1048708 Develop learning issues at each session phrase them as full-sentence questions write them on the board and post them on the course web page
1048708 Consider biological population behaviormental health issuesexplanations and questions of professional attitudes values and ethics related to the patientrsquos problem(s) described in the case
Tutorial Session contd1048708 Go to the board to diagram outline draw etc in
explanation of mechanisms relatedto hypotheses1048708 Debate evidence related to the case and avoid
personal attacks on others1048708 Comply with ground rules with regard to how
the group will function and how itsmembers treat one another1048708 Participate in end-of-session reflection and
assessment by giving and receivingconstructive criticism regarding self tutor
student and group performance
Between Tutorial Session
1048708 Research key learning issues using a variety of resources
1048708 Critically evaluate the credibility of sources and the validity of the information they have obtained in their research
1048708 Integrate what they have learned through research lectures labs clinical skills Perspectives in Medicine (PIM) etc into what is discussed in tutorials
1048708 Synthesize what they have learned and be prepared to discuss it without reading directly from their materials as much as possible and apply it to the case at the next tutorial session
Determine priorities for learning
bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue
bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan
bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge
bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career
PBL Starting the casebull After the introductions and discussion
are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it
bull Reading the case aloud keeps the group focused
bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here
Problem-based learning is designed to develop
1048708 Integrated context-specific knowledge base
1048708 Decision-makingcritical thinking process and skills
1048708 Self-directed life-long learning skills 1048708 Interpersonal collaboration and
communication skills 1048708 Constructive self and peer
assessment skills 1048708 Professional ethics and behavior
PBL Case (contd)
bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session
What is problem based learning
bull In PBL students use triggers from the problem case or scenario to define their own learning objectives
bull Subsequently they do independent self directed study before returning to the group to discuss and refine their acquired knowledge
bull Thus PBL is not about problem solving per se but rather it uses appropriate problems to increase knowledge and understanding
bull The process is clearly defined
PBL
bull PBL uses clinical cases as the context for students to study basic and clinical sciences
bull 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
bull Possible disadvantages include higher costs both in resources and staff time
PBL
bull An educational method characterized by the use of patient problems as a context for students to learn problem-solving skills and acquire knowledge about the basic and clinical sciences
bull Students usually meet in small groups two or three times a week for PBL tutorials
bull They are presented with a clinical problem (eg a patient with chest pain) and in a series of steps they discuss possible mechanisms and causes develop hypotheses and strategies to test the hypotheses are presented with further information and use this new information to refine their hypotheses finally reaching a conclusion
bull A tutor usually acts as a facilitator guiding students in this group-learning process
bull In the course of this exercise students identify both their existing levels and gaps in their knowledge These gaps form the basis for independent learning outside the PBL tutorials The identification and pursuit of these so-called learning goals is a key element of the PBL process
Rationale for using PBL bull The PBL approach is based on principles of adult
education20 and cognitive psychology21 It differs fundamentally from traditional curricula in which students acquire background knowledge of the basic sciences in the early years of the course and in the later years apply this knowledge to the diagnosis and management of clinical problems This traditional approach has been criticised for a number of reasons42223
bull It creates an artificial divide between the basic and clinical sciences
bull Time is wasted in acquiring knowledge that is subsequently forgotten or found to be irrelevant
bull Application of the acquired knowledge can be difficult bull The acquisition and retention of information that has no
apparent relevance can be boring and even demoralising for students
The group learning process acquiring
desirable learning skills
Generic Skills amp attitudes
bull Teamwork bull Critical evaluation of literature bull Chairing a group bull Self directed learning and use of
resources bull Listening Presentation skills
Recording bull Cooperation bull Respect for colleagues views
bull Group learning facilitates not only the acquisition of knowledge but also several other desirable attributes such as communication skills teamwork problem solving independent responsibility for learning sharing information and respect for others PBL can therefore be thought of as a small group teaching method that combines the acquisition of knowledge with the development of generic skills and attitudes Presentation of clinical material as the stimulus for learning enables students to understand the relevance of underlying scientific knowledge and principles in clinical practice
bull when PBL is introduced into a curriculum several other issues for curriculum design and implementation need to be tackled PBL is generally introduced in the context of a defined core curriculum and integration of basic and clinical sciences It has implications for staffing and learning resources and demands a different approach to timetabling workload and assessment PBL is often used to deliver core material in non-clinical parts of the curriculum Paper based PBL scenarios form the basis of the core curriculum and ensure that all students are exposed to the same problems Recently modified PBL techniques have been introduced into clinical education with real patients being used as the stimulus for learning Despite the essential ad hoc nature of learning clinical medicine a key cases approach can enable PBL to be used to deliver the core clinical curriculum
Copyright copy2003 BMJ Publishing Group Ltd
Wood D F BMJ 2003326328-330
No CRoles of participants in a PBL tutorial aption Found
What happens in a PBL tutorial bull PBL tutorials are conducted in several ways In
this article the examples are modelled on the Maastricht seven jump process but its format of seven steps may be shortened
bull A typical PBL tutorial consists of a group of students (usually eight to 10) and a tutor who facilitates the session The length of time (number of sessions) that a group stays together with each other and with individual tutors varies between institutions A group needs to be together long enough to allow good group dynamics to develop but may need to be changed occasionally if personality clashes or other dysfunctional behaviour emerges
bull Students elect a chair for each PBL scenario and a scribe to record the discussion The roles are rotated for each scenario Suitable flip charts or a whiteboard should be used for recording the proceedings At the start of the session depending on the trigger material either the student chair reads out the scenario or all students study the material If the trigger is a real patient in a ward clinic or surgery then a student may be asked to take a clinical history or identify an abnormal physical sign before the group moves to a tutorial room For each module students may be given a handbook containing the problem scenarios and suggested learning resources or learning materials may be handed out at appropriate times as the tutorials progress
Examples of trigger material for PBL scenarios bull Paper based clinical scenarios bull Experimental or clinical laboratory data bull Photographs bull Video clips bull Newspaper articles bull All or part of an article from a scientific
journal bull A real or simulated patient bull A family tree showing an inherited
disorder
PBL tutorial process ndash Step 1 Identify and clarify unfamiliar terms presented in the scenario
scribe lists those that remain unexplained after discussion ndash Step 2 Define the problem or problems to be discussed students may
have different views on the issues but all should be considered scribe records a list of agreed problems
ndash Step 3 Brainstorming session to discuss the problem(s) suggestingpossible explanations on basis of prior knowledge students draw on each others knowledge and identify areas of incomplete knowledge scribe records all discussion
ndash Step 4 Review steps 2 and 3 and arrange explanations into tentativesolutions scribe organises the explanations and restructures if necessary
ndash Step 5 Formulate learning objectives group reaches consensus onthe learning objectives tutor ensures learning objectives are focused achievable comprehensive and appropriate
ndash Step 6 Private study (all students gather information related to eachlearning objective)
ndash Step 7 Group shares results of private study (students identify theirlearning resources and share their results) tutor checks learning and may assess the group
bull The role of the tutor is to facilitate the proceedings (helping the chair to maintain group dynamics and moving the group through the task) and to ensure that the group achieves appropriate learning objectives in line with those set by the curriculum design team The tutor may need to take a more active role in step 7 of the process to ensure that all the students have done the appropriate work and to help the chair to suggest a suitable format for group members to use to present the results of their private study The tutor should encourage students to check their understanding of the material He or she can do this by encouraging the students to ask open questions and ask each other to explain topics in their own words or by the use of drawings and diagrams
PBL in curriculum design bull PBL may be used either as the mainstay of an entire
curriculum or for the delivery of individual courses In practice PBL is usually part of an integrated curriculum using a systems based approach with non-clinical material delivered in the context of clinical practice A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge skills and attitudes A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios Sufficient time should be allowed each week for students to do the self directed learning required for PBL
bull
Copyright copy2003 BMJ Publishing Group Ltd
Wood D F BMJ 2003326328-330
No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found
Writing PBL scenarios
bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives
bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after
studying the scenario should be consistent with the faculty learning objectives
bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding
bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice
bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge
bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented
bull The problem should be sufficiently open so that discussion is not curtailed too early in the process
bull Scenarios should promote participation by the students in seeking information from various learning resources
bull Adapted from Dolmans et al Med Teacher 199719185-9
Staff development
bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)
A dysfunctional group a dominant character may
make it difficult for other students to be heard
A dysfunctional group a dominant character may make it difficult for other students to be heard
bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties
Advantages of PBL bull Student centred PBLIt fostersactive learning improved
understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks
Disadvantagesbull Tutors who cant teachTutorsenjoy passing on
their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful
Assessment of PBL
bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods
bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL
Conclusion
bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning
bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL
PBL 5 Easy Steps
bull Read the problem
Mrs Paula Embledon
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
2 Brain storm
bull Brainstorm
bull ndash hypotheses
bull - what do we know in support of the hypothesis
bull - what do we need to know to test the hypothesis
ndash learning issues
Brainstorm
bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)
ndash specific issues (for individuals to look up)
ndash overlapping issues
bull 4 Individual Reading - Research - Preparation
bull 5 Return
bull ndash review case so far ndash report and discuss
ndash assess progress - continue pagenext pagecomplete
ndash self-evaluation - How did things go Any suggestions for next time
ndash next problem
bull 5 Return
THE FIRST GROUP SESSION
bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day
bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session
bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr
bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine
bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise
bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator
bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues
bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know
bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)
bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)
bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)
Framework for PBL
bull A trigger initiates the problem (papercomputervideo)
bull Groups brainstorm to identify key issues for discussion
bull Broad thinking produces a rich array of mechanisms amp ideas
bull Hypothesis are critically explored through reasoning
bull The need for additional info is identifiedbull A Conclusion is reachedbull Group reviews the process
Framework for PBL - II
bull In Breaks between Tutorials students identfy Learning Issues to be pursued
bull They are encouraged to adot an evidence-based approach
bull When they reconvene they share and review the learning
Characteristics of an effective PBL Group
An Effective Group is Cohesive motivated mutually supportive amp actively engaged in learning
bull The Group understands the process amp energetically pursues its task
bull Members respect each otherrsquos contribution but examine them critically
bull Discussions flow as students cooperate rather than compete
bull The atmosphere is friendly amp good humouredbull Roles are shared all take turns in scribing
leading discussion taking responsibility for acquiring information
Staff Development
bull Basic training is mandatorybull Further development may be a requirementbull Initial training may involve observation amp
practice with a group from the programbull Effective training ensures that necessary
background goals amp local strategies are considered together with info on assessment amp evaluation
bull In addition to materials supplied to students tutors are usually issued with handbooks highlighting issues for each problem
Tutorrsquos Role in Assessment
bull Individual StudentsGroups may be assessed Summatively (determining progression) or formatively (for feedback)
The GROUP
bull At the end of each problem groups review their processes to encourage self-reflection ampenhance their collective performance
Tutorrsquos Role in Assessment
Individual students
bull Tutors should provide formative feedback to each member
bull Ask students to complete a simple self-assessment questionnaire reviewing appropriate behaviors the tutor returns them with comments
bull Students will be a writtenoralclinical tests that will determine their progression amp ultimate graduation
Evaluating PBL Tutorials-II
bull At the end of each problem time is allocated for evaluation
bull Both the process amp learning in PBL can be evaluated against explicit goals
bull The tutorrsquos review of effectiveness of group processes offers insight for the members
bull Students normally evaluate their tutor helpfulness support for clinical reasoning encouragement for independent learning appropriate intervention provision for effective feedback
PBLbull 1048708 Enabling students to learn in the context in which the
information will be used which increases the ability to retrieve and apply information
bull 1048708 Focusing on important concepts which helps learners organize and store new information in a way that facilitates retrieval and application
bull 1048708 Exploring prior knowledge formulating inquiries derived from and defined by the learnersrsquo need to know and actively constructing meaning through dialogue and reflection
bull 1048708 Utilizing problems designed to simulate studentsrsquo perception of their future profession which serves as a powerful stimulus for studentsrsquo intrinsic motivation to learn
bull 1048708 Actively involving students in monitoring their own progress and reflecting on what works and what needs improvement frequently assessing student performance and providing feedback
PBL Starting the casebull After the introductions and discussion
are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it
bull Reading the case aloud keeps the group focused
bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here
PBL Case (contd)
bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session
PBL Case contdbull SECOND deciding which issues everyone will
tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)
bull THIRD deciding what SPECIFIC questions individuals will try to answer
bull FOURTH deciding how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet or consulting an expert)
The Process of PBL
bullWhat are the issues Identify the important issues in the problem
bull How well do you understand the issues
bull Are there any words or terms about which you are unclear
The Process of PBL contd
bull Consider the basic mechanisms that might explain each important aspect of each problem
bull Assess your current understanding of the basic structural andor functional mechanisms that may contribute to the presentation of the problem
bull Use the collective skills and experiences of group members to explore or explain these phenomena Identify current gaps in knowledge or understanding
Learn from each other
bullShare your own knowledge expertise or ability to reason and synthesize information Be receptive and appreciative of the contribution of your small group members
Determine priorities for learning
bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue
bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan
bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge
bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career
PBL
bull The problem comes first without advance readings lectures or preparation
bull The problem serves as a stimulus for the need to know
Learning Issues
bull Learning issues are questions that cannot be answered with studentsrsquo current knowledge and that can be explored and answered through systematic self-directed inquiry
bull The use of learning issues in tutorials prepares students to handle similar challenges in clinical practice and life-long learning
Learning Issues in PBL First Session1 Getting Started (Introductions Ground
Rules Expectations)2 Identifying Problem3 Exploring Pre-Existing Knowledge4 Generating Hypotheses and Explaining
Mechanisms5 Unfolding the Case Incrementally6 Re-EvaluatingReprioritizing Hypotheses
Based on New Information7 AssessmentReflection
PBL Second Session
8 Independent Self-Directed Study of Learning Issues
PBL Third Session
bull 9 Discussion of Learning Issues and Application of New Knowledge to the Case
bull 10 Continued Unfolding of the Case Incrementally
bull 11 AssessmentReflection
During Tutorial Session students will
1048708 Come prepared to discuss the case and learning issues researched since the last tutorial
1048708 Actively participate in group discussions and contribute to the learning process in a manner that allows for the balanced participation of everyone in the group
1048708 Develop learning issues at each session phrase them as full-sentence questions write them on the board and post them on the course web page
1048708 Consider biological population behaviormental health issuesexplanations and questions of professional attitudes values and ethics related to the patientrsquos problem(s) described in the case
Tutorial Session contd1048708 Go to the board to diagram outline draw etc in
explanation of mechanisms relatedto hypotheses1048708 Debate evidence related to the case and avoid
personal attacks on others1048708 Comply with ground rules with regard to how
the group will function and how itsmembers treat one another1048708 Participate in end-of-session reflection and
assessment by giving and receivingconstructive criticism regarding self tutor
student and group performance
Between Tutorial Session
1048708 Research key learning issues using a variety of resources
1048708 Critically evaluate the credibility of sources and the validity of the information they have obtained in their research
1048708 Integrate what they have learned through research lectures labs clinical skills Perspectives in Medicine (PIM) etc into what is discussed in tutorials
1048708 Synthesize what they have learned and be prepared to discuss it without reading directly from their materials as much as possible and apply it to the case at the next tutorial session
Determine priorities for learning
bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue
bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan
bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge
bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career
PBL Starting the casebull After the introductions and discussion
are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it
bull Reading the case aloud keeps the group focused
bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here
Problem-based learning is designed to develop
1048708 Integrated context-specific knowledge base
1048708 Decision-makingcritical thinking process and skills
1048708 Self-directed life-long learning skills 1048708 Interpersonal collaboration and
communication skills 1048708 Constructive self and peer
assessment skills 1048708 Professional ethics and behavior
PBL Case (contd)
bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session
What is problem based learning
bull In PBL students use triggers from the problem case or scenario to define their own learning objectives
bull Subsequently they do independent self directed study before returning to the group to discuss and refine their acquired knowledge
bull Thus PBL is not about problem solving per se but rather it uses appropriate problems to increase knowledge and understanding
bull The process is clearly defined
PBL
bull PBL uses clinical cases as the context for students to study basic and clinical sciences
bull 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
bull Possible disadvantages include higher costs both in resources and staff time
PBL
bull An educational method characterized by the use of patient problems as a context for students to learn problem-solving skills and acquire knowledge about the basic and clinical sciences
bull Students usually meet in small groups two or three times a week for PBL tutorials
bull They are presented with a clinical problem (eg a patient with chest pain) and in a series of steps they discuss possible mechanisms and causes develop hypotheses and strategies to test the hypotheses are presented with further information and use this new information to refine their hypotheses finally reaching a conclusion
bull A tutor usually acts as a facilitator guiding students in this group-learning process
bull In the course of this exercise students identify both their existing levels and gaps in their knowledge These gaps form the basis for independent learning outside the PBL tutorials The identification and pursuit of these so-called learning goals is a key element of the PBL process
Rationale for using PBL bull The PBL approach is based on principles of adult
education20 and cognitive psychology21 It differs fundamentally from traditional curricula in which students acquire background knowledge of the basic sciences in the early years of the course and in the later years apply this knowledge to the diagnosis and management of clinical problems This traditional approach has been criticised for a number of reasons42223
bull It creates an artificial divide between the basic and clinical sciences
bull Time is wasted in acquiring knowledge that is subsequently forgotten or found to be irrelevant
bull Application of the acquired knowledge can be difficult bull The acquisition and retention of information that has no
apparent relevance can be boring and even demoralising for students
The group learning process acquiring
desirable learning skills
Generic Skills amp attitudes
bull Teamwork bull Critical evaluation of literature bull Chairing a group bull Self directed learning and use of
resources bull Listening Presentation skills
Recording bull Cooperation bull Respect for colleagues views
bull Group learning facilitates not only the acquisition of knowledge but also several other desirable attributes such as communication skills teamwork problem solving independent responsibility for learning sharing information and respect for others PBL can therefore be thought of as a small group teaching method that combines the acquisition of knowledge with the development of generic skills and attitudes Presentation of clinical material as the stimulus for learning enables students to understand the relevance of underlying scientific knowledge and principles in clinical practice
bull when PBL is introduced into a curriculum several other issues for curriculum design and implementation need to be tackled PBL is generally introduced in the context of a defined core curriculum and integration of basic and clinical sciences It has implications for staffing and learning resources and demands a different approach to timetabling workload and assessment PBL is often used to deliver core material in non-clinical parts of the curriculum Paper based PBL scenarios form the basis of the core curriculum and ensure that all students are exposed to the same problems Recently modified PBL techniques have been introduced into clinical education with real patients being used as the stimulus for learning Despite the essential ad hoc nature of learning clinical medicine a key cases approach can enable PBL to be used to deliver the core clinical curriculum
Copyright copy2003 BMJ Publishing Group Ltd
Wood D F BMJ 2003326328-330
No CRoles of participants in a PBL tutorial aption Found
What happens in a PBL tutorial bull PBL tutorials are conducted in several ways In
this article the examples are modelled on the Maastricht seven jump process but its format of seven steps may be shortened
bull A typical PBL tutorial consists of a group of students (usually eight to 10) and a tutor who facilitates the session The length of time (number of sessions) that a group stays together with each other and with individual tutors varies between institutions A group needs to be together long enough to allow good group dynamics to develop but may need to be changed occasionally if personality clashes or other dysfunctional behaviour emerges
bull Students elect a chair for each PBL scenario and a scribe to record the discussion The roles are rotated for each scenario Suitable flip charts or a whiteboard should be used for recording the proceedings At the start of the session depending on the trigger material either the student chair reads out the scenario or all students study the material If the trigger is a real patient in a ward clinic or surgery then a student may be asked to take a clinical history or identify an abnormal physical sign before the group moves to a tutorial room For each module students may be given a handbook containing the problem scenarios and suggested learning resources or learning materials may be handed out at appropriate times as the tutorials progress
Examples of trigger material for PBL scenarios bull Paper based clinical scenarios bull Experimental or clinical laboratory data bull Photographs bull Video clips bull Newspaper articles bull All or part of an article from a scientific
journal bull A real or simulated patient bull A family tree showing an inherited
disorder
PBL tutorial process ndash Step 1 Identify and clarify unfamiliar terms presented in the scenario
scribe lists those that remain unexplained after discussion ndash Step 2 Define the problem or problems to be discussed students may
have different views on the issues but all should be considered scribe records a list of agreed problems
ndash Step 3 Brainstorming session to discuss the problem(s) suggestingpossible explanations on basis of prior knowledge students draw on each others knowledge and identify areas of incomplete knowledge scribe records all discussion
ndash Step 4 Review steps 2 and 3 and arrange explanations into tentativesolutions scribe organises the explanations and restructures if necessary
ndash Step 5 Formulate learning objectives group reaches consensus onthe learning objectives tutor ensures learning objectives are focused achievable comprehensive and appropriate
ndash Step 6 Private study (all students gather information related to eachlearning objective)
ndash Step 7 Group shares results of private study (students identify theirlearning resources and share their results) tutor checks learning and may assess the group
bull The role of the tutor is to facilitate the proceedings (helping the chair to maintain group dynamics and moving the group through the task) and to ensure that the group achieves appropriate learning objectives in line with those set by the curriculum design team The tutor may need to take a more active role in step 7 of the process to ensure that all the students have done the appropriate work and to help the chair to suggest a suitable format for group members to use to present the results of their private study The tutor should encourage students to check their understanding of the material He or she can do this by encouraging the students to ask open questions and ask each other to explain topics in their own words or by the use of drawings and diagrams
PBL in curriculum design bull PBL may be used either as the mainstay of an entire
curriculum or for the delivery of individual courses In practice PBL is usually part of an integrated curriculum using a systems based approach with non-clinical material delivered in the context of clinical practice A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge skills and attitudes A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios Sufficient time should be allowed each week for students to do the self directed learning required for PBL
bull
Copyright copy2003 BMJ Publishing Group Ltd
Wood D F BMJ 2003326328-330
No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found
Writing PBL scenarios
bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives
bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after
studying the scenario should be consistent with the faculty learning objectives
bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding
bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice
bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge
bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented
bull The problem should be sufficiently open so that discussion is not curtailed too early in the process
bull Scenarios should promote participation by the students in seeking information from various learning resources
bull Adapted from Dolmans et al Med Teacher 199719185-9
Staff development
bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)
A dysfunctional group a dominant character may
make it difficult for other students to be heard
A dysfunctional group a dominant character may make it difficult for other students to be heard
bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties
Advantages of PBL bull Student centred PBLIt fostersactive learning improved
understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks
Disadvantagesbull Tutors who cant teachTutorsenjoy passing on
their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful
Assessment of PBL
bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods
bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL
Conclusion
bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning
bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL
PBL 5 Easy Steps
bull Read the problem
Mrs Paula Embledon
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
2 Brain storm
bull Brainstorm
bull ndash hypotheses
bull - what do we know in support of the hypothesis
bull - what do we need to know to test the hypothesis
ndash learning issues
Brainstorm
bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)
ndash specific issues (for individuals to look up)
ndash overlapping issues
bull 4 Individual Reading - Research - Preparation
bull 5 Return
bull ndash review case so far ndash report and discuss
ndash assess progress - continue pagenext pagecomplete
ndash self-evaluation - How did things go Any suggestions for next time
ndash next problem
bull 5 Return
THE FIRST GROUP SESSION
bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day
bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session
bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr
bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine
bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise
bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator
bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues
bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know
bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)
bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)
bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)
Framework for PBL - II
bull In Breaks between Tutorials students identfy Learning Issues to be pursued
bull They are encouraged to adot an evidence-based approach
bull When they reconvene they share and review the learning
Characteristics of an effective PBL Group
An Effective Group is Cohesive motivated mutually supportive amp actively engaged in learning
bull The Group understands the process amp energetically pursues its task
bull Members respect each otherrsquos contribution but examine them critically
bull Discussions flow as students cooperate rather than compete
bull The atmosphere is friendly amp good humouredbull Roles are shared all take turns in scribing
leading discussion taking responsibility for acquiring information
Staff Development
bull Basic training is mandatorybull Further development may be a requirementbull Initial training may involve observation amp
practice with a group from the programbull Effective training ensures that necessary
background goals amp local strategies are considered together with info on assessment amp evaluation
bull In addition to materials supplied to students tutors are usually issued with handbooks highlighting issues for each problem
Tutorrsquos Role in Assessment
bull Individual StudentsGroups may be assessed Summatively (determining progression) or formatively (for feedback)
The GROUP
bull At the end of each problem groups review their processes to encourage self-reflection ampenhance their collective performance
Tutorrsquos Role in Assessment
Individual students
bull Tutors should provide formative feedback to each member
bull Ask students to complete a simple self-assessment questionnaire reviewing appropriate behaviors the tutor returns them with comments
bull Students will be a writtenoralclinical tests that will determine their progression amp ultimate graduation
Evaluating PBL Tutorials-II
bull At the end of each problem time is allocated for evaluation
bull Both the process amp learning in PBL can be evaluated against explicit goals
bull The tutorrsquos review of effectiveness of group processes offers insight for the members
bull Students normally evaluate their tutor helpfulness support for clinical reasoning encouragement for independent learning appropriate intervention provision for effective feedback
PBLbull 1048708 Enabling students to learn in the context in which the
information will be used which increases the ability to retrieve and apply information
bull 1048708 Focusing on important concepts which helps learners organize and store new information in a way that facilitates retrieval and application
bull 1048708 Exploring prior knowledge formulating inquiries derived from and defined by the learnersrsquo need to know and actively constructing meaning through dialogue and reflection
bull 1048708 Utilizing problems designed to simulate studentsrsquo perception of their future profession which serves as a powerful stimulus for studentsrsquo intrinsic motivation to learn
bull 1048708 Actively involving students in monitoring their own progress and reflecting on what works and what needs improvement frequently assessing student performance and providing feedback
PBL Starting the casebull After the introductions and discussion
are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it
bull Reading the case aloud keeps the group focused
bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here
PBL Case (contd)
bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session
PBL Case contdbull SECOND deciding which issues everyone will
tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)
bull THIRD deciding what SPECIFIC questions individuals will try to answer
bull FOURTH deciding how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet or consulting an expert)
The Process of PBL
bullWhat are the issues Identify the important issues in the problem
bull How well do you understand the issues
bull Are there any words or terms about which you are unclear
The Process of PBL contd
bull Consider the basic mechanisms that might explain each important aspect of each problem
bull Assess your current understanding of the basic structural andor functional mechanisms that may contribute to the presentation of the problem
bull Use the collective skills and experiences of group members to explore or explain these phenomena Identify current gaps in knowledge or understanding
Learn from each other
bullShare your own knowledge expertise or ability to reason and synthesize information Be receptive and appreciative of the contribution of your small group members
Determine priorities for learning
bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue
bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan
bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge
bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career
PBL
bull The problem comes first without advance readings lectures or preparation
bull The problem serves as a stimulus for the need to know
Learning Issues
bull Learning issues are questions that cannot be answered with studentsrsquo current knowledge and that can be explored and answered through systematic self-directed inquiry
bull The use of learning issues in tutorials prepares students to handle similar challenges in clinical practice and life-long learning
Learning Issues in PBL First Session1 Getting Started (Introductions Ground
Rules Expectations)2 Identifying Problem3 Exploring Pre-Existing Knowledge4 Generating Hypotheses and Explaining
Mechanisms5 Unfolding the Case Incrementally6 Re-EvaluatingReprioritizing Hypotheses
Based on New Information7 AssessmentReflection
PBL Second Session
8 Independent Self-Directed Study of Learning Issues
PBL Third Session
bull 9 Discussion of Learning Issues and Application of New Knowledge to the Case
bull 10 Continued Unfolding of the Case Incrementally
bull 11 AssessmentReflection
During Tutorial Session students will
1048708 Come prepared to discuss the case and learning issues researched since the last tutorial
1048708 Actively participate in group discussions and contribute to the learning process in a manner that allows for the balanced participation of everyone in the group
1048708 Develop learning issues at each session phrase them as full-sentence questions write them on the board and post them on the course web page
1048708 Consider biological population behaviormental health issuesexplanations and questions of professional attitudes values and ethics related to the patientrsquos problem(s) described in the case
Tutorial Session contd1048708 Go to the board to diagram outline draw etc in
explanation of mechanisms relatedto hypotheses1048708 Debate evidence related to the case and avoid
personal attacks on others1048708 Comply with ground rules with regard to how
the group will function and how itsmembers treat one another1048708 Participate in end-of-session reflection and
assessment by giving and receivingconstructive criticism regarding self tutor
student and group performance
Between Tutorial Session
1048708 Research key learning issues using a variety of resources
1048708 Critically evaluate the credibility of sources and the validity of the information they have obtained in their research
1048708 Integrate what they have learned through research lectures labs clinical skills Perspectives in Medicine (PIM) etc into what is discussed in tutorials
1048708 Synthesize what they have learned and be prepared to discuss it without reading directly from their materials as much as possible and apply it to the case at the next tutorial session
Determine priorities for learning
bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue
bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan
bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge
bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career
PBL Starting the casebull After the introductions and discussion
are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it
bull Reading the case aloud keeps the group focused
bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here
Problem-based learning is designed to develop
1048708 Integrated context-specific knowledge base
1048708 Decision-makingcritical thinking process and skills
1048708 Self-directed life-long learning skills 1048708 Interpersonal collaboration and
communication skills 1048708 Constructive self and peer
assessment skills 1048708 Professional ethics and behavior
PBL Case (contd)
bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session
What is problem based learning
bull In PBL students use triggers from the problem case or scenario to define their own learning objectives
bull Subsequently they do independent self directed study before returning to the group to discuss and refine their acquired knowledge
bull Thus PBL is not about problem solving per se but rather it uses appropriate problems to increase knowledge and understanding
bull The process is clearly defined
PBL
bull PBL uses clinical cases as the context for students to study basic and clinical sciences
bull 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
bull Possible disadvantages include higher costs both in resources and staff time
PBL
bull An educational method characterized by the use of patient problems as a context for students to learn problem-solving skills and acquire knowledge about the basic and clinical sciences
bull Students usually meet in small groups two or three times a week for PBL tutorials
bull They are presented with a clinical problem (eg a patient with chest pain) and in a series of steps they discuss possible mechanisms and causes develop hypotheses and strategies to test the hypotheses are presented with further information and use this new information to refine their hypotheses finally reaching a conclusion
bull A tutor usually acts as a facilitator guiding students in this group-learning process
bull In the course of this exercise students identify both their existing levels and gaps in their knowledge These gaps form the basis for independent learning outside the PBL tutorials The identification and pursuit of these so-called learning goals is a key element of the PBL process
Rationale for using PBL bull The PBL approach is based on principles of adult
education20 and cognitive psychology21 It differs fundamentally from traditional curricula in which students acquire background knowledge of the basic sciences in the early years of the course and in the later years apply this knowledge to the diagnosis and management of clinical problems This traditional approach has been criticised for a number of reasons42223
bull It creates an artificial divide between the basic and clinical sciences
bull Time is wasted in acquiring knowledge that is subsequently forgotten or found to be irrelevant
bull Application of the acquired knowledge can be difficult bull The acquisition and retention of information that has no
apparent relevance can be boring and even demoralising for students
The group learning process acquiring
desirable learning skills
Generic Skills amp attitudes
bull Teamwork bull Critical evaluation of literature bull Chairing a group bull Self directed learning and use of
resources bull Listening Presentation skills
Recording bull Cooperation bull Respect for colleagues views
bull Group learning facilitates not only the acquisition of knowledge but also several other desirable attributes such as communication skills teamwork problem solving independent responsibility for learning sharing information and respect for others PBL can therefore be thought of as a small group teaching method that combines the acquisition of knowledge with the development of generic skills and attitudes Presentation of clinical material as the stimulus for learning enables students to understand the relevance of underlying scientific knowledge and principles in clinical practice
bull when PBL is introduced into a curriculum several other issues for curriculum design and implementation need to be tackled PBL is generally introduced in the context of a defined core curriculum and integration of basic and clinical sciences It has implications for staffing and learning resources and demands a different approach to timetabling workload and assessment PBL is often used to deliver core material in non-clinical parts of the curriculum Paper based PBL scenarios form the basis of the core curriculum and ensure that all students are exposed to the same problems Recently modified PBL techniques have been introduced into clinical education with real patients being used as the stimulus for learning Despite the essential ad hoc nature of learning clinical medicine a key cases approach can enable PBL to be used to deliver the core clinical curriculum
Copyright copy2003 BMJ Publishing Group Ltd
Wood D F BMJ 2003326328-330
No CRoles of participants in a PBL tutorial aption Found
What happens in a PBL tutorial bull PBL tutorials are conducted in several ways In
this article the examples are modelled on the Maastricht seven jump process but its format of seven steps may be shortened
bull A typical PBL tutorial consists of a group of students (usually eight to 10) and a tutor who facilitates the session The length of time (number of sessions) that a group stays together with each other and with individual tutors varies between institutions A group needs to be together long enough to allow good group dynamics to develop but may need to be changed occasionally if personality clashes or other dysfunctional behaviour emerges
bull Students elect a chair for each PBL scenario and a scribe to record the discussion The roles are rotated for each scenario Suitable flip charts or a whiteboard should be used for recording the proceedings At the start of the session depending on the trigger material either the student chair reads out the scenario or all students study the material If the trigger is a real patient in a ward clinic or surgery then a student may be asked to take a clinical history or identify an abnormal physical sign before the group moves to a tutorial room For each module students may be given a handbook containing the problem scenarios and suggested learning resources or learning materials may be handed out at appropriate times as the tutorials progress
Examples of trigger material for PBL scenarios bull Paper based clinical scenarios bull Experimental or clinical laboratory data bull Photographs bull Video clips bull Newspaper articles bull All or part of an article from a scientific
journal bull A real or simulated patient bull A family tree showing an inherited
disorder
PBL tutorial process ndash Step 1 Identify and clarify unfamiliar terms presented in the scenario
scribe lists those that remain unexplained after discussion ndash Step 2 Define the problem or problems to be discussed students may
have different views on the issues but all should be considered scribe records a list of agreed problems
ndash Step 3 Brainstorming session to discuss the problem(s) suggestingpossible explanations on basis of prior knowledge students draw on each others knowledge and identify areas of incomplete knowledge scribe records all discussion
ndash Step 4 Review steps 2 and 3 and arrange explanations into tentativesolutions scribe organises the explanations and restructures if necessary
ndash Step 5 Formulate learning objectives group reaches consensus onthe learning objectives tutor ensures learning objectives are focused achievable comprehensive and appropriate
ndash Step 6 Private study (all students gather information related to eachlearning objective)
ndash Step 7 Group shares results of private study (students identify theirlearning resources and share their results) tutor checks learning and may assess the group
bull The role of the tutor is to facilitate the proceedings (helping the chair to maintain group dynamics and moving the group through the task) and to ensure that the group achieves appropriate learning objectives in line with those set by the curriculum design team The tutor may need to take a more active role in step 7 of the process to ensure that all the students have done the appropriate work and to help the chair to suggest a suitable format for group members to use to present the results of their private study The tutor should encourage students to check their understanding of the material He or she can do this by encouraging the students to ask open questions and ask each other to explain topics in their own words or by the use of drawings and diagrams
PBL in curriculum design bull PBL may be used either as the mainstay of an entire
curriculum or for the delivery of individual courses In practice PBL is usually part of an integrated curriculum using a systems based approach with non-clinical material delivered in the context of clinical practice A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge skills and attitudes A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios Sufficient time should be allowed each week for students to do the self directed learning required for PBL
bull
Copyright copy2003 BMJ Publishing Group Ltd
Wood D F BMJ 2003326328-330
No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found
Writing PBL scenarios
bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives
bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after
studying the scenario should be consistent with the faculty learning objectives
bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding
bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice
bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge
bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented
bull The problem should be sufficiently open so that discussion is not curtailed too early in the process
bull Scenarios should promote participation by the students in seeking information from various learning resources
bull Adapted from Dolmans et al Med Teacher 199719185-9
Staff development
bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)
A dysfunctional group a dominant character may
make it difficult for other students to be heard
A dysfunctional group a dominant character may make it difficult for other students to be heard
bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties
Advantages of PBL bull Student centred PBLIt fostersactive learning improved
understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks
Disadvantagesbull Tutors who cant teachTutorsenjoy passing on
their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful
Assessment of PBL
bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods
bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL
Conclusion
bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning
bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL
PBL 5 Easy Steps
bull Read the problem
Mrs Paula Embledon
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
2 Brain storm
bull Brainstorm
bull ndash hypotheses
bull - what do we know in support of the hypothesis
bull - what do we need to know to test the hypothesis
ndash learning issues
Brainstorm
bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)
ndash specific issues (for individuals to look up)
ndash overlapping issues
bull 4 Individual Reading - Research - Preparation
bull 5 Return
bull ndash review case so far ndash report and discuss
ndash assess progress - continue pagenext pagecomplete
ndash self-evaluation - How did things go Any suggestions for next time
ndash next problem
bull 5 Return
THE FIRST GROUP SESSION
bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day
bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session
bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr
bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine
bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise
bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator
bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues
bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know
bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)
bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)
bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)
Characteristics of an effective PBL Group
An Effective Group is Cohesive motivated mutually supportive amp actively engaged in learning
bull The Group understands the process amp energetically pursues its task
bull Members respect each otherrsquos contribution but examine them critically
bull Discussions flow as students cooperate rather than compete
bull The atmosphere is friendly amp good humouredbull Roles are shared all take turns in scribing
leading discussion taking responsibility for acquiring information
Staff Development
bull Basic training is mandatorybull Further development may be a requirementbull Initial training may involve observation amp
practice with a group from the programbull Effective training ensures that necessary
background goals amp local strategies are considered together with info on assessment amp evaluation
bull In addition to materials supplied to students tutors are usually issued with handbooks highlighting issues for each problem
Tutorrsquos Role in Assessment
bull Individual StudentsGroups may be assessed Summatively (determining progression) or formatively (for feedback)
The GROUP
bull At the end of each problem groups review their processes to encourage self-reflection ampenhance their collective performance
Tutorrsquos Role in Assessment
Individual students
bull Tutors should provide formative feedback to each member
bull Ask students to complete a simple self-assessment questionnaire reviewing appropriate behaviors the tutor returns them with comments
bull Students will be a writtenoralclinical tests that will determine their progression amp ultimate graduation
Evaluating PBL Tutorials-II
bull At the end of each problem time is allocated for evaluation
bull Both the process amp learning in PBL can be evaluated against explicit goals
bull The tutorrsquos review of effectiveness of group processes offers insight for the members
bull Students normally evaluate their tutor helpfulness support for clinical reasoning encouragement for independent learning appropriate intervention provision for effective feedback
PBLbull 1048708 Enabling students to learn in the context in which the
information will be used which increases the ability to retrieve and apply information
bull 1048708 Focusing on important concepts which helps learners organize and store new information in a way that facilitates retrieval and application
bull 1048708 Exploring prior knowledge formulating inquiries derived from and defined by the learnersrsquo need to know and actively constructing meaning through dialogue and reflection
bull 1048708 Utilizing problems designed to simulate studentsrsquo perception of their future profession which serves as a powerful stimulus for studentsrsquo intrinsic motivation to learn
bull 1048708 Actively involving students in monitoring their own progress and reflecting on what works and what needs improvement frequently assessing student performance and providing feedback
PBL Starting the casebull After the introductions and discussion
are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it
bull Reading the case aloud keeps the group focused
bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here
PBL Case (contd)
bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session
PBL Case contdbull SECOND deciding which issues everyone will
tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)
bull THIRD deciding what SPECIFIC questions individuals will try to answer
bull FOURTH deciding how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet or consulting an expert)
The Process of PBL
bullWhat are the issues Identify the important issues in the problem
bull How well do you understand the issues
bull Are there any words or terms about which you are unclear
The Process of PBL contd
bull Consider the basic mechanisms that might explain each important aspect of each problem
bull Assess your current understanding of the basic structural andor functional mechanisms that may contribute to the presentation of the problem
bull Use the collective skills and experiences of group members to explore or explain these phenomena Identify current gaps in knowledge or understanding
Learn from each other
bullShare your own knowledge expertise or ability to reason and synthesize information Be receptive and appreciative of the contribution of your small group members
Determine priorities for learning
bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue
bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan
bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge
bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career
PBL
bull The problem comes first without advance readings lectures or preparation
bull The problem serves as a stimulus for the need to know
Learning Issues
bull Learning issues are questions that cannot be answered with studentsrsquo current knowledge and that can be explored and answered through systematic self-directed inquiry
bull The use of learning issues in tutorials prepares students to handle similar challenges in clinical practice and life-long learning
Learning Issues in PBL First Session1 Getting Started (Introductions Ground
Rules Expectations)2 Identifying Problem3 Exploring Pre-Existing Knowledge4 Generating Hypotheses and Explaining
Mechanisms5 Unfolding the Case Incrementally6 Re-EvaluatingReprioritizing Hypotheses
Based on New Information7 AssessmentReflection
PBL Second Session
8 Independent Self-Directed Study of Learning Issues
PBL Third Session
bull 9 Discussion of Learning Issues and Application of New Knowledge to the Case
bull 10 Continued Unfolding of the Case Incrementally
bull 11 AssessmentReflection
During Tutorial Session students will
1048708 Come prepared to discuss the case and learning issues researched since the last tutorial
1048708 Actively participate in group discussions and contribute to the learning process in a manner that allows for the balanced participation of everyone in the group
1048708 Develop learning issues at each session phrase them as full-sentence questions write them on the board and post them on the course web page
1048708 Consider biological population behaviormental health issuesexplanations and questions of professional attitudes values and ethics related to the patientrsquos problem(s) described in the case
Tutorial Session contd1048708 Go to the board to diagram outline draw etc in
explanation of mechanisms relatedto hypotheses1048708 Debate evidence related to the case and avoid
personal attacks on others1048708 Comply with ground rules with regard to how
the group will function and how itsmembers treat one another1048708 Participate in end-of-session reflection and
assessment by giving and receivingconstructive criticism regarding self tutor
student and group performance
Between Tutorial Session
1048708 Research key learning issues using a variety of resources
1048708 Critically evaluate the credibility of sources and the validity of the information they have obtained in their research
1048708 Integrate what they have learned through research lectures labs clinical skills Perspectives in Medicine (PIM) etc into what is discussed in tutorials
1048708 Synthesize what they have learned and be prepared to discuss it without reading directly from their materials as much as possible and apply it to the case at the next tutorial session
Determine priorities for learning
bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue
bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan
bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge
bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career
PBL Starting the casebull After the introductions and discussion
are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it
bull Reading the case aloud keeps the group focused
bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here
Problem-based learning is designed to develop
1048708 Integrated context-specific knowledge base
1048708 Decision-makingcritical thinking process and skills
1048708 Self-directed life-long learning skills 1048708 Interpersonal collaboration and
communication skills 1048708 Constructive self and peer
assessment skills 1048708 Professional ethics and behavior
PBL Case (contd)
bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session
What is problem based learning
bull In PBL students use triggers from the problem case or scenario to define their own learning objectives
bull Subsequently they do independent self directed study before returning to the group to discuss and refine their acquired knowledge
bull Thus PBL is not about problem solving per se but rather it uses appropriate problems to increase knowledge and understanding
bull The process is clearly defined
PBL
bull PBL uses clinical cases as the context for students to study basic and clinical sciences
bull 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
bull Possible disadvantages include higher costs both in resources and staff time
PBL
bull An educational method characterized by the use of patient problems as a context for students to learn problem-solving skills and acquire knowledge about the basic and clinical sciences
bull Students usually meet in small groups two or three times a week for PBL tutorials
bull They are presented with a clinical problem (eg a patient with chest pain) and in a series of steps they discuss possible mechanisms and causes develop hypotheses and strategies to test the hypotheses are presented with further information and use this new information to refine their hypotheses finally reaching a conclusion
bull A tutor usually acts as a facilitator guiding students in this group-learning process
bull In the course of this exercise students identify both their existing levels and gaps in their knowledge These gaps form the basis for independent learning outside the PBL tutorials The identification and pursuit of these so-called learning goals is a key element of the PBL process
Rationale for using PBL bull The PBL approach is based on principles of adult
education20 and cognitive psychology21 It differs fundamentally from traditional curricula in which students acquire background knowledge of the basic sciences in the early years of the course and in the later years apply this knowledge to the diagnosis and management of clinical problems This traditional approach has been criticised for a number of reasons42223
bull It creates an artificial divide between the basic and clinical sciences
bull Time is wasted in acquiring knowledge that is subsequently forgotten or found to be irrelevant
bull Application of the acquired knowledge can be difficult bull The acquisition and retention of information that has no
apparent relevance can be boring and even demoralising for students
The group learning process acquiring
desirable learning skills
Generic Skills amp attitudes
bull Teamwork bull Critical evaluation of literature bull Chairing a group bull Self directed learning and use of
resources bull Listening Presentation skills
Recording bull Cooperation bull Respect for colleagues views
bull Group learning facilitates not only the acquisition of knowledge but also several other desirable attributes such as communication skills teamwork problem solving independent responsibility for learning sharing information and respect for others PBL can therefore be thought of as a small group teaching method that combines the acquisition of knowledge with the development of generic skills and attitudes Presentation of clinical material as the stimulus for learning enables students to understand the relevance of underlying scientific knowledge and principles in clinical practice
bull when PBL is introduced into a curriculum several other issues for curriculum design and implementation need to be tackled PBL is generally introduced in the context of a defined core curriculum and integration of basic and clinical sciences It has implications for staffing and learning resources and demands a different approach to timetabling workload and assessment PBL is often used to deliver core material in non-clinical parts of the curriculum Paper based PBL scenarios form the basis of the core curriculum and ensure that all students are exposed to the same problems Recently modified PBL techniques have been introduced into clinical education with real patients being used as the stimulus for learning Despite the essential ad hoc nature of learning clinical medicine a key cases approach can enable PBL to be used to deliver the core clinical curriculum
Copyright copy2003 BMJ Publishing Group Ltd
Wood D F BMJ 2003326328-330
No CRoles of participants in a PBL tutorial aption Found
What happens in a PBL tutorial bull PBL tutorials are conducted in several ways In
this article the examples are modelled on the Maastricht seven jump process but its format of seven steps may be shortened
bull A typical PBL tutorial consists of a group of students (usually eight to 10) and a tutor who facilitates the session The length of time (number of sessions) that a group stays together with each other and with individual tutors varies between institutions A group needs to be together long enough to allow good group dynamics to develop but may need to be changed occasionally if personality clashes or other dysfunctional behaviour emerges
bull Students elect a chair for each PBL scenario and a scribe to record the discussion The roles are rotated for each scenario Suitable flip charts or a whiteboard should be used for recording the proceedings At the start of the session depending on the trigger material either the student chair reads out the scenario or all students study the material If the trigger is a real patient in a ward clinic or surgery then a student may be asked to take a clinical history or identify an abnormal physical sign before the group moves to a tutorial room For each module students may be given a handbook containing the problem scenarios and suggested learning resources or learning materials may be handed out at appropriate times as the tutorials progress
Examples of trigger material for PBL scenarios bull Paper based clinical scenarios bull Experimental or clinical laboratory data bull Photographs bull Video clips bull Newspaper articles bull All or part of an article from a scientific
journal bull A real or simulated patient bull A family tree showing an inherited
disorder
PBL tutorial process ndash Step 1 Identify and clarify unfamiliar terms presented in the scenario
scribe lists those that remain unexplained after discussion ndash Step 2 Define the problem or problems to be discussed students may
have different views on the issues but all should be considered scribe records a list of agreed problems
ndash Step 3 Brainstorming session to discuss the problem(s) suggestingpossible explanations on basis of prior knowledge students draw on each others knowledge and identify areas of incomplete knowledge scribe records all discussion
ndash Step 4 Review steps 2 and 3 and arrange explanations into tentativesolutions scribe organises the explanations and restructures if necessary
ndash Step 5 Formulate learning objectives group reaches consensus onthe learning objectives tutor ensures learning objectives are focused achievable comprehensive and appropriate
ndash Step 6 Private study (all students gather information related to eachlearning objective)
ndash Step 7 Group shares results of private study (students identify theirlearning resources and share their results) tutor checks learning and may assess the group
bull The role of the tutor is to facilitate the proceedings (helping the chair to maintain group dynamics and moving the group through the task) and to ensure that the group achieves appropriate learning objectives in line with those set by the curriculum design team The tutor may need to take a more active role in step 7 of the process to ensure that all the students have done the appropriate work and to help the chair to suggest a suitable format for group members to use to present the results of their private study The tutor should encourage students to check their understanding of the material He or she can do this by encouraging the students to ask open questions and ask each other to explain topics in their own words or by the use of drawings and diagrams
PBL in curriculum design bull PBL may be used either as the mainstay of an entire
curriculum or for the delivery of individual courses In practice PBL is usually part of an integrated curriculum using a systems based approach with non-clinical material delivered in the context of clinical practice A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge skills and attitudes A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios Sufficient time should be allowed each week for students to do the self directed learning required for PBL
bull
Copyright copy2003 BMJ Publishing Group Ltd
Wood D F BMJ 2003326328-330
No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found
Writing PBL scenarios
bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives
bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after
studying the scenario should be consistent with the faculty learning objectives
bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding
bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice
bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge
bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented
bull The problem should be sufficiently open so that discussion is not curtailed too early in the process
bull Scenarios should promote participation by the students in seeking information from various learning resources
bull Adapted from Dolmans et al Med Teacher 199719185-9
Staff development
bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)
A dysfunctional group a dominant character may
make it difficult for other students to be heard
A dysfunctional group a dominant character may make it difficult for other students to be heard
bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties
Advantages of PBL bull Student centred PBLIt fostersactive learning improved
understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks
Disadvantagesbull Tutors who cant teachTutorsenjoy passing on
their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful
Assessment of PBL
bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods
bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL
Conclusion
bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning
bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL
PBL 5 Easy Steps
bull Read the problem
Mrs Paula Embledon
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
2 Brain storm
bull Brainstorm
bull ndash hypotheses
bull - what do we know in support of the hypothesis
bull - what do we need to know to test the hypothesis
ndash learning issues
Brainstorm
bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)
ndash specific issues (for individuals to look up)
ndash overlapping issues
bull 4 Individual Reading - Research - Preparation
bull 5 Return
bull ndash review case so far ndash report and discuss
ndash assess progress - continue pagenext pagecomplete
ndash self-evaluation - How did things go Any suggestions for next time
ndash next problem
bull 5 Return
THE FIRST GROUP SESSION
bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day
bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session
bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr
bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine
bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise
bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator
bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues
bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know
bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)
bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)
bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)
Staff Development
bull Basic training is mandatorybull Further development may be a requirementbull Initial training may involve observation amp
practice with a group from the programbull Effective training ensures that necessary
background goals amp local strategies are considered together with info on assessment amp evaluation
bull In addition to materials supplied to students tutors are usually issued with handbooks highlighting issues for each problem
Tutorrsquos Role in Assessment
bull Individual StudentsGroups may be assessed Summatively (determining progression) or formatively (for feedback)
The GROUP
bull At the end of each problem groups review their processes to encourage self-reflection ampenhance their collective performance
Tutorrsquos Role in Assessment
Individual students
bull Tutors should provide formative feedback to each member
bull Ask students to complete a simple self-assessment questionnaire reviewing appropriate behaviors the tutor returns them with comments
bull Students will be a writtenoralclinical tests that will determine their progression amp ultimate graduation
Evaluating PBL Tutorials-II
bull At the end of each problem time is allocated for evaluation
bull Both the process amp learning in PBL can be evaluated against explicit goals
bull The tutorrsquos review of effectiveness of group processes offers insight for the members
bull Students normally evaluate their tutor helpfulness support for clinical reasoning encouragement for independent learning appropriate intervention provision for effective feedback
PBLbull 1048708 Enabling students to learn in the context in which the
information will be used which increases the ability to retrieve and apply information
bull 1048708 Focusing on important concepts which helps learners organize and store new information in a way that facilitates retrieval and application
bull 1048708 Exploring prior knowledge formulating inquiries derived from and defined by the learnersrsquo need to know and actively constructing meaning through dialogue and reflection
bull 1048708 Utilizing problems designed to simulate studentsrsquo perception of their future profession which serves as a powerful stimulus for studentsrsquo intrinsic motivation to learn
bull 1048708 Actively involving students in monitoring their own progress and reflecting on what works and what needs improvement frequently assessing student performance and providing feedback
PBL Starting the casebull After the introductions and discussion
are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it
bull Reading the case aloud keeps the group focused
bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here
PBL Case (contd)
bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session
PBL Case contdbull SECOND deciding which issues everyone will
tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)
bull THIRD deciding what SPECIFIC questions individuals will try to answer
bull FOURTH deciding how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet or consulting an expert)
The Process of PBL
bullWhat are the issues Identify the important issues in the problem
bull How well do you understand the issues
bull Are there any words or terms about which you are unclear
The Process of PBL contd
bull Consider the basic mechanisms that might explain each important aspect of each problem
bull Assess your current understanding of the basic structural andor functional mechanisms that may contribute to the presentation of the problem
bull Use the collective skills and experiences of group members to explore or explain these phenomena Identify current gaps in knowledge or understanding
Learn from each other
bullShare your own knowledge expertise or ability to reason and synthesize information Be receptive and appreciative of the contribution of your small group members
Determine priorities for learning
bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue
bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan
bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge
bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career
PBL
bull The problem comes first without advance readings lectures or preparation
bull The problem serves as a stimulus for the need to know
Learning Issues
bull Learning issues are questions that cannot be answered with studentsrsquo current knowledge and that can be explored and answered through systematic self-directed inquiry
bull The use of learning issues in tutorials prepares students to handle similar challenges in clinical practice and life-long learning
Learning Issues in PBL First Session1 Getting Started (Introductions Ground
Rules Expectations)2 Identifying Problem3 Exploring Pre-Existing Knowledge4 Generating Hypotheses and Explaining
Mechanisms5 Unfolding the Case Incrementally6 Re-EvaluatingReprioritizing Hypotheses
Based on New Information7 AssessmentReflection
PBL Second Session
8 Independent Self-Directed Study of Learning Issues
PBL Third Session
bull 9 Discussion of Learning Issues and Application of New Knowledge to the Case
bull 10 Continued Unfolding of the Case Incrementally
bull 11 AssessmentReflection
During Tutorial Session students will
1048708 Come prepared to discuss the case and learning issues researched since the last tutorial
1048708 Actively participate in group discussions and contribute to the learning process in a manner that allows for the balanced participation of everyone in the group
1048708 Develop learning issues at each session phrase them as full-sentence questions write them on the board and post them on the course web page
1048708 Consider biological population behaviormental health issuesexplanations and questions of professional attitudes values and ethics related to the patientrsquos problem(s) described in the case
Tutorial Session contd1048708 Go to the board to diagram outline draw etc in
explanation of mechanisms relatedto hypotheses1048708 Debate evidence related to the case and avoid
personal attacks on others1048708 Comply with ground rules with regard to how
the group will function and how itsmembers treat one another1048708 Participate in end-of-session reflection and
assessment by giving and receivingconstructive criticism regarding self tutor
student and group performance
Between Tutorial Session
1048708 Research key learning issues using a variety of resources
1048708 Critically evaluate the credibility of sources and the validity of the information they have obtained in their research
1048708 Integrate what they have learned through research lectures labs clinical skills Perspectives in Medicine (PIM) etc into what is discussed in tutorials
1048708 Synthesize what they have learned and be prepared to discuss it without reading directly from their materials as much as possible and apply it to the case at the next tutorial session
Determine priorities for learning
bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue
bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan
bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge
bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career
PBL Starting the casebull After the introductions and discussion
are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it
bull Reading the case aloud keeps the group focused
bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here
Problem-based learning is designed to develop
1048708 Integrated context-specific knowledge base
1048708 Decision-makingcritical thinking process and skills
1048708 Self-directed life-long learning skills 1048708 Interpersonal collaboration and
communication skills 1048708 Constructive self and peer
assessment skills 1048708 Professional ethics and behavior
PBL Case (contd)
bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session
What is problem based learning
bull In PBL students use triggers from the problem case or scenario to define their own learning objectives
bull Subsequently they do independent self directed study before returning to the group to discuss and refine their acquired knowledge
bull Thus PBL is not about problem solving per se but rather it uses appropriate problems to increase knowledge and understanding
bull The process is clearly defined
PBL
bull PBL uses clinical cases as the context for students to study basic and clinical sciences
bull 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
bull Possible disadvantages include higher costs both in resources and staff time
PBL
bull An educational method characterized by the use of patient problems as a context for students to learn problem-solving skills and acquire knowledge about the basic and clinical sciences
bull Students usually meet in small groups two or three times a week for PBL tutorials
bull They are presented with a clinical problem (eg a patient with chest pain) and in a series of steps they discuss possible mechanisms and causes develop hypotheses and strategies to test the hypotheses are presented with further information and use this new information to refine their hypotheses finally reaching a conclusion
bull A tutor usually acts as a facilitator guiding students in this group-learning process
bull In the course of this exercise students identify both their existing levels and gaps in their knowledge These gaps form the basis for independent learning outside the PBL tutorials The identification and pursuit of these so-called learning goals is a key element of the PBL process
Rationale for using PBL bull The PBL approach is based on principles of adult
education20 and cognitive psychology21 It differs fundamentally from traditional curricula in which students acquire background knowledge of the basic sciences in the early years of the course and in the later years apply this knowledge to the diagnosis and management of clinical problems This traditional approach has been criticised for a number of reasons42223
bull It creates an artificial divide between the basic and clinical sciences
bull Time is wasted in acquiring knowledge that is subsequently forgotten or found to be irrelevant
bull Application of the acquired knowledge can be difficult bull The acquisition and retention of information that has no
apparent relevance can be boring and even demoralising for students
The group learning process acquiring
desirable learning skills
Generic Skills amp attitudes
bull Teamwork bull Critical evaluation of literature bull Chairing a group bull Self directed learning and use of
resources bull Listening Presentation skills
Recording bull Cooperation bull Respect for colleagues views
bull Group learning facilitates not only the acquisition of knowledge but also several other desirable attributes such as communication skills teamwork problem solving independent responsibility for learning sharing information and respect for others PBL can therefore be thought of as a small group teaching method that combines the acquisition of knowledge with the development of generic skills and attitudes Presentation of clinical material as the stimulus for learning enables students to understand the relevance of underlying scientific knowledge and principles in clinical practice
bull when PBL is introduced into a curriculum several other issues for curriculum design and implementation need to be tackled PBL is generally introduced in the context of a defined core curriculum and integration of basic and clinical sciences It has implications for staffing and learning resources and demands a different approach to timetabling workload and assessment PBL is often used to deliver core material in non-clinical parts of the curriculum Paper based PBL scenarios form the basis of the core curriculum and ensure that all students are exposed to the same problems Recently modified PBL techniques have been introduced into clinical education with real patients being used as the stimulus for learning Despite the essential ad hoc nature of learning clinical medicine a key cases approach can enable PBL to be used to deliver the core clinical curriculum
Copyright copy2003 BMJ Publishing Group Ltd
Wood D F BMJ 2003326328-330
No CRoles of participants in a PBL tutorial aption Found
What happens in a PBL tutorial bull PBL tutorials are conducted in several ways In
this article the examples are modelled on the Maastricht seven jump process but its format of seven steps may be shortened
bull A typical PBL tutorial consists of a group of students (usually eight to 10) and a tutor who facilitates the session The length of time (number of sessions) that a group stays together with each other and with individual tutors varies between institutions A group needs to be together long enough to allow good group dynamics to develop but may need to be changed occasionally if personality clashes or other dysfunctional behaviour emerges
bull Students elect a chair for each PBL scenario and a scribe to record the discussion The roles are rotated for each scenario Suitable flip charts or a whiteboard should be used for recording the proceedings At the start of the session depending on the trigger material either the student chair reads out the scenario or all students study the material If the trigger is a real patient in a ward clinic or surgery then a student may be asked to take a clinical history or identify an abnormal physical sign before the group moves to a tutorial room For each module students may be given a handbook containing the problem scenarios and suggested learning resources or learning materials may be handed out at appropriate times as the tutorials progress
Examples of trigger material for PBL scenarios bull Paper based clinical scenarios bull Experimental or clinical laboratory data bull Photographs bull Video clips bull Newspaper articles bull All or part of an article from a scientific
journal bull A real or simulated patient bull A family tree showing an inherited
disorder
PBL tutorial process ndash Step 1 Identify and clarify unfamiliar terms presented in the scenario
scribe lists those that remain unexplained after discussion ndash Step 2 Define the problem or problems to be discussed students may
have different views on the issues but all should be considered scribe records a list of agreed problems
ndash Step 3 Brainstorming session to discuss the problem(s) suggestingpossible explanations on basis of prior knowledge students draw on each others knowledge and identify areas of incomplete knowledge scribe records all discussion
ndash Step 4 Review steps 2 and 3 and arrange explanations into tentativesolutions scribe organises the explanations and restructures if necessary
ndash Step 5 Formulate learning objectives group reaches consensus onthe learning objectives tutor ensures learning objectives are focused achievable comprehensive and appropriate
ndash Step 6 Private study (all students gather information related to eachlearning objective)
ndash Step 7 Group shares results of private study (students identify theirlearning resources and share their results) tutor checks learning and may assess the group
bull The role of the tutor is to facilitate the proceedings (helping the chair to maintain group dynamics and moving the group through the task) and to ensure that the group achieves appropriate learning objectives in line with those set by the curriculum design team The tutor may need to take a more active role in step 7 of the process to ensure that all the students have done the appropriate work and to help the chair to suggest a suitable format for group members to use to present the results of their private study The tutor should encourage students to check their understanding of the material He or she can do this by encouraging the students to ask open questions and ask each other to explain topics in their own words or by the use of drawings and diagrams
PBL in curriculum design bull PBL may be used either as the mainstay of an entire
curriculum or for the delivery of individual courses In practice PBL is usually part of an integrated curriculum using a systems based approach with non-clinical material delivered in the context of clinical practice A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge skills and attitudes A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios Sufficient time should be allowed each week for students to do the self directed learning required for PBL
bull
Copyright copy2003 BMJ Publishing Group Ltd
Wood D F BMJ 2003326328-330
No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found
Writing PBL scenarios
bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives
bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after
studying the scenario should be consistent with the faculty learning objectives
bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding
bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice
bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge
bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented
bull The problem should be sufficiently open so that discussion is not curtailed too early in the process
bull Scenarios should promote participation by the students in seeking information from various learning resources
bull Adapted from Dolmans et al Med Teacher 199719185-9
Staff development
bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)
A dysfunctional group a dominant character may
make it difficult for other students to be heard
A dysfunctional group a dominant character may make it difficult for other students to be heard
bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties
Advantages of PBL bull Student centred PBLIt fostersactive learning improved
understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks
Disadvantagesbull Tutors who cant teachTutorsenjoy passing on
their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful
Assessment of PBL
bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods
bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL
Conclusion
bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning
bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL
PBL 5 Easy Steps
bull Read the problem
Mrs Paula Embledon
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
2 Brain storm
bull Brainstorm
bull ndash hypotheses
bull - what do we know in support of the hypothesis
bull - what do we need to know to test the hypothesis
ndash learning issues
Brainstorm
bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)
ndash specific issues (for individuals to look up)
ndash overlapping issues
bull 4 Individual Reading - Research - Preparation
bull 5 Return
bull ndash review case so far ndash report and discuss
ndash assess progress - continue pagenext pagecomplete
ndash self-evaluation - How did things go Any suggestions for next time
ndash next problem
bull 5 Return
THE FIRST GROUP SESSION
bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day
bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session
bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr
bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine
bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise
bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator
bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues
bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know
bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)
bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)
bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)
Tutorrsquos Role in Assessment
bull Individual StudentsGroups may be assessed Summatively (determining progression) or formatively (for feedback)
The GROUP
bull At the end of each problem groups review their processes to encourage self-reflection ampenhance their collective performance
Tutorrsquos Role in Assessment
Individual students
bull Tutors should provide formative feedback to each member
bull Ask students to complete a simple self-assessment questionnaire reviewing appropriate behaviors the tutor returns them with comments
bull Students will be a writtenoralclinical tests that will determine their progression amp ultimate graduation
Evaluating PBL Tutorials-II
bull At the end of each problem time is allocated for evaluation
bull Both the process amp learning in PBL can be evaluated against explicit goals
bull The tutorrsquos review of effectiveness of group processes offers insight for the members
bull Students normally evaluate their tutor helpfulness support for clinical reasoning encouragement for independent learning appropriate intervention provision for effective feedback
PBLbull 1048708 Enabling students to learn in the context in which the
information will be used which increases the ability to retrieve and apply information
bull 1048708 Focusing on important concepts which helps learners organize and store new information in a way that facilitates retrieval and application
bull 1048708 Exploring prior knowledge formulating inquiries derived from and defined by the learnersrsquo need to know and actively constructing meaning through dialogue and reflection
bull 1048708 Utilizing problems designed to simulate studentsrsquo perception of their future profession which serves as a powerful stimulus for studentsrsquo intrinsic motivation to learn
bull 1048708 Actively involving students in monitoring their own progress and reflecting on what works and what needs improvement frequently assessing student performance and providing feedback
PBL Starting the casebull After the introductions and discussion
are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it
bull Reading the case aloud keeps the group focused
bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here
PBL Case (contd)
bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session
PBL Case contdbull SECOND deciding which issues everyone will
tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)
bull THIRD deciding what SPECIFIC questions individuals will try to answer
bull FOURTH deciding how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet or consulting an expert)
The Process of PBL
bullWhat are the issues Identify the important issues in the problem
bull How well do you understand the issues
bull Are there any words or terms about which you are unclear
The Process of PBL contd
bull Consider the basic mechanisms that might explain each important aspect of each problem
bull Assess your current understanding of the basic structural andor functional mechanisms that may contribute to the presentation of the problem
bull Use the collective skills and experiences of group members to explore or explain these phenomena Identify current gaps in knowledge or understanding
Learn from each other
bullShare your own knowledge expertise or ability to reason and synthesize information Be receptive and appreciative of the contribution of your small group members
Determine priorities for learning
bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue
bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan
bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge
bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career
PBL
bull The problem comes first without advance readings lectures or preparation
bull The problem serves as a stimulus for the need to know
Learning Issues
bull Learning issues are questions that cannot be answered with studentsrsquo current knowledge and that can be explored and answered through systematic self-directed inquiry
bull The use of learning issues in tutorials prepares students to handle similar challenges in clinical practice and life-long learning
Learning Issues in PBL First Session1 Getting Started (Introductions Ground
Rules Expectations)2 Identifying Problem3 Exploring Pre-Existing Knowledge4 Generating Hypotheses and Explaining
Mechanisms5 Unfolding the Case Incrementally6 Re-EvaluatingReprioritizing Hypotheses
Based on New Information7 AssessmentReflection
PBL Second Session
8 Independent Self-Directed Study of Learning Issues
PBL Third Session
bull 9 Discussion of Learning Issues and Application of New Knowledge to the Case
bull 10 Continued Unfolding of the Case Incrementally
bull 11 AssessmentReflection
During Tutorial Session students will
1048708 Come prepared to discuss the case and learning issues researched since the last tutorial
1048708 Actively participate in group discussions and contribute to the learning process in a manner that allows for the balanced participation of everyone in the group
1048708 Develop learning issues at each session phrase them as full-sentence questions write them on the board and post them on the course web page
1048708 Consider biological population behaviormental health issuesexplanations and questions of professional attitudes values and ethics related to the patientrsquos problem(s) described in the case
Tutorial Session contd1048708 Go to the board to diagram outline draw etc in
explanation of mechanisms relatedto hypotheses1048708 Debate evidence related to the case and avoid
personal attacks on others1048708 Comply with ground rules with regard to how
the group will function and how itsmembers treat one another1048708 Participate in end-of-session reflection and
assessment by giving and receivingconstructive criticism regarding self tutor
student and group performance
Between Tutorial Session
1048708 Research key learning issues using a variety of resources
1048708 Critically evaluate the credibility of sources and the validity of the information they have obtained in their research
1048708 Integrate what they have learned through research lectures labs clinical skills Perspectives in Medicine (PIM) etc into what is discussed in tutorials
1048708 Synthesize what they have learned and be prepared to discuss it without reading directly from their materials as much as possible and apply it to the case at the next tutorial session
Determine priorities for learning
bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue
bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan
bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge
bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career
PBL Starting the casebull After the introductions and discussion
are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it
bull Reading the case aloud keeps the group focused
bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here
Problem-based learning is designed to develop
1048708 Integrated context-specific knowledge base
1048708 Decision-makingcritical thinking process and skills
1048708 Self-directed life-long learning skills 1048708 Interpersonal collaboration and
communication skills 1048708 Constructive self and peer
assessment skills 1048708 Professional ethics and behavior
PBL Case (contd)
bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session
What is problem based learning
bull In PBL students use triggers from the problem case or scenario to define their own learning objectives
bull Subsequently they do independent self directed study before returning to the group to discuss and refine their acquired knowledge
bull Thus PBL is not about problem solving per se but rather it uses appropriate problems to increase knowledge and understanding
bull The process is clearly defined
PBL
bull PBL uses clinical cases as the context for students to study basic and clinical sciences
bull 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
bull Possible disadvantages include higher costs both in resources and staff time
PBL
bull An educational method characterized by the use of patient problems as a context for students to learn problem-solving skills and acquire knowledge about the basic and clinical sciences
bull Students usually meet in small groups two or three times a week for PBL tutorials
bull They are presented with a clinical problem (eg a patient with chest pain) and in a series of steps they discuss possible mechanisms and causes develop hypotheses and strategies to test the hypotheses are presented with further information and use this new information to refine their hypotheses finally reaching a conclusion
bull A tutor usually acts as a facilitator guiding students in this group-learning process
bull In the course of this exercise students identify both their existing levels and gaps in their knowledge These gaps form the basis for independent learning outside the PBL tutorials The identification and pursuit of these so-called learning goals is a key element of the PBL process
Rationale for using PBL bull The PBL approach is based on principles of adult
education20 and cognitive psychology21 It differs fundamentally from traditional curricula in which students acquire background knowledge of the basic sciences in the early years of the course and in the later years apply this knowledge to the diagnosis and management of clinical problems This traditional approach has been criticised for a number of reasons42223
bull It creates an artificial divide between the basic and clinical sciences
bull Time is wasted in acquiring knowledge that is subsequently forgotten or found to be irrelevant
bull Application of the acquired knowledge can be difficult bull The acquisition and retention of information that has no
apparent relevance can be boring and even demoralising for students
The group learning process acquiring
desirable learning skills
Generic Skills amp attitudes
bull Teamwork bull Critical evaluation of literature bull Chairing a group bull Self directed learning and use of
resources bull Listening Presentation skills
Recording bull Cooperation bull Respect for colleagues views
bull Group learning facilitates not only the acquisition of knowledge but also several other desirable attributes such as communication skills teamwork problem solving independent responsibility for learning sharing information and respect for others PBL can therefore be thought of as a small group teaching method that combines the acquisition of knowledge with the development of generic skills and attitudes Presentation of clinical material as the stimulus for learning enables students to understand the relevance of underlying scientific knowledge and principles in clinical practice
bull when PBL is introduced into a curriculum several other issues for curriculum design and implementation need to be tackled PBL is generally introduced in the context of a defined core curriculum and integration of basic and clinical sciences It has implications for staffing and learning resources and demands a different approach to timetabling workload and assessment PBL is often used to deliver core material in non-clinical parts of the curriculum Paper based PBL scenarios form the basis of the core curriculum and ensure that all students are exposed to the same problems Recently modified PBL techniques have been introduced into clinical education with real patients being used as the stimulus for learning Despite the essential ad hoc nature of learning clinical medicine a key cases approach can enable PBL to be used to deliver the core clinical curriculum
Copyright copy2003 BMJ Publishing Group Ltd
Wood D F BMJ 2003326328-330
No CRoles of participants in a PBL tutorial aption Found
What happens in a PBL tutorial bull PBL tutorials are conducted in several ways In
this article the examples are modelled on the Maastricht seven jump process but its format of seven steps may be shortened
bull A typical PBL tutorial consists of a group of students (usually eight to 10) and a tutor who facilitates the session The length of time (number of sessions) that a group stays together with each other and with individual tutors varies between institutions A group needs to be together long enough to allow good group dynamics to develop but may need to be changed occasionally if personality clashes or other dysfunctional behaviour emerges
bull Students elect a chair for each PBL scenario and a scribe to record the discussion The roles are rotated for each scenario Suitable flip charts or a whiteboard should be used for recording the proceedings At the start of the session depending on the trigger material either the student chair reads out the scenario or all students study the material If the trigger is a real patient in a ward clinic or surgery then a student may be asked to take a clinical history or identify an abnormal physical sign before the group moves to a tutorial room For each module students may be given a handbook containing the problem scenarios and suggested learning resources or learning materials may be handed out at appropriate times as the tutorials progress
Examples of trigger material for PBL scenarios bull Paper based clinical scenarios bull Experimental or clinical laboratory data bull Photographs bull Video clips bull Newspaper articles bull All or part of an article from a scientific
journal bull A real or simulated patient bull A family tree showing an inherited
disorder
PBL tutorial process ndash Step 1 Identify and clarify unfamiliar terms presented in the scenario
scribe lists those that remain unexplained after discussion ndash Step 2 Define the problem or problems to be discussed students may
have different views on the issues but all should be considered scribe records a list of agreed problems
ndash Step 3 Brainstorming session to discuss the problem(s) suggestingpossible explanations on basis of prior knowledge students draw on each others knowledge and identify areas of incomplete knowledge scribe records all discussion
ndash Step 4 Review steps 2 and 3 and arrange explanations into tentativesolutions scribe organises the explanations and restructures if necessary
ndash Step 5 Formulate learning objectives group reaches consensus onthe learning objectives tutor ensures learning objectives are focused achievable comprehensive and appropriate
ndash Step 6 Private study (all students gather information related to eachlearning objective)
ndash Step 7 Group shares results of private study (students identify theirlearning resources and share their results) tutor checks learning and may assess the group
bull The role of the tutor is to facilitate the proceedings (helping the chair to maintain group dynamics and moving the group through the task) and to ensure that the group achieves appropriate learning objectives in line with those set by the curriculum design team The tutor may need to take a more active role in step 7 of the process to ensure that all the students have done the appropriate work and to help the chair to suggest a suitable format for group members to use to present the results of their private study The tutor should encourage students to check their understanding of the material He or she can do this by encouraging the students to ask open questions and ask each other to explain topics in their own words or by the use of drawings and diagrams
PBL in curriculum design bull PBL may be used either as the mainstay of an entire
curriculum or for the delivery of individual courses In practice PBL is usually part of an integrated curriculum using a systems based approach with non-clinical material delivered in the context of clinical practice A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge skills and attitudes A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios Sufficient time should be allowed each week for students to do the self directed learning required for PBL
bull
Copyright copy2003 BMJ Publishing Group Ltd
Wood D F BMJ 2003326328-330
No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found
Writing PBL scenarios
bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives
bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after
studying the scenario should be consistent with the faculty learning objectives
bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding
bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice
bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge
bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented
bull The problem should be sufficiently open so that discussion is not curtailed too early in the process
bull Scenarios should promote participation by the students in seeking information from various learning resources
bull Adapted from Dolmans et al Med Teacher 199719185-9
Staff development
bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)
A dysfunctional group a dominant character may
make it difficult for other students to be heard
A dysfunctional group a dominant character may make it difficult for other students to be heard
bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties
Advantages of PBL bull Student centred PBLIt fostersactive learning improved
understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks
Disadvantagesbull Tutors who cant teachTutorsenjoy passing on
their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful
Assessment of PBL
bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods
bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL
Conclusion
bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning
bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL
PBL 5 Easy Steps
bull Read the problem
Mrs Paula Embledon
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
2 Brain storm
bull Brainstorm
bull ndash hypotheses
bull - what do we know in support of the hypothesis
bull - what do we need to know to test the hypothesis
ndash learning issues
Brainstorm
bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)
ndash specific issues (for individuals to look up)
ndash overlapping issues
bull 4 Individual Reading - Research - Preparation
bull 5 Return
bull ndash review case so far ndash report and discuss
ndash assess progress - continue pagenext pagecomplete
ndash self-evaluation - How did things go Any suggestions for next time
ndash next problem
bull 5 Return
THE FIRST GROUP SESSION
bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day
bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session
bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr
bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine
bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise
bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator
bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues
bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know
bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)
bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)
bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)
Tutorrsquos Role in Assessment
Individual students
bull Tutors should provide formative feedback to each member
bull Ask students to complete a simple self-assessment questionnaire reviewing appropriate behaviors the tutor returns them with comments
bull Students will be a writtenoralclinical tests that will determine their progression amp ultimate graduation
Evaluating PBL Tutorials-II
bull At the end of each problem time is allocated for evaluation
bull Both the process amp learning in PBL can be evaluated against explicit goals
bull The tutorrsquos review of effectiveness of group processes offers insight for the members
bull Students normally evaluate their tutor helpfulness support for clinical reasoning encouragement for independent learning appropriate intervention provision for effective feedback
PBLbull 1048708 Enabling students to learn in the context in which the
information will be used which increases the ability to retrieve and apply information
bull 1048708 Focusing on important concepts which helps learners organize and store new information in a way that facilitates retrieval and application
bull 1048708 Exploring prior knowledge formulating inquiries derived from and defined by the learnersrsquo need to know and actively constructing meaning through dialogue and reflection
bull 1048708 Utilizing problems designed to simulate studentsrsquo perception of their future profession which serves as a powerful stimulus for studentsrsquo intrinsic motivation to learn
bull 1048708 Actively involving students in monitoring their own progress and reflecting on what works and what needs improvement frequently assessing student performance and providing feedback
PBL Starting the casebull After the introductions and discussion
are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it
bull Reading the case aloud keeps the group focused
bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here
PBL Case (contd)
bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session
PBL Case contdbull SECOND deciding which issues everyone will
tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)
bull THIRD deciding what SPECIFIC questions individuals will try to answer
bull FOURTH deciding how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet or consulting an expert)
The Process of PBL
bullWhat are the issues Identify the important issues in the problem
bull How well do you understand the issues
bull Are there any words or terms about which you are unclear
The Process of PBL contd
bull Consider the basic mechanisms that might explain each important aspect of each problem
bull Assess your current understanding of the basic structural andor functional mechanisms that may contribute to the presentation of the problem
bull Use the collective skills and experiences of group members to explore or explain these phenomena Identify current gaps in knowledge or understanding
Learn from each other
bullShare your own knowledge expertise or ability to reason and synthesize information Be receptive and appreciative of the contribution of your small group members
Determine priorities for learning
bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue
bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan
bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge
bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career
PBL
bull The problem comes first without advance readings lectures or preparation
bull The problem serves as a stimulus for the need to know
Learning Issues
bull Learning issues are questions that cannot be answered with studentsrsquo current knowledge and that can be explored and answered through systematic self-directed inquiry
bull The use of learning issues in tutorials prepares students to handle similar challenges in clinical practice and life-long learning
Learning Issues in PBL First Session1 Getting Started (Introductions Ground
Rules Expectations)2 Identifying Problem3 Exploring Pre-Existing Knowledge4 Generating Hypotheses and Explaining
Mechanisms5 Unfolding the Case Incrementally6 Re-EvaluatingReprioritizing Hypotheses
Based on New Information7 AssessmentReflection
PBL Second Session
8 Independent Self-Directed Study of Learning Issues
PBL Third Session
bull 9 Discussion of Learning Issues and Application of New Knowledge to the Case
bull 10 Continued Unfolding of the Case Incrementally
bull 11 AssessmentReflection
During Tutorial Session students will
1048708 Come prepared to discuss the case and learning issues researched since the last tutorial
1048708 Actively participate in group discussions and contribute to the learning process in a manner that allows for the balanced participation of everyone in the group
1048708 Develop learning issues at each session phrase them as full-sentence questions write them on the board and post them on the course web page
1048708 Consider biological population behaviormental health issuesexplanations and questions of professional attitudes values and ethics related to the patientrsquos problem(s) described in the case
Tutorial Session contd1048708 Go to the board to diagram outline draw etc in
explanation of mechanisms relatedto hypotheses1048708 Debate evidence related to the case and avoid
personal attacks on others1048708 Comply with ground rules with regard to how
the group will function and how itsmembers treat one another1048708 Participate in end-of-session reflection and
assessment by giving and receivingconstructive criticism regarding self tutor
student and group performance
Between Tutorial Session
1048708 Research key learning issues using a variety of resources
1048708 Critically evaluate the credibility of sources and the validity of the information they have obtained in their research
1048708 Integrate what they have learned through research lectures labs clinical skills Perspectives in Medicine (PIM) etc into what is discussed in tutorials
1048708 Synthesize what they have learned and be prepared to discuss it without reading directly from their materials as much as possible and apply it to the case at the next tutorial session
Determine priorities for learning
bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue
bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan
bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge
bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career
PBL Starting the casebull After the introductions and discussion
are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it
bull Reading the case aloud keeps the group focused
bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here
Problem-based learning is designed to develop
1048708 Integrated context-specific knowledge base
1048708 Decision-makingcritical thinking process and skills
1048708 Self-directed life-long learning skills 1048708 Interpersonal collaboration and
communication skills 1048708 Constructive self and peer
assessment skills 1048708 Professional ethics and behavior
PBL Case (contd)
bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session
What is problem based learning
bull In PBL students use triggers from the problem case or scenario to define their own learning objectives
bull Subsequently they do independent self directed study before returning to the group to discuss and refine their acquired knowledge
bull Thus PBL is not about problem solving per se but rather it uses appropriate problems to increase knowledge and understanding
bull The process is clearly defined
PBL
bull PBL uses clinical cases as the context for students to study basic and clinical sciences
bull 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
bull Possible disadvantages include higher costs both in resources and staff time
PBL
bull An educational method characterized by the use of patient problems as a context for students to learn problem-solving skills and acquire knowledge about the basic and clinical sciences
bull Students usually meet in small groups two or three times a week for PBL tutorials
bull They are presented with a clinical problem (eg a patient with chest pain) and in a series of steps they discuss possible mechanisms and causes develop hypotheses and strategies to test the hypotheses are presented with further information and use this new information to refine their hypotheses finally reaching a conclusion
bull A tutor usually acts as a facilitator guiding students in this group-learning process
bull In the course of this exercise students identify both their existing levels and gaps in their knowledge These gaps form the basis for independent learning outside the PBL tutorials The identification and pursuit of these so-called learning goals is a key element of the PBL process
Rationale for using PBL bull The PBL approach is based on principles of adult
education20 and cognitive psychology21 It differs fundamentally from traditional curricula in which students acquire background knowledge of the basic sciences in the early years of the course and in the later years apply this knowledge to the diagnosis and management of clinical problems This traditional approach has been criticised for a number of reasons42223
bull It creates an artificial divide between the basic and clinical sciences
bull Time is wasted in acquiring knowledge that is subsequently forgotten or found to be irrelevant
bull Application of the acquired knowledge can be difficult bull The acquisition and retention of information that has no
apparent relevance can be boring and even demoralising for students
The group learning process acquiring
desirable learning skills
Generic Skills amp attitudes
bull Teamwork bull Critical evaluation of literature bull Chairing a group bull Self directed learning and use of
resources bull Listening Presentation skills
Recording bull Cooperation bull Respect for colleagues views
bull Group learning facilitates not only the acquisition of knowledge but also several other desirable attributes such as communication skills teamwork problem solving independent responsibility for learning sharing information and respect for others PBL can therefore be thought of as a small group teaching method that combines the acquisition of knowledge with the development of generic skills and attitudes Presentation of clinical material as the stimulus for learning enables students to understand the relevance of underlying scientific knowledge and principles in clinical practice
bull when PBL is introduced into a curriculum several other issues for curriculum design and implementation need to be tackled PBL is generally introduced in the context of a defined core curriculum and integration of basic and clinical sciences It has implications for staffing and learning resources and demands a different approach to timetabling workload and assessment PBL is often used to deliver core material in non-clinical parts of the curriculum Paper based PBL scenarios form the basis of the core curriculum and ensure that all students are exposed to the same problems Recently modified PBL techniques have been introduced into clinical education with real patients being used as the stimulus for learning Despite the essential ad hoc nature of learning clinical medicine a key cases approach can enable PBL to be used to deliver the core clinical curriculum
Copyright copy2003 BMJ Publishing Group Ltd
Wood D F BMJ 2003326328-330
No CRoles of participants in a PBL tutorial aption Found
What happens in a PBL tutorial bull PBL tutorials are conducted in several ways In
this article the examples are modelled on the Maastricht seven jump process but its format of seven steps may be shortened
bull A typical PBL tutorial consists of a group of students (usually eight to 10) and a tutor who facilitates the session The length of time (number of sessions) that a group stays together with each other and with individual tutors varies between institutions A group needs to be together long enough to allow good group dynamics to develop but may need to be changed occasionally if personality clashes or other dysfunctional behaviour emerges
bull Students elect a chair for each PBL scenario and a scribe to record the discussion The roles are rotated for each scenario Suitable flip charts or a whiteboard should be used for recording the proceedings At the start of the session depending on the trigger material either the student chair reads out the scenario or all students study the material If the trigger is a real patient in a ward clinic or surgery then a student may be asked to take a clinical history or identify an abnormal physical sign before the group moves to a tutorial room For each module students may be given a handbook containing the problem scenarios and suggested learning resources or learning materials may be handed out at appropriate times as the tutorials progress
Examples of trigger material for PBL scenarios bull Paper based clinical scenarios bull Experimental or clinical laboratory data bull Photographs bull Video clips bull Newspaper articles bull All or part of an article from a scientific
journal bull A real or simulated patient bull A family tree showing an inherited
disorder
PBL tutorial process ndash Step 1 Identify and clarify unfamiliar terms presented in the scenario
scribe lists those that remain unexplained after discussion ndash Step 2 Define the problem or problems to be discussed students may
have different views on the issues but all should be considered scribe records a list of agreed problems
ndash Step 3 Brainstorming session to discuss the problem(s) suggestingpossible explanations on basis of prior knowledge students draw on each others knowledge and identify areas of incomplete knowledge scribe records all discussion
ndash Step 4 Review steps 2 and 3 and arrange explanations into tentativesolutions scribe organises the explanations and restructures if necessary
ndash Step 5 Formulate learning objectives group reaches consensus onthe learning objectives tutor ensures learning objectives are focused achievable comprehensive and appropriate
ndash Step 6 Private study (all students gather information related to eachlearning objective)
ndash Step 7 Group shares results of private study (students identify theirlearning resources and share their results) tutor checks learning and may assess the group
bull The role of the tutor is to facilitate the proceedings (helping the chair to maintain group dynamics and moving the group through the task) and to ensure that the group achieves appropriate learning objectives in line with those set by the curriculum design team The tutor may need to take a more active role in step 7 of the process to ensure that all the students have done the appropriate work and to help the chair to suggest a suitable format for group members to use to present the results of their private study The tutor should encourage students to check their understanding of the material He or she can do this by encouraging the students to ask open questions and ask each other to explain topics in their own words or by the use of drawings and diagrams
PBL in curriculum design bull PBL may be used either as the mainstay of an entire
curriculum or for the delivery of individual courses In practice PBL is usually part of an integrated curriculum using a systems based approach with non-clinical material delivered in the context of clinical practice A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge skills and attitudes A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios Sufficient time should be allowed each week for students to do the self directed learning required for PBL
bull
Copyright copy2003 BMJ Publishing Group Ltd
Wood D F BMJ 2003326328-330
No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found
Writing PBL scenarios
bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives
bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after
studying the scenario should be consistent with the faculty learning objectives
bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding
bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice
bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge
bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented
bull The problem should be sufficiently open so that discussion is not curtailed too early in the process
bull Scenarios should promote participation by the students in seeking information from various learning resources
bull Adapted from Dolmans et al Med Teacher 199719185-9
Staff development
bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)
A dysfunctional group a dominant character may
make it difficult for other students to be heard
A dysfunctional group a dominant character may make it difficult for other students to be heard
bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties
Advantages of PBL bull Student centred PBLIt fostersactive learning improved
understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks
Disadvantagesbull Tutors who cant teachTutorsenjoy passing on
their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful
Assessment of PBL
bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods
bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL
Conclusion
bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning
bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL
PBL 5 Easy Steps
bull Read the problem
Mrs Paula Embledon
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
2 Brain storm
bull Brainstorm
bull ndash hypotheses
bull - what do we know in support of the hypothesis
bull - what do we need to know to test the hypothesis
ndash learning issues
Brainstorm
bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)
ndash specific issues (for individuals to look up)
ndash overlapping issues
bull 4 Individual Reading - Research - Preparation
bull 5 Return
bull ndash review case so far ndash report and discuss
ndash assess progress - continue pagenext pagecomplete
ndash self-evaluation - How did things go Any suggestions for next time
ndash next problem
bull 5 Return
THE FIRST GROUP SESSION
bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day
bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session
bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr
bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine
bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise
bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator
bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues
bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know
bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)
bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)
bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)
Evaluating PBL Tutorials-II
bull At the end of each problem time is allocated for evaluation
bull Both the process amp learning in PBL can be evaluated against explicit goals
bull The tutorrsquos review of effectiveness of group processes offers insight for the members
bull Students normally evaluate their tutor helpfulness support for clinical reasoning encouragement for independent learning appropriate intervention provision for effective feedback
PBLbull 1048708 Enabling students to learn in the context in which the
information will be used which increases the ability to retrieve and apply information
bull 1048708 Focusing on important concepts which helps learners organize and store new information in a way that facilitates retrieval and application
bull 1048708 Exploring prior knowledge formulating inquiries derived from and defined by the learnersrsquo need to know and actively constructing meaning through dialogue and reflection
bull 1048708 Utilizing problems designed to simulate studentsrsquo perception of their future profession which serves as a powerful stimulus for studentsrsquo intrinsic motivation to learn
bull 1048708 Actively involving students in monitoring their own progress and reflecting on what works and what needs improvement frequently assessing student performance and providing feedback
PBL Starting the casebull After the introductions and discussion
are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it
bull Reading the case aloud keeps the group focused
bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here
PBL Case (contd)
bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session
PBL Case contdbull SECOND deciding which issues everyone will
tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)
bull THIRD deciding what SPECIFIC questions individuals will try to answer
bull FOURTH deciding how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet or consulting an expert)
The Process of PBL
bullWhat are the issues Identify the important issues in the problem
bull How well do you understand the issues
bull Are there any words or terms about which you are unclear
The Process of PBL contd
bull Consider the basic mechanisms that might explain each important aspect of each problem
bull Assess your current understanding of the basic structural andor functional mechanisms that may contribute to the presentation of the problem
bull Use the collective skills and experiences of group members to explore or explain these phenomena Identify current gaps in knowledge or understanding
Learn from each other
bullShare your own knowledge expertise or ability to reason and synthesize information Be receptive and appreciative of the contribution of your small group members
Determine priorities for learning
bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue
bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan
bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge
bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career
PBL
bull The problem comes first without advance readings lectures or preparation
bull The problem serves as a stimulus for the need to know
Learning Issues
bull Learning issues are questions that cannot be answered with studentsrsquo current knowledge and that can be explored and answered through systematic self-directed inquiry
bull The use of learning issues in tutorials prepares students to handle similar challenges in clinical practice and life-long learning
Learning Issues in PBL First Session1 Getting Started (Introductions Ground
Rules Expectations)2 Identifying Problem3 Exploring Pre-Existing Knowledge4 Generating Hypotheses and Explaining
Mechanisms5 Unfolding the Case Incrementally6 Re-EvaluatingReprioritizing Hypotheses
Based on New Information7 AssessmentReflection
PBL Second Session
8 Independent Self-Directed Study of Learning Issues
PBL Third Session
bull 9 Discussion of Learning Issues and Application of New Knowledge to the Case
bull 10 Continued Unfolding of the Case Incrementally
bull 11 AssessmentReflection
During Tutorial Session students will
1048708 Come prepared to discuss the case and learning issues researched since the last tutorial
1048708 Actively participate in group discussions and contribute to the learning process in a manner that allows for the balanced participation of everyone in the group
1048708 Develop learning issues at each session phrase them as full-sentence questions write them on the board and post them on the course web page
1048708 Consider biological population behaviormental health issuesexplanations and questions of professional attitudes values and ethics related to the patientrsquos problem(s) described in the case
Tutorial Session contd1048708 Go to the board to diagram outline draw etc in
explanation of mechanisms relatedto hypotheses1048708 Debate evidence related to the case and avoid
personal attacks on others1048708 Comply with ground rules with regard to how
the group will function and how itsmembers treat one another1048708 Participate in end-of-session reflection and
assessment by giving and receivingconstructive criticism regarding self tutor
student and group performance
Between Tutorial Session
1048708 Research key learning issues using a variety of resources
1048708 Critically evaluate the credibility of sources and the validity of the information they have obtained in their research
1048708 Integrate what they have learned through research lectures labs clinical skills Perspectives in Medicine (PIM) etc into what is discussed in tutorials
1048708 Synthesize what they have learned and be prepared to discuss it without reading directly from their materials as much as possible and apply it to the case at the next tutorial session
Determine priorities for learning
bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue
bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan
bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge
bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career
PBL Starting the casebull After the introductions and discussion
are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it
bull Reading the case aloud keeps the group focused
bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here
Problem-based learning is designed to develop
1048708 Integrated context-specific knowledge base
1048708 Decision-makingcritical thinking process and skills
1048708 Self-directed life-long learning skills 1048708 Interpersonal collaboration and
communication skills 1048708 Constructive self and peer
assessment skills 1048708 Professional ethics and behavior
PBL Case (contd)
bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session
What is problem based learning
bull In PBL students use triggers from the problem case or scenario to define their own learning objectives
bull Subsequently they do independent self directed study before returning to the group to discuss and refine their acquired knowledge
bull Thus PBL is not about problem solving per se but rather it uses appropriate problems to increase knowledge and understanding
bull The process is clearly defined
PBL
bull PBL uses clinical cases as the context for students to study basic and clinical sciences
bull 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
bull Possible disadvantages include higher costs both in resources and staff time
PBL
bull An educational method characterized by the use of patient problems as a context for students to learn problem-solving skills and acquire knowledge about the basic and clinical sciences
bull Students usually meet in small groups two or three times a week for PBL tutorials
bull They are presented with a clinical problem (eg a patient with chest pain) and in a series of steps they discuss possible mechanisms and causes develop hypotheses and strategies to test the hypotheses are presented with further information and use this new information to refine their hypotheses finally reaching a conclusion
bull A tutor usually acts as a facilitator guiding students in this group-learning process
bull In the course of this exercise students identify both their existing levels and gaps in their knowledge These gaps form the basis for independent learning outside the PBL tutorials The identification and pursuit of these so-called learning goals is a key element of the PBL process
Rationale for using PBL bull The PBL approach is based on principles of adult
education20 and cognitive psychology21 It differs fundamentally from traditional curricula in which students acquire background knowledge of the basic sciences in the early years of the course and in the later years apply this knowledge to the diagnosis and management of clinical problems This traditional approach has been criticised for a number of reasons42223
bull It creates an artificial divide between the basic and clinical sciences
bull Time is wasted in acquiring knowledge that is subsequently forgotten or found to be irrelevant
bull Application of the acquired knowledge can be difficult bull The acquisition and retention of information that has no
apparent relevance can be boring and even demoralising for students
The group learning process acquiring
desirable learning skills
Generic Skills amp attitudes
bull Teamwork bull Critical evaluation of literature bull Chairing a group bull Self directed learning and use of
resources bull Listening Presentation skills
Recording bull Cooperation bull Respect for colleagues views
bull Group learning facilitates not only the acquisition of knowledge but also several other desirable attributes such as communication skills teamwork problem solving independent responsibility for learning sharing information and respect for others PBL can therefore be thought of as a small group teaching method that combines the acquisition of knowledge with the development of generic skills and attitudes Presentation of clinical material as the stimulus for learning enables students to understand the relevance of underlying scientific knowledge and principles in clinical practice
bull when PBL is introduced into a curriculum several other issues for curriculum design and implementation need to be tackled PBL is generally introduced in the context of a defined core curriculum and integration of basic and clinical sciences It has implications for staffing and learning resources and demands a different approach to timetabling workload and assessment PBL is often used to deliver core material in non-clinical parts of the curriculum Paper based PBL scenarios form the basis of the core curriculum and ensure that all students are exposed to the same problems Recently modified PBL techniques have been introduced into clinical education with real patients being used as the stimulus for learning Despite the essential ad hoc nature of learning clinical medicine a key cases approach can enable PBL to be used to deliver the core clinical curriculum
Copyright copy2003 BMJ Publishing Group Ltd
Wood D F BMJ 2003326328-330
No CRoles of participants in a PBL tutorial aption Found
What happens in a PBL tutorial bull PBL tutorials are conducted in several ways In
this article the examples are modelled on the Maastricht seven jump process but its format of seven steps may be shortened
bull A typical PBL tutorial consists of a group of students (usually eight to 10) and a tutor who facilitates the session The length of time (number of sessions) that a group stays together with each other and with individual tutors varies between institutions A group needs to be together long enough to allow good group dynamics to develop but may need to be changed occasionally if personality clashes or other dysfunctional behaviour emerges
bull Students elect a chair for each PBL scenario and a scribe to record the discussion The roles are rotated for each scenario Suitable flip charts or a whiteboard should be used for recording the proceedings At the start of the session depending on the trigger material either the student chair reads out the scenario or all students study the material If the trigger is a real patient in a ward clinic or surgery then a student may be asked to take a clinical history or identify an abnormal physical sign before the group moves to a tutorial room For each module students may be given a handbook containing the problem scenarios and suggested learning resources or learning materials may be handed out at appropriate times as the tutorials progress
Examples of trigger material for PBL scenarios bull Paper based clinical scenarios bull Experimental or clinical laboratory data bull Photographs bull Video clips bull Newspaper articles bull All or part of an article from a scientific
journal bull A real or simulated patient bull A family tree showing an inherited
disorder
PBL tutorial process ndash Step 1 Identify and clarify unfamiliar terms presented in the scenario
scribe lists those that remain unexplained after discussion ndash Step 2 Define the problem or problems to be discussed students may
have different views on the issues but all should be considered scribe records a list of agreed problems
ndash Step 3 Brainstorming session to discuss the problem(s) suggestingpossible explanations on basis of prior knowledge students draw on each others knowledge and identify areas of incomplete knowledge scribe records all discussion
ndash Step 4 Review steps 2 and 3 and arrange explanations into tentativesolutions scribe organises the explanations and restructures if necessary
ndash Step 5 Formulate learning objectives group reaches consensus onthe learning objectives tutor ensures learning objectives are focused achievable comprehensive and appropriate
ndash Step 6 Private study (all students gather information related to eachlearning objective)
ndash Step 7 Group shares results of private study (students identify theirlearning resources and share their results) tutor checks learning and may assess the group
bull The role of the tutor is to facilitate the proceedings (helping the chair to maintain group dynamics and moving the group through the task) and to ensure that the group achieves appropriate learning objectives in line with those set by the curriculum design team The tutor may need to take a more active role in step 7 of the process to ensure that all the students have done the appropriate work and to help the chair to suggest a suitable format for group members to use to present the results of their private study The tutor should encourage students to check their understanding of the material He or she can do this by encouraging the students to ask open questions and ask each other to explain topics in their own words or by the use of drawings and diagrams
PBL in curriculum design bull PBL may be used either as the mainstay of an entire
curriculum or for the delivery of individual courses In practice PBL is usually part of an integrated curriculum using a systems based approach with non-clinical material delivered in the context of clinical practice A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge skills and attitudes A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios Sufficient time should be allowed each week for students to do the self directed learning required for PBL
bull
Copyright copy2003 BMJ Publishing Group Ltd
Wood D F BMJ 2003326328-330
No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found
Writing PBL scenarios
bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives
bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after
studying the scenario should be consistent with the faculty learning objectives
bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding
bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice
bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge
bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented
bull The problem should be sufficiently open so that discussion is not curtailed too early in the process
bull Scenarios should promote participation by the students in seeking information from various learning resources
bull Adapted from Dolmans et al Med Teacher 199719185-9
Staff development
bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)
A dysfunctional group a dominant character may
make it difficult for other students to be heard
A dysfunctional group a dominant character may make it difficult for other students to be heard
bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties
Advantages of PBL bull Student centred PBLIt fostersactive learning improved
understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks
Disadvantagesbull Tutors who cant teachTutorsenjoy passing on
their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful
Assessment of PBL
bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods
bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL
Conclusion
bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning
bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL
PBL 5 Easy Steps
bull Read the problem
Mrs Paula Embledon
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
2 Brain storm
bull Brainstorm
bull ndash hypotheses
bull - what do we know in support of the hypothesis
bull - what do we need to know to test the hypothesis
ndash learning issues
Brainstorm
bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)
ndash specific issues (for individuals to look up)
ndash overlapping issues
bull 4 Individual Reading - Research - Preparation
bull 5 Return
bull ndash review case so far ndash report and discuss
ndash assess progress - continue pagenext pagecomplete
ndash self-evaluation - How did things go Any suggestions for next time
ndash next problem
bull 5 Return
THE FIRST GROUP SESSION
bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day
bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session
bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr
bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine
bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise
bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator
bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues
bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know
bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)
bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)
bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)
PBLbull 1048708 Enabling students to learn in the context in which the
information will be used which increases the ability to retrieve and apply information
bull 1048708 Focusing on important concepts which helps learners organize and store new information in a way that facilitates retrieval and application
bull 1048708 Exploring prior knowledge formulating inquiries derived from and defined by the learnersrsquo need to know and actively constructing meaning through dialogue and reflection
bull 1048708 Utilizing problems designed to simulate studentsrsquo perception of their future profession which serves as a powerful stimulus for studentsrsquo intrinsic motivation to learn
bull 1048708 Actively involving students in monitoring their own progress and reflecting on what works and what needs improvement frequently assessing student performance and providing feedback
PBL Starting the casebull After the introductions and discussion
are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it
bull Reading the case aloud keeps the group focused
bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here
PBL Case (contd)
bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session
PBL Case contdbull SECOND deciding which issues everyone will
tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)
bull THIRD deciding what SPECIFIC questions individuals will try to answer
bull FOURTH deciding how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet or consulting an expert)
The Process of PBL
bullWhat are the issues Identify the important issues in the problem
bull How well do you understand the issues
bull Are there any words or terms about which you are unclear
The Process of PBL contd
bull Consider the basic mechanisms that might explain each important aspect of each problem
bull Assess your current understanding of the basic structural andor functional mechanisms that may contribute to the presentation of the problem
bull Use the collective skills and experiences of group members to explore or explain these phenomena Identify current gaps in knowledge or understanding
Learn from each other
bullShare your own knowledge expertise or ability to reason and synthesize information Be receptive and appreciative of the contribution of your small group members
Determine priorities for learning
bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue
bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan
bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge
bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career
PBL
bull The problem comes first without advance readings lectures or preparation
bull The problem serves as a stimulus for the need to know
Learning Issues
bull Learning issues are questions that cannot be answered with studentsrsquo current knowledge and that can be explored and answered through systematic self-directed inquiry
bull The use of learning issues in tutorials prepares students to handle similar challenges in clinical practice and life-long learning
Learning Issues in PBL First Session1 Getting Started (Introductions Ground
Rules Expectations)2 Identifying Problem3 Exploring Pre-Existing Knowledge4 Generating Hypotheses and Explaining
Mechanisms5 Unfolding the Case Incrementally6 Re-EvaluatingReprioritizing Hypotheses
Based on New Information7 AssessmentReflection
PBL Second Session
8 Independent Self-Directed Study of Learning Issues
PBL Third Session
bull 9 Discussion of Learning Issues and Application of New Knowledge to the Case
bull 10 Continued Unfolding of the Case Incrementally
bull 11 AssessmentReflection
During Tutorial Session students will
1048708 Come prepared to discuss the case and learning issues researched since the last tutorial
1048708 Actively participate in group discussions and contribute to the learning process in a manner that allows for the balanced participation of everyone in the group
1048708 Develop learning issues at each session phrase them as full-sentence questions write them on the board and post them on the course web page
1048708 Consider biological population behaviormental health issuesexplanations and questions of professional attitudes values and ethics related to the patientrsquos problem(s) described in the case
Tutorial Session contd1048708 Go to the board to diagram outline draw etc in
explanation of mechanisms relatedto hypotheses1048708 Debate evidence related to the case and avoid
personal attacks on others1048708 Comply with ground rules with regard to how
the group will function and how itsmembers treat one another1048708 Participate in end-of-session reflection and
assessment by giving and receivingconstructive criticism regarding self tutor
student and group performance
Between Tutorial Session
1048708 Research key learning issues using a variety of resources
1048708 Critically evaluate the credibility of sources and the validity of the information they have obtained in their research
1048708 Integrate what they have learned through research lectures labs clinical skills Perspectives in Medicine (PIM) etc into what is discussed in tutorials
1048708 Synthesize what they have learned and be prepared to discuss it without reading directly from their materials as much as possible and apply it to the case at the next tutorial session
Determine priorities for learning
bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue
bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan
bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge
bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career
PBL Starting the casebull After the introductions and discussion
are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it
bull Reading the case aloud keeps the group focused
bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here
Problem-based learning is designed to develop
1048708 Integrated context-specific knowledge base
1048708 Decision-makingcritical thinking process and skills
1048708 Self-directed life-long learning skills 1048708 Interpersonal collaboration and
communication skills 1048708 Constructive self and peer
assessment skills 1048708 Professional ethics and behavior
PBL Case (contd)
bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session
What is problem based learning
bull In PBL students use triggers from the problem case or scenario to define their own learning objectives
bull Subsequently they do independent self directed study before returning to the group to discuss and refine their acquired knowledge
bull Thus PBL is not about problem solving per se but rather it uses appropriate problems to increase knowledge and understanding
bull The process is clearly defined
PBL
bull PBL uses clinical cases as the context for students to study basic and clinical sciences
bull 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
bull Possible disadvantages include higher costs both in resources and staff time
PBL
bull An educational method characterized by the use of patient problems as a context for students to learn problem-solving skills and acquire knowledge about the basic and clinical sciences
bull Students usually meet in small groups two or three times a week for PBL tutorials
bull They are presented with a clinical problem (eg a patient with chest pain) and in a series of steps they discuss possible mechanisms and causes develop hypotheses and strategies to test the hypotheses are presented with further information and use this new information to refine their hypotheses finally reaching a conclusion
bull A tutor usually acts as a facilitator guiding students in this group-learning process
bull In the course of this exercise students identify both their existing levels and gaps in their knowledge These gaps form the basis for independent learning outside the PBL tutorials The identification and pursuit of these so-called learning goals is a key element of the PBL process
Rationale for using PBL bull The PBL approach is based on principles of adult
education20 and cognitive psychology21 It differs fundamentally from traditional curricula in which students acquire background knowledge of the basic sciences in the early years of the course and in the later years apply this knowledge to the diagnosis and management of clinical problems This traditional approach has been criticised for a number of reasons42223
bull It creates an artificial divide between the basic and clinical sciences
bull Time is wasted in acquiring knowledge that is subsequently forgotten or found to be irrelevant
bull Application of the acquired knowledge can be difficult bull The acquisition and retention of information that has no
apparent relevance can be boring and even demoralising for students
The group learning process acquiring
desirable learning skills
Generic Skills amp attitudes
bull Teamwork bull Critical evaluation of literature bull Chairing a group bull Self directed learning and use of
resources bull Listening Presentation skills
Recording bull Cooperation bull Respect for colleagues views
bull Group learning facilitates not only the acquisition of knowledge but also several other desirable attributes such as communication skills teamwork problem solving independent responsibility for learning sharing information and respect for others PBL can therefore be thought of as a small group teaching method that combines the acquisition of knowledge with the development of generic skills and attitudes Presentation of clinical material as the stimulus for learning enables students to understand the relevance of underlying scientific knowledge and principles in clinical practice
bull when PBL is introduced into a curriculum several other issues for curriculum design and implementation need to be tackled PBL is generally introduced in the context of a defined core curriculum and integration of basic and clinical sciences It has implications for staffing and learning resources and demands a different approach to timetabling workload and assessment PBL is often used to deliver core material in non-clinical parts of the curriculum Paper based PBL scenarios form the basis of the core curriculum and ensure that all students are exposed to the same problems Recently modified PBL techniques have been introduced into clinical education with real patients being used as the stimulus for learning Despite the essential ad hoc nature of learning clinical medicine a key cases approach can enable PBL to be used to deliver the core clinical curriculum
Copyright copy2003 BMJ Publishing Group Ltd
Wood D F BMJ 2003326328-330
No CRoles of participants in a PBL tutorial aption Found
What happens in a PBL tutorial bull PBL tutorials are conducted in several ways In
this article the examples are modelled on the Maastricht seven jump process but its format of seven steps may be shortened
bull A typical PBL tutorial consists of a group of students (usually eight to 10) and a tutor who facilitates the session The length of time (number of sessions) that a group stays together with each other and with individual tutors varies between institutions A group needs to be together long enough to allow good group dynamics to develop but may need to be changed occasionally if personality clashes or other dysfunctional behaviour emerges
bull Students elect a chair for each PBL scenario and a scribe to record the discussion The roles are rotated for each scenario Suitable flip charts or a whiteboard should be used for recording the proceedings At the start of the session depending on the trigger material either the student chair reads out the scenario or all students study the material If the trigger is a real patient in a ward clinic or surgery then a student may be asked to take a clinical history or identify an abnormal physical sign before the group moves to a tutorial room For each module students may be given a handbook containing the problem scenarios and suggested learning resources or learning materials may be handed out at appropriate times as the tutorials progress
Examples of trigger material for PBL scenarios bull Paper based clinical scenarios bull Experimental or clinical laboratory data bull Photographs bull Video clips bull Newspaper articles bull All or part of an article from a scientific
journal bull A real or simulated patient bull A family tree showing an inherited
disorder
PBL tutorial process ndash Step 1 Identify and clarify unfamiliar terms presented in the scenario
scribe lists those that remain unexplained after discussion ndash Step 2 Define the problem or problems to be discussed students may
have different views on the issues but all should be considered scribe records a list of agreed problems
ndash Step 3 Brainstorming session to discuss the problem(s) suggestingpossible explanations on basis of prior knowledge students draw on each others knowledge and identify areas of incomplete knowledge scribe records all discussion
ndash Step 4 Review steps 2 and 3 and arrange explanations into tentativesolutions scribe organises the explanations and restructures if necessary
ndash Step 5 Formulate learning objectives group reaches consensus onthe learning objectives tutor ensures learning objectives are focused achievable comprehensive and appropriate
ndash Step 6 Private study (all students gather information related to eachlearning objective)
ndash Step 7 Group shares results of private study (students identify theirlearning resources and share their results) tutor checks learning and may assess the group
bull The role of the tutor is to facilitate the proceedings (helping the chair to maintain group dynamics and moving the group through the task) and to ensure that the group achieves appropriate learning objectives in line with those set by the curriculum design team The tutor may need to take a more active role in step 7 of the process to ensure that all the students have done the appropriate work and to help the chair to suggest a suitable format for group members to use to present the results of their private study The tutor should encourage students to check their understanding of the material He or she can do this by encouraging the students to ask open questions and ask each other to explain topics in their own words or by the use of drawings and diagrams
PBL in curriculum design bull PBL may be used either as the mainstay of an entire
curriculum or for the delivery of individual courses In practice PBL is usually part of an integrated curriculum using a systems based approach with non-clinical material delivered in the context of clinical practice A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge skills and attitudes A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios Sufficient time should be allowed each week for students to do the self directed learning required for PBL
bull
Copyright copy2003 BMJ Publishing Group Ltd
Wood D F BMJ 2003326328-330
No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found
Writing PBL scenarios
bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives
bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after
studying the scenario should be consistent with the faculty learning objectives
bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding
bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice
bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge
bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented
bull The problem should be sufficiently open so that discussion is not curtailed too early in the process
bull Scenarios should promote participation by the students in seeking information from various learning resources
bull Adapted from Dolmans et al Med Teacher 199719185-9
Staff development
bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)
A dysfunctional group a dominant character may
make it difficult for other students to be heard
A dysfunctional group a dominant character may make it difficult for other students to be heard
bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties
Advantages of PBL bull Student centred PBLIt fostersactive learning improved
understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks
Disadvantagesbull Tutors who cant teachTutorsenjoy passing on
their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful
Assessment of PBL
bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods
bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL
Conclusion
bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning
bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL
PBL 5 Easy Steps
bull Read the problem
Mrs Paula Embledon
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
2 Brain storm
bull Brainstorm
bull ndash hypotheses
bull - what do we know in support of the hypothesis
bull - what do we need to know to test the hypothesis
ndash learning issues
Brainstorm
bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)
ndash specific issues (for individuals to look up)
ndash overlapping issues
bull 4 Individual Reading - Research - Preparation
bull 5 Return
bull ndash review case so far ndash report and discuss
ndash assess progress - continue pagenext pagecomplete
ndash self-evaluation - How did things go Any suggestions for next time
ndash next problem
bull 5 Return
THE FIRST GROUP SESSION
bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day
bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session
bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr
bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine
bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise
bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator
bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues
bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know
bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)
bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)
bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)
PBL Starting the casebull After the introductions and discussion
are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it
bull Reading the case aloud keeps the group focused
bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here
PBL Case (contd)
bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session
PBL Case contdbull SECOND deciding which issues everyone will
tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)
bull THIRD deciding what SPECIFIC questions individuals will try to answer
bull FOURTH deciding how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet or consulting an expert)
The Process of PBL
bullWhat are the issues Identify the important issues in the problem
bull How well do you understand the issues
bull Are there any words or terms about which you are unclear
The Process of PBL contd
bull Consider the basic mechanisms that might explain each important aspect of each problem
bull Assess your current understanding of the basic structural andor functional mechanisms that may contribute to the presentation of the problem
bull Use the collective skills and experiences of group members to explore or explain these phenomena Identify current gaps in knowledge or understanding
Learn from each other
bullShare your own knowledge expertise or ability to reason and synthesize information Be receptive and appreciative of the contribution of your small group members
Determine priorities for learning
bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue
bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan
bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge
bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career
PBL
bull The problem comes first without advance readings lectures or preparation
bull The problem serves as a stimulus for the need to know
Learning Issues
bull Learning issues are questions that cannot be answered with studentsrsquo current knowledge and that can be explored and answered through systematic self-directed inquiry
bull The use of learning issues in tutorials prepares students to handle similar challenges in clinical practice and life-long learning
Learning Issues in PBL First Session1 Getting Started (Introductions Ground
Rules Expectations)2 Identifying Problem3 Exploring Pre-Existing Knowledge4 Generating Hypotheses and Explaining
Mechanisms5 Unfolding the Case Incrementally6 Re-EvaluatingReprioritizing Hypotheses
Based on New Information7 AssessmentReflection
PBL Second Session
8 Independent Self-Directed Study of Learning Issues
PBL Third Session
bull 9 Discussion of Learning Issues and Application of New Knowledge to the Case
bull 10 Continued Unfolding of the Case Incrementally
bull 11 AssessmentReflection
During Tutorial Session students will
1048708 Come prepared to discuss the case and learning issues researched since the last tutorial
1048708 Actively participate in group discussions and contribute to the learning process in a manner that allows for the balanced participation of everyone in the group
1048708 Develop learning issues at each session phrase them as full-sentence questions write them on the board and post them on the course web page
1048708 Consider biological population behaviormental health issuesexplanations and questions of professional attitudes values and ethics related to the patientrsquos problem(s) described in the case
Tutorial Session contd1048708 Go to the board to diagram outline draw etc in
explanation of mechanisms relatedto hypotheses1048708 Debate evidence related to the case and avoid
personal attacks on others1048708 Comply with ground rules with regard to how
the group will function and how itsmembers treat one another1048708 Participate in end-of-session reflection and
assessment by giving and receivingconstructive criticism regarding self tutor
student and group performance
Between Tutorial Session
1048708 Research key learning issues using a variety of resources
1048708 Critically evaluate the credibility of sources and the validity of the information they have obtained in their research
1048708 Integrate what they have learned through research lectures labs clinical skills Perspectives in Medicine (PIM) etc into what is discussed in tutorials
1048708 Synthesize what they have learned and be prepared to discuss it without reading directly from their materials as much as possible and apply it to the case at the next tutorial session
Determine priorities for learning
bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue
bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan
bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge
bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career
PBL Starting the casebull After the introductions and discussion
are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it
bull Reading the case aloud keeps the group focused
bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here
Problem-based learning is designed to develop
1048708 Integrated context-specific knowledge base
1048708 Decision-makingcritical thinking process and skills
1048708 Self-directed life-long learning skills 1048708 Interpersonal collaboration and
communication skills 1048708 Constructive self and peer
assessment skills 1048708 Professional ethics and behavior
PBL Case (contd)
bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session
What is problem based learning
bull In PBL students use triggers from the problem case or scenario to define their own learning objectives
bull Subsequently they do independent self directed study before returning to the group to discuss and refine their acquired knowledge
bull Thus PBL is not about problem solving per se but rather it uses appropriate problems to increase knowledge and understanding
bull The process is clearly defined
PBL
bull PBL uses clinical cases as the context for students to study basic and clinical sciences
bull 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
bull Possible disadvantages include higher costs both in resources and staff time
PBL
bull An educational method characterized by the use of patient problems as a context for students to learn problem-solving skills and acquire knowledge about the basic and clinical sciences
bull Students usually meet in small groups two or three times a week for PBL tutorials
bull They are presented with a clinical problem (eg a patient with chest pain) and in a series of steps they discuss possible mechanisms and causes develop hypotheses and strategies to test the hypotheses are presented with further information and use this new information to refine their hypotheses finally reaching a conclusion
bull A tutor usually acts as a facilitator guiding students in this group-learning process
bull In the course of this exercise students identify both their existing levels and gaps in their knowledge These gaps form the basis for independent learning outside the PBL tutorials The identification and pursuit of these so-called learning goals is a key element of the PBL process
Rationale for using PBL bull The PBL approach is based on principles of adult
education20 and cognitive psychology21 It differs fundamentally from traditional curricula in which students acquire background knowledge of the basic sciences in the early years of the course and in the later years apply this knowledge to the diagnosis and management of clinical problems This traditional approach has been criticised for a number of reasons42223
bull It creates an artificial divide between the basic and clinical sciences
bull Time is wasted in acquiring knowledge that is subsequently forgotten or found to be irrelevant
bull Application of the acquired knowledge can be difficult bull The acquisition and retention of information that has no
apparent relevance can be boring and even demoralising for students
The group learning process acquiring
desirable learning skills
Generic Skills amp attitudes
bull Teamwork bull Critical evaluation of literature bull Chairing a group bull Self directed learning and use of
resources bull Listening Presentation skills
Recording bull Cooperation bull Respect for colleagues views
bull Group learning facilitates not only the acquisition of knowledge but also several other desirable attributes such as communication skills teamwork problem solving independent responsibility for learning sharing information and respect for others PBL can therefore be thought of as a small group teaching method that combines the acquisition of knowledge with the development of generic skills and attitudes Presentation of clinical material as the stimulus for learning enables students to understand the relevance of underlying scientific knowledge and principles in clinical practice
bull when PBL is introduced into a curriculum several other issues for curriculum design and implementation need to be tackled PBL is generally introduced in the context of a defined core curriculum and integration of basic and clinical sciences It has implications for staffing and learning resources and demands a different approach to timetabling workload and assessment PBL is often used to deliver core material in non-clinical parts of the curriculum Paper based PBL scenarios form the basis of the core curriculum and ensure that all students are exposed to the same problems Recently modified PBL techniques have been introduced into clinical education with real patients being used as the stimulus for learning Despite the essential ad hoc nature of learning clinical medicine a key cases approach can enable PBL to be used to deliver the core clinical curriculum
Copyright copy2003 BMJ Publishing Group Ltd
Wood D F BMJ 2003326328-330
No CRoles of participants in a PBL tutorial aption Found
What happens in a PBL tutorial bull PBL tutorials are conducted in several ways In
this article the examples are modelled on the Maastricht seven jump process but its format of seven steps may be shortened
bull A typical PBL tutorial consists of a group of students (usually eight to 10) and a tutor who facilitates the session The length of time (number of sessions) that a group stays together with each other and with individual tutors varies between institutions A group needs to be together long enough to allow good group dynamics to develop but may need to be changed occasionally if personality clashes or other dysfunctional behaviour emerges
bull Students elect a chair for each PBL scenario and a scribe to record the discussion The roles are rotated for each scenario Suitable flip charts or a whiteboard should be used for recording the proceedings At the start of the session depending on the trigger material either the student chair reads out the scenario or all students study the material If the trigger is a real patient in a ward clinic or surgery then a student may be asked to take a clinical history or identify an abnormal physical sign before the group moves to a tutorial room For each module students may be given a handbook containing the problem scenarios and suggested learning resources or learning materials may be handed out at appropriate times as the tutorials progress
Examples of trigger material for PBL scenarios bull Paper based clinical scenarios bull Experimental or clinical laboratory data bull Photographs bull Video clips bull Newspaper articles bull All or part of an article from a scientific
journal bull A real or simulated patient bull A family tree showing an inherited
disorder
PBL tutorial process ndash Step 1 Identify and clarify unfamiliar terms presented in the scenario
scribe lists those that remain unexplained after discussion ndash Step 2 Define the problem or problems to be discussed students may
have different views on the issues but all should be considered scribe records a list of agreed problems
ndash Step 3 Brainstorming session to discuss the problem(s) suggestingpossible explanations on basis of prior knowledge students draw on each others knowledge and identify areas of incomplete knowledge scribe records all discussion
ndash Step 4 Review steps 2 and 3 and arrange explanations into tentativesolutions scribe organises the explanations and restructures if necessary
ndash Step 5 Formulate learning objectives group reaches consensus onthe learning objectives tutor ensures learning objectives are focused achievable comprehensive and appropriate
ndash Step 6 Private study (all students gather information related to eachlearning objective)
ndash Step 7 Group shares results of private study (students identify theirlearning resources and share their results) tutor checks learning and may assess the group
bull The role of the tutor is to facilitate the proceedings (helping the chair to maintain group dynamics and moving the group through the task) and to ensure that the group achieves appropriate learning objectives in line with those set by the curriculum design team The tutor may need to take a more active role in step 7 of the process to ensure that all the students have done the appropriate work and to help the chair to suggest a suitable format for group members to use to present the results of their private study The tutor should encourage students to check their understanding of the material He or she can do this by encouraging the students to ask open questions and ask each other to explain topics in their own words or by the use of drawings and diagrams
PBL in curriculum design bull PBL may be used either as the mainstay of an entire
curriculum or for the delivery of individual courses In practice PBL is usually part of an integrated curriculum using a systems based approach with non-clinical material delivered in the context of clinical practice A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge skills and attitudes A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios Sufficient time should be allowed each week for students to do the self directed learning required for PBL
bull
Copyright copy2003 BMJ Publishing Group Ltd
Wood D F BMJ 2003326328-330
No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found
Writing PBL scenarios
bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives
bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after
studying the scenario should be consistent with the faculty learning objectives
bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding
bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice
bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge
bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented
bull The problem should be sufficiently open so that discussion is not curtailed too early in the process
bull Scenarios should promote participation by the students in seeking information from various learning resources
bull Adapted from Dolmans et al Med Teacher 199719185-9
Staff development
bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)
A dysfunctional group a dominant character may
make it difficult for other students to be heard
A dysfunctional group a dominant character may make it difficult for other students to be heard
bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties
Advantages of PBL bull Student centred PBLIt fostersactive learning improved
understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks
Disadvantagesbull Tutors who cant teachTutorsenjoy passing on
their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful
Assessment of PBL
bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods
bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL
Conclusion
bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning
bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL
PBL 5 Easy Steps
bull Read the problem
Mrs Paula Embledon
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
2 Brain storm
bull Brainstorm
bull ndash hypotheses
bull - what do we know in support of the hypothesis
bull - what do we need to know to test the hypothesis
ndash learning issues
Brainstorm
bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)
ndash specific issues (for individuals to look up)
ndash overlapping issues
bull 4 Individual Reading - Research - Preparation
bull 5 Return
bull ndash review case so far ndash report and discuss
ndash assess progress - continue pagenext pagecomplete
ndash self-evaluation - How did things go Any suggestions for next time
ndash next problem
bull 5 Return
THE FIRST GROUP SESSION
bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day
bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session
bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr
bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine
bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise
bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator
bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues
bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know
bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)
bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)
bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)
PBL Case (contd)
bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session
PBL Case contdbull SECOND deciding which issues everyone will
tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)
bull THIRD deciding what SPECIFIC questions individuals will try to answer
bull FOURTH deciding how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet or consulting an expert)
The Process of PBL
bullWhat are the issues Identify the important issues in the problem
bull How well do you understand the issues
bull Are there any words or terms about which you are unclear
The Process of PBL contd
bull Consider the basic mechanisms that might explain each important aspect of each problem
bull Assess your current understanding of the basic structural andor functional mechanisms that may contribute to the presentation of the problem
bull Use the collective skills and experiences of group members to explore or explain these phenomena Identify current gaps in knowledge or understanding
Learn from each other
bullShare your own knowledge expertise or ability to reason and synthesize information Be receptive and appreciative of the contribution of your small group members
Determine priorities for learning
bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue
bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan
bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge
bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career
PBL
bull The problem comes first without advance readings lectures or preparation
bull The problem serves as a stimulus for the need to know
Learning Issues
bull Learning issues are questions that cannot be answered with studentsrsquo current knowledge and that can be explored and answered through systematic self-directed inquiry
bull The use of learning issues in tutorials prepares students to handle similar challenges in clinical practice and life-long learning
Learning Issues in PBL First Session1 Getting Started (Introductions Ground
Rules Expectations)2 Identifying Problem3 Exploring Pre-Existing Knowledge4 Generating Hypotheses and Explaining
Mechanisms5 Unfolding the Case Incrementally6 Re-EvaluatingReprioritizing Hypotheses
Based on New Information7 AssessmentReflection
PBL Second Session
8 Independent Self-Directed Study of Learning Issues
PBL Third Session
bull 9 Discussion of Learning Issues and Application of New Knowledge to the Case
bull 10 Continued Unfolding of the Case Incrementally
bull 11 AssessmentReflection
During Tutorial Session students will
1048708 Come prepared to discuss the case and learning issues researched since the last tutorial
1048708 Actively participate in group discussions and contribute to the learning process in a manner that allows for the balanced participation of everyone in the group
1048708 Develop learning issues at each session phrase them as full-sentence questions write them on the board and post them on the course web page
1048708 Consider biological population behaviormental health issuesexplanations and questions of professional attitudes values and ethics related to the patientrsquos problem(s) described in the case
Tutorial Session contd1048708 Go to the board to diagram outline draw etc in
explanation of mechanisms relatedto hypotheses1048708 Debate evidence related to the case and avoid
personal attacks on others1048708 Comply with ground rules with regard to how
the group will function and how itsmembers treat one another1048708 Participate in end-of-session reflection and
assessment by giving and receivingconstructive criticism regarding self tutor
student and group performance
Between Tutorial Session
1048708 Research key learning issues using a variety of resources
1048708 Critically evaluate the credibility of sources and the validity of the information they have obtained in their research
1048708 Integrate what they have learned through research lectures labs clinical skills Perspectives in Medicine (PIM) etc into what is discussed in tutorials
1048708 Synthesize what they have learned and be prepared to discuss it without reading directly from their materials as much as possible and apply it to the case at the next tutorial session
Determine priorities for learning
bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue
bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan
bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge
bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career
PBL Starting the casebull After the introductions and discussion
are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it
bull Reading the case aloud keeps the group focused
bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here
Problem-based learning is designed to develop
1048708 Integrated context-specific knowledge base
1048708 Decision-makingcritical thinking process and skills
1048708 Self-directed life-long learning skills 1048708 Interpersonal collaboration and
communication skills 1048708 Constructive self and peer
assessment skills 1048708 Professional ethics and behavior
PBL Case (contd)
bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session
What is problem based learning
bull In PBL students use triggers from the problem case or scenario to define their own learning objectives
bull Subsequently they do independent self directed study before returning to the group to discuss and refine their acquired knowledge
bull Thus PBL is not about problem solving per se but rather it uses appropriate problems to increase knowledge and understanding
bull The process is clearly defined
PBL
bull PBL uses clinical cases as the context for students to study basic and clinical sciences
bull 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
bull Possible disadvantages include higher costs both in resources and staff time
PBL
bull An educational method characterized by the use of patient problems as a context for students to learn problem-solving skills and acquire knowledge about the basic and clinical sciences
bull Students usually meet in small groups two or three times a week for PBL tutorials
bull They are presented with a clinical problem (eg a patient with chest pain) and in a series of steps they discuss possible mechanisms and causes develop hypotheses and strategies to test the hypotheses are presented with further information and use this new information to refine their hypotheses finally reaching a conclusion
bull A tutor usually acts as a facilitator guiding students in this group-learning process
bull In the course of this exercise students identify both their existing levels and gaps in their knowledge These gaps form the basis for independent learning outside the PBL tutorials The identification and pursuit of these so-called learning goals is a key element of the PBL process
Rationale for using PBL bull The PBL approach is based on principles of adult
education20 and cognitive psychology21 It differs fundamentally from traditional curricula in which students acquire background knowledge of the basic sciences in the early years of the course and in the later years apply this knowledge to the diagnosis and management of clinical problems This traditional approach has been criticised for a number of reasons42223
bull It creates an artificial divide between the basic and clinical sciences
bull Time is wasted in acquiring knowledge that is subsequently forgotten or found to be irrelevant
bull Application of the acquired knowledge can be difficult bull The acquisition and retention of information that has no
apparent relevance can be boring and even demoralising for students
The group learning process acquiring
desirable learning skills
Generic Skills amp attitudes
bull Teamwork bull Critical evaluation of literature bull Chairing a group bull Self directed learning and use of
resources bull Listening Presentation skills
Recording bull Cooperation bull Respect for colleagues views
bull Group learning facilitates not only the acquisition of knowledge but also several other desirable attributes such as communication skills teamwork problem solving independent responsibility for learning sharing information and respect for others PBL can therefore be thought of as a small group teaching method that combines the acquisition of knowledge with the development of generic skills and attitudes Presentation of clinical material as the stimulus for learning enables students to understand the relevance of underlying scientific knowledge and principles in clinical practice
bull when PBL is introduced into a curriculum several other issues for curriculum design and implementation need to be tackled PBL is generally introduced in the context of a defined core curriculum and integration of basic and clinical sciences It has implications for staffing and learning resources and demands a different approach to timetabling workload and assessment PBL is often used to deliver core material in non-clinical parts of the curriculum Paper based PBL scenarios form the basis of the core curriculum and ensure that all students are exposed to the same problems Recently modified PBL techniques have been introduced into clinical education with real patients being used as the stimulus for learning Despite the essential ad hoc nature of learning clinical medicine a key cases approach can enable PBL to be used to deliver the core clinical curriculum
Copyright copy2003 BMJ Publishing Group Ltd
Wood D F BMJ 2003326328-330
No CRoles of participants in a PBL tutorial aption Found
What happens in a PBL tutorial bull PBL tutorials are conducted in several ways In
this article the examples are modelled on the Maastricht seven jump process but its format of seven steps may be shortened
bull A typical PBL tutorial consists of a group of students (usually eight to 10) and a tutor who facilitates the session The length of time (number of sessions) that a group stays together with each other and with individual tutors varies between institutions A group needs to be together long enough to allow good group dynamics to develop but may need to be changed occasionally if personality clashes or other dysfunctional behaviour emerges
bull Students elect a chair for each PBL scenario and a scribe to record the discussion The roles are rotated for each scenario Suitable flip charts or a whiteboard should be used for recording the proceedings At the start of the session depending on the trigger material either the student chair reads out the scenario or all students study the material If the trigger is a real patient in a ward clinic or surgery then a student may be asked to take a clinical history or identify an abnormal physical sign before the group moves to a tutorial room For each module students may be given a handbook containing the problem scenarios and suggested learning resources or learning materials may be handed out at appropriate times as the tutorials progress
Examples of trigger material for PBL scenarios bull Paper based clinical scenarios bull Experimental or clinical laboratory data bull Photographs bull Video clips bull Newspaper articles bull All or part of an article from a scientific
journal bull A real or simulated patient bull A family tree showing an inherited
disorder
PBL tutorial process ndash Step 1 Identify and clarify unfamiliar terms presented in the scenario
scribe lists those that remain unexplained after discussion ndash Step 2 Define the problem or problems to be discussed students may
have different views on the issues but all should be considered scribe records a list of agreed problems
ndash Step 3 Brainstorming session to discuss the problem(s) suggestingpossible explanations on basis of prior knowledge students draw on each others knowledge and identify areas of incomplete knowledge scribe records all discussion
ndash Step 4 Review steps 2 and 3 and arrange explanations into tentativesolutions scribe organises the explanations and restructures if necessary
ndash Step 5 Formulate learning objectives group reaches consensus onthe learning objectives tutor ensures learning objectives are focused achievable comprehensive and appropriate
ndash Step 6 Private study (all students gather information related to eachlearning objective)
ndash Step 7 Group shares results of private study (students identify theirlearning resources and share their results) tutor checks learning and may assess the group
bull The role of the tutor is to facilitate the proceedings (helping the chair to maintain group dynamics and moving the group through the task) and to ensure that the group achieves appropriate learning objectives in line with those set by the curriculum design team The tutor may need to take a more active role in step 7 of the process to ensure that all the students have done the appropriate work and to help the chair to suggest a suitable format for group members to use to present the results of their private study The tutor should encourage students to check their understanding of the material He or she can do this by encouraging the students to ask open questions and ask each other to explain topics in their own words or by the use of drawings and diagrams
PBL in curriculum design bull PBL may be used either as the mainstay of an entire
curriculum or for the delivery of individual courses In practice PBL is usually part of an integrated curriculum using a systems based approach with non-clinical material delivered in the context of clinical practice A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge skills and attitudes A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios Sufficient time should be allowed each week for students to do the self directed learning required for PBL
bull
Copyright copy2003 BMJ Publishing Group Ltd
Wood D F BMJ 2003326328-330
No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found
Writing PBL scenarios
bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives
bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after
studying the scenario should be consistent with the faculty learning objectives
bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding
bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice
bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge
bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented
bull The problem should be sufficiently open so that discussion is not curtailed too early in the process
bull Scenarios should promote participation by the students in seeking information from various learning resources
bull Adapted from Dolmans et al Med Teacher 199719185-9
Staff development
bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)
A dysfunctional group a dominant character may
make it difficult for other students to be heard
A dysfunctional group a dominant character may make it difficult for other students to be heard
bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties
Advantages of PBL bull Student centred PBLIt fostersactive learning improved
understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks
Disadvantagesbull Tutors who cant teachTutorsenjoy passing on
their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful
Assessment of PBL
bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods
bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL
Conclusion
bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning
bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL
PBL 5 Easy Steps
bull Read the problem
Mrs Paula Embledon
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
2 Brain storm
bull Brainstorm
bull ndash hypotheses
bull - what do we know in support of the hypothesis
bull - what do we need to know to test the hypothesis
ndash learning issues
Brainstorm
bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)
ndash specific issues (for individuals to look up)
ndash overlapping issues
bull 4 Individual Reading - Research - Preparation
bull 5 Return
bull ndash review case so far ndash report and discuss
ndash assess progress - continue pagenext pagecomplete
ndash self-evaluation - How did things go Any suggestions for next time
ndash next problem
bull 5 Return
THE FIRST GROUP SESSION
bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day
bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session
bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr
bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine
bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise
bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator
bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues
bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know
bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)
bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)
bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)
PBL Case contdbull SECOND deciding which issues everyone will
tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)
bull THIRD deciding what SPECIFIC questions individuals will try to answer
bull FOURTH deciding how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet or consulting an expert)
The Process of PBL
bullWhat are the issues Identify the important issues in the problem
bull How well do you understand the issues
bull Are there any words or terms about which you are unclear
The Process of PBL contd
bull Consider the basic mechanisms that might explain each important aspect of each problem
bull Assess your current understanding of the basic structural andor functional mechanisms that may contribute to the presentation of the problem
bull Use the collective skills and experiences of group members to explore or explain these phenomena Identify current gaps in knowledge or understanding
Learn from each other
bullShare your own knowledge expertise or ability to reason and synthesize information Be receptive and appreciative of the contribution of your small group members
Determine priorities for learning
bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue
bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan
bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge
bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career
PBL
bull The problem comes first without advance readings lectures or preparation
bull The problem serves as a stimulus for the need to know
Learning Issues
bull Learning issues are questions that cannot be answered with studentsrsquo current knowledge and that can be explored and answered through systematic self-directed inquiry
bull The use of learning issues in tutorials prepares students to handle similar challenges in clinical practice and life-long learning
Learning Issues in PBL First Session1 Getting Started (Introductions Ground
Rules Expectations)2 Identifying Problem3 Exploring Pre-Existing Knowledge4 Generating Hypotheses and Explaining
Mechanisms5 Unfolding the Case Incrementally6 Re-EvaluatingReprioritizing Hypotheses
Based on New Information7 AssessmentReflection
PBL Second Session
8 Independent Self-Directed Study of Learning Issues
PBL Third Session
bull 9 Discussion of Learning Issues and Application of New Knowledge to the Case
bull 10 Continued Unfolding of the Case Incrementally
bull 11 AssessmentReflection
During Tutorial Session students will
1048708 Come prepared to discuss the case and learning issues researched since the last tutorial
1048708 Actively participate in group discussions and contribute to the learning process in a manner that allows for the balanced participation of everyone in the group
1048708 Develop learning issues at each session phrase them as full-sentence questions write them on the board and post them on the course web page
1048708 Consider biological population behaviormental health issuesexplanations and questions of professional attitudes values and ethics related to the patientrsquos problem(s) described in the case
Tutorial Session contd1048708 Go to the board to diagram outline draw etc in
explanation of mechanisms relatedto hypotheses1048708 Debate evidence related to the case and avoid
personal attacks on others1048708 Comply with ground rules with regard to how
the group will function and how itsmembers treat one another1048708 Participate in end-of-session reflection and
assessment by giving and receivingconstructive criticism regarding self tutor
student and group performance
Between Tutorial Session
1048708 Research key learning issues using a variety of resources
1048708 Critically evaluate the credibility of sources and the validity of the information they have obtained in their research
1048708 Integrate what they have learned through research lectures labs clinical skills Perspectives in Medicine (PIM) etc into what is discussed in tutorials
1048708 Synthesize what they have learned and be prepared to discuss it without reading directly from their materials as much as possible and apply it to the case at the next tutorial session
Determine priorities for learning
bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue
bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan
bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge
bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career
PBL Starting the casebull After the introductions and discussion
are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it
bull Reading the case aloud keeps the group focused
bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here
Problem-based learning is designed to develop
1048708 Integrated context-specific knowledge base
1048708 Decision-makingcritical thinking process and skills
1048708 Self-directed life-long learning skills 1048708 Interpersonal collaboration and
communication skills 1048708 Constructive self and peer
assessment skills 1048708 Professional ethics and behavior
PBL Case (contd)
bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session
What is problem based learning
bull In PBL students use triggers from the problem case or scenario to define their own learning objectives
bull Subsequently they do independent self directed study before returning to the group to discuss and refine their acquired knowledge
bull Thus PBL is not about problem solving per se but rather it uses appropriate problems to increase knowledge and understanding
bull The process is clearly defined
PBL
bull PBL uses clinical cases as the context for students to study basic and clinical sciences
bull 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
bull Possible disadvantages include higher costs both in resources and staff time
PBL
bull An educational method characterized by the use of patient problems as a context for students to learn problem-solving skills and acquire knowledge about the basic and clinical sciences
bull Students usually meet in small groups two or three times a week for PBL tutorials
bull They are presented with a clinical problem (eg a patient with chest pain) and in a series of steps they discuss possible mechanisms and causes develop hypotheses and strategies to test the hypotheses are presented with further information and use this new information to refine their hypotheses finally reaching a conclusion
bull A tutor usually acts as a facilitator guiding students in this group-learning process
bull In the course of this exercise students identify both their existing levels and gaps in their knowledge These gaps form the basis for independent learning outside the PBL tutorials The identification and pursuit of these so-called learning goals is a key element of the PBL process
Rationale for using PBL bull The PBL approach is based on principles of adult
education20 and cognitive psychology21 It differs fundamentally from traditional curricula in which students acquire background knowledge of the basic sciences in the early years of the course and in the later years apply this knowledge to the diagnosis and management of clinical problems This traditional approach has been criticised for a number of reasons42223
bull It creates an artificial divide between the basic and clinical sciences
bull Time is wasted in acquiring knowledge that is subsequently forgotten or found to be irrelevant
bull Application of the acquired knowledge can be difficult bull The acquisition and retention of information that has no
apparent relevance can be boring and even demoralising for students
The group learning process acquiring
desirable learning skills
Generic Skills amp attitudes
bull Teamwork bull Critical evaluation of literature bull Chairing a group bull Self directed learning and use of
resources bull Listening Presentation skills
Recording bull Cooperation bull Respect for colleagues views
bull Group learning facilitates not only the acquisition of knowledge but also several other desirable attributes such as communication skills teamwork problem solving independent responsibility for learning sharing information and respect for others PBL can therefore be thought of as a small group teaching method that combines the acquisition of knowledge with the development of generic skills and attitudes Presentation of clinical material as the stimulus for learning enables students to understand the relevance of underlying scientific knowledge and principles in clinical practice
bull when PBL is introduced into a curriculum several other issues for curriculum design and implementation need to be tackled PBL is generally introduced in the context of a defined core curriculum and integration of basic and clinical sciences It has implications for staffing and learning resources and demands a different approach to timetabling workload and assessment PBL is often used to deliver core material in non-clinical parts of the curriculum Paper based PBL scenarios form the basis of the core curriculum and ensure that all students are exposed to the same problems Recently modified PBL techniques have been introduced into clinical education with real patients being used as the stimulus for learning Despite the essential ad hoc nature of learning clinical medicine a key cases approach can enable PBL to be used to deliver the core clinical curriculum
Copyright copy2003 BMJ Publishing Group Ltd
Wood D F BMJ 2003326328-330
No CRoles of participants in a PBL tutorial aption Found
What happens in a PBL tutorial bull PBL tutorials are conducted in several ways In
this article the examples are modelled on the Maastricht seven jump process but its format of seven steps may be shortened
bull A typical PBL tutorial consists of a group of students (usually eight to 10) and a tutor who facilitates the session The length of time (number of sessions) that a group stays together with each other and with individual tutors varies between institutions A group needs to be together long enough to allow good group dynamics to develop but may need to be changed occasionally if personality clashes or other dysfunctional behaviour emerges
bull Students elect a chair for each PBL scenario and a scribe to record the discussion The roles are rotated for each scenario Suitable flip charts or a whiteboard should be used for recording the proceedings At the start of the session depending on the trigger material either the student chair reads out the scenario or all students study the material If the trigger is a real patient in a ward clinic or surgery then a student may be asked to take a clinical history or identify an abnormal physical sign before the group moves to a tutorial room For each module students may be given a handbook containing the problem scenarios and suggested learning resources or learning materials may be handed out at appropriate times as the tutorials progress
Examples of trigger material for PBL scenarios bull Paper based clinical scenarios bull Experimental or clinical laboratory data bull Photographs bull Video clips bull Newspaper articles bull All or part of an article from a scientific
journal bull A real or simulated patient bull A family tree showing an inherited
disorder
PBL tutorial process ndash Step 1 Identify and clarify unfamiliar terms presented in the scenario
scribe lists those that remain unexplained after discussion ndash Step 2 Define the problem or problems to be discussed students may
have different views on the issues but all should be considered scribe records a list of agreed problems
ndash Step 3 Brainstorming session to discuss the problem(s) suggestingpossible explanations on basis of prior knowledge students draw on each others knowledge and identify areas of incomplete knowledge scribe records all discussion
ndash Step 4 Review steps 2 and 3 and arrange explanations into tentativesolutions scribe organises the explanations and restructures if necessary
ndash Step 5 Formulate learning objectives group reaches consensus onthe learning objectives tutor ensures learning objectives are focused achievable comprehensive and appropriate
ndash Step 6 Private study (all students gather information related to eachlearning objective)
ndash Step 7 Group shares results of private study (students identify theirlearning resources and share their results) tutor checks learning and may assess the group
bull The role of the tutor is to facilitate the proceedings (helping the chair to maintain group dynamics and moving the group through the task) and to ensure that the group achieves appropriate learning objectives in line with those set by the curriculum design team The tutor may need to take a more active role in step 7 of the process to ensure that all the students have done the appropriate work and to help the chair to suggest a suitable format for group members to use to present the results of their private study The tutor should encourage students to check their understanding of the material He or she can do this by encouraging the students to ask open questions and ask each other to explain topics in their own words or by the use of drawings and diagrams
PBL in curriculum design bull PBL may be used either as the mainstay of an entire
curriculum or for the delivery of individual courses In practice PBL is usually part of an integrated curriculum using a systems based approach with non-clinical material delivered in the context of clinical practice A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge skills and attitudes A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios Sufficient time should be allowed each week for students to do the self directed learning required for PBL
bull
Copyright copy2003 BMJ Publishing Group Ltd
Wood D F BMJ 2003326328-330
No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found
Writing PBL scenarios
bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives
bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after
studying the scenario should be consistent with the faculty learning objectives
bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding
bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice
bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge
bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented
bull The problem should be sufficiently open so that discussion is not curtailed too early in the process
bull Scenarios should promote participation by the students in seeking information from various learning resources
bull Adapted from Dolmans et al Med Teacher 199719185-9
Staff development
bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)
A dysfunctional group a dominant character may
make it difficult for other students to be heard
A dysfunctional group a dominant character may make it difficult for other students to be heard
bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties
Advantages of PBL bull Student centred PBLIt fostersactive learning improved
understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks
Disadvantagesbull Tutors who cant teachTutorsenjoy passing on
their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful
Assessment of PBL
bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods
bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL
Conclusion
bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning
bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL
PBL 5 Easy Steps
bull Read the problem
Mrs Paula Embledon
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
2 Brain storm
bull Brainstorm
bull ndash hypotheses
bull - what do we know in support of the hypothesis
bull - what do we need to know to test the hypothesis
ndash learning issues
Brainstorm
bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)
ndash specific issues (for individuals to look up)
ndash overlapping issues
bull 4 Individual Reading - Research - Preparation
bull 5 Return
bull ndash review case so far ndash report and discuss
ndash assess progress - continue pagenext pagecomplete
ndash self-evaluation - How did things go Any suggestions for next time
ndash next problem
bull 5 Return
THE FIRST GROUP SESSION
bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day
bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session
bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr
bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine
bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise
bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator
bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues
bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know
bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)
bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)
bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)
The Process of PBL
bullWhat are the issues Identify the important issues in the problem
bull How well do you understand the issues
bull Are there any words or terms about which you are unclear
The Process of PBL contd
bull Consider the basic mechanisms that might explain each important aspect of each problem
bull Assess your current understanding of the basic structural andor functional mechanisms that may contribute to the presentation of the problem
bull Use the collective skills and experiences of group members to explore or explain these phenomena Identify current gaps in knowledge or understanding
Learn from each other
bullShare your own knowledge expertise or ability to reason and synthesize information Be receptive and appreciative of the contribution of your small group members
Determine priorities for learning
bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue
bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan
bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge
bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career
PBL
bull The problem comes first without advance readings lectures or preparation
bull The problem serves as a stimulus for the need to know
Learning Issues
bull Learning issues are questions that cannot be answered with studentsrsquo current knowledge and that can be explored and answered through systematic self-directed inquiry
bull The use of learning issues in tutorials prepares students to handle similar challenges in clinical practice and life-long learning
Learning Issues in PBL First Session1 Getting Started (Introductions Ground
Rules Expectations)2 Identifying Problem3 Exploring Pre-Existing Knowledge4 Generating Hypotheses and Explaining
Mechanisms5 Unfolding the Case Incrementally6 Re-EvaluatingReprioritizing Hypotheses
Based on New Information7 AssessmentReflection
PBL Second Session
8 Independent Self-Directed Study of Learning Issues
PBL Third Session
bull 9 Discussion of Learning Issues and Application of New Knowledge to the Case
bull 10 Continued Unfolding of the Case Incrementally
bull 11 AssessmentReflection
During Tutorial Session students will
1048708 Come prepared to discuss the case and learning issues researched since the last tutorial
1048708 Actively participate in group discussions and contribute to the learning process in a manner that allows for the balanced participation of everyone in the group
1048708 Develop learning issues at each session phrase them as full-sentence questions write them on the board and post them on the course web page
1048708 Consider biological population behaviormental health issuesexplanations and questions of professional attitudes values and ethics related to the patientrsquos problem(s) described in the case
Tutorial Session contd1048708 Go to the board to diagram outline draw etc in
explanation of mechanisms relatedto hypotheses1048708 Debate evidence related to the case and avoid
personal attacks on others1048708 Comply with ground rules with regard to how
the group will function and how itsmembers treat one another1048708 Participate in end-of-session reflection and
assessment by giving and receivingconstructive criticism regarding self tutor
student and group performance
Between Tutorial Session
1048708 Research key learning issues using a variety of resources
1048708 Critically evaluate the credibility of sources and the validity of the information they have obtained in their research
1048708 Integrate what they have learned through research lectures labs clinical skills Perspectives in Medicine (PIM) etc into what is discussed in tutorials
1048708 Synthesize what they have learned and be prepared to discuss it without reading directly from their materials as much as possible and apply it to the case at the next tutorial session
Determine priorities for learning
bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue
bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan
bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge
bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career
PBL Starting the casebull After the introductions and discussion
are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it
bull Reading the case aloud keeps the group focused
bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here
Problem-based learning is designed to develop
1048708 Integrated context-specific knowledge base
1048708 Decision-makingcritical thinking process and skills
1048708 Self-directed life-long learning skills 1048708 Interpersonal collaboration and
communication skills 1048708 Constructive self and peer
assessment skills 1048708 Professional ethics and behavior
PBL Case (contd)
bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session
What is problem based learning
bull In PBL students use triggers from the problem case or scenario to define their own learning objectives
bull Subsequently they do independent self directed study before returning to the group to discuss and refine their acquired knowledge
bull Thus PBL is not about problem solving per se but rather it uses appropriate problems to increase knowledge and understanding
bull The process is clearly defined
PBL
bull PBL uses clinical cases as the context for students to study basic and clinical sciences
bull 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
bull Possible disadvantages include higher costs both in resources and staff time
PBL
bull An educational method characterized by the use of patient problems as a context for students to learn problem-solving skills and acquire knowledge about the basic and clinical sciences
bull Students usually meet in small groups two or three times a week for PBL tutorials
bull They are presented with a clinical problem (eg a patient with chest pain) and in a series of steps they discuss possible mechanisms and causes develop hypotheses and strategies to test the hypotheses are presented with further information and use this new information to refine their hypotheses finally reaching a conclusion
bull A tutor usually acts as a facilitator guiding students in this group-learning process
bull In the course of this exercise students identify both their existing levels and gaps in their knowledge These gaps form the basis for independent learning outside the PBL tutorials The identification and pursuit of these so-called learning goals is a key element of the PBL process
Rationale for using PBL bull The PBL approach is based on principles of adult
education20 and cognitive psychology21 It differs fundamentally from traditional curricula in which students acquire background knowledge of the basic sciences in the early years of the course and in the later years apply this knowledge to the diagnosis and management of clinical problems This traditional approach has been criticised for a number of reasons42223
bull It creates an artificial divide between the basic and clinical sciences
bull Time is wasted in acquiring knowledge that is subsequently forgotten or found to be irrelevant
bull Application of the acquired knowledge can be difficult bull The acquisition and retention of information that has no
apparent relevance can be boring and even demoralising for students
The group learning process acquiring
desirable learning skills
Generic Skills amp attitudes
bull Teamwork bull Critical evaluation of literature bull Chairing a group bull Self directed learning and use of
resources bull Listening Presentation skills
Recording bull Cooperation bull Respect for colleagues views
bull Group learning facilitates not only the acquisition of knowledge but also several other desirable attributes such as communication skills teamwork problem solving independent responsibility for learning sharing information and respect for others PBL can therefore be thought of as a small group teaching method that combines the acquisition of knowledge with the development of generic skills and attitudes Presentation of clinical material as the stimulus for learning enables students to understand the relevance of underlying scientific knowledge and principles in clinical practice
bull when PBL is introduced into a curriculum several other issues for curriculum design and implementation need to be tackled PBL is generally introduced in the context of a defined core curriculum and integration of basic and clinical sciences It has implications for staffing and learning resources and demands a different approach to timetabling workload and assessment PBL is often used to deliver core material in non-clinical parts of the curriculum Paper based PBL scenarios form the basis of the core curriculum and ensure that all students are exposed to the same problems Recently modified PBL techniques have been introduced into clinical education with real patients being used as the stimulus for learning Despite the essential ad hoc nature of learning clinical medicine a key cases approach can enable PBL to be used to deliver the core clinical curriculum
Copyright copy2003 BMJ Publishing Group Ltd
Wood D F BMJ 2003326328-330
No CRoles of participants in a PBL tutorial aption Found
What happens in a PBL tutorial bull PBL tutorials are conducted in several ways In
this article the examples are modelled on the Maastricht seven jump process but its format of seven steps may be shortened
bull A typical PBL tutorial consists of a group of students (usually eight to 10) and a tutor who facilitates the session The length of time (number of sessions) that a group stays together with each other and with individual tutors varies between institutions A group needs to be together long enough to allow good group dynamics to develop but may need to be changed occasionally if personality clashes or other dysfunctional behaviour emerges
bull Students elect a chair for each PBL scenario and a scribe to record the discussion The roles are rotated for each scenario Suitable flip charts or a whiteboard should be used for recording the proceedings At the start of the session depending on the trigger material either the student chair reads out the scenario or all students study the material If the trigger is a real patient in a ward clinic or surgery then a student may be asked to take a clinical history or identify an abnormal physical sign before the group moves to a tutorial room For each module students may be given a handbook containing the problem scenarios and suggested learning resources or learning materials may be handed out at appropriate times as the tutorials progress
Examples of trigger material for PBL scenarios bull Paper based clinical scenarios bull Experimental or clinical laboratory data bull Photographs bull Video clips bull Newspaper articles bull All or part of an article from a scientific
journal bull A real or simulated patient bull A family tree showing an inherited
disorder
PBL tutorial process ndash Step 1 Identify and clarify unfamiliar terms presented in the scenario
scribe lists those that remain unexplained after discussion ndash Step 2 Define the problem or problems to be discussed students may
have different views on the issues but all should be considered scribe records a list of agreed problems
ndash Step 3 Brainstorming session to discuss the problem(s) suggestingpossible explanations on basis of prior knowledge students draw on each others knowledge and identify areas of incomplete knowledge scribe records all discussion
ndash Step 4 Review steps 2 and 3 and arrange explanations into tentativesolutions scribe organises the explanations and restructures if necessary
ndash Step 5 Formulate learning objectives group reaches consensus onthe learning objectives tutor ensures learning objectives are focused achievable comprehensive and appropriate
ndash Step 6 Private study (all students gather information related to eachlearning objective)
ndash Step 7 Group shares results of private study (students identify theirlearning resources and share their results) tutor checks learning and may assess the group
bull The role of the tutor is to facilitate the proceedings (helping the chair to maintain group dynamics and moving the group through the task) and to ensure that the group achieves appropriate learning objectives in line with those set by the curriculum design team The tutor may need to take a more active role in step 7 of the process to ensure that all the students have done the appropriate work and to help the chair to suggest a suitable format for group members to use to present the results of their private study The tutor should encourage students to check their understanding of the material He or she can do this by encouraging the students to ask open questions and ask each other to explain topics in their own words or by the use of drawings and diagrams
PBL in curriculum design bull PBL may be used either as the mainstay of an entire
curriculum or for the delivery of individual courses In practice PBL is usually part of an integrated curriculum using a systems based approach with non-clinical material delivered in the context of clinical practice A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge skills and attitudes A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios Sufficient time should be allowed each week for students to do the self directed learning required for PBL
bull
Copyright copy2003 BMJ Publishing Group Ltd
Wood D F BMJ 2003326328-330
No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found
Writing PBL scenarios
bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives
bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after
studying the scenario should be consistent with the faculty learning objectives
bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding
bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice
bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge
bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented
bull The problem should be sufficiently open so that discussion is not curtailed too early in the process
bull Scenarios should promote participation by the students in seeking information from various learning resources
bull Adapted from Dolmans et al Med Teacher 199719185-9
Staff development
bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)
A dysfunctional group a dominant character may
make it difficult for other students to be heard
A dysfunctional group a dominant character may make it difficult for other students to be heard
bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties
Advantages of PBL bull Student centred PBLIt fostersactive learning improved
understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks
Disadvantagesbull Tutors who cant teachTutorsenjoy passing on
their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful
Assessment of PBL
bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods
bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL
Conclusion
bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning
bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL
PBL 5 Easy Steps
bull Read the problem
Mrs Paula Embledon
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
2 Brain storm
bull Brainstorm
bull ndash hypotheses
bull - what do we know in support of the hypothesis
bull - what do we need to know to test the hypothesis
ndash learning issues
Brainstorm
bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)
ndash specific issues (for individuals to look up)
ndash overlapping issues
bull 4 Individual Reading - Research - Preparation
bull 5 Return
bull ndash review case so far ndash report and discuss
ndash assess progress - continue pagenext pagecomplete
ndash self-evaluation - How did things go Any suggestions for next time
ndash next problem
bull 5 Return
THE FIRST GROUP SESSION
bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day
bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session
bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr
bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine
bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise
bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator
bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues
bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know
bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)
bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)
bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)
The Process of PBL contd
bull Consider the basic mechanisms that might explain each important aspect of each problem
bull Assess your current understanding of the basic structural andor functional mechanisms that may contribute to the presentation of the problem
bull Use the collective skills and experiences of group members to explore or explain these phenomena Identify current gaps in knowledge or understanding
Learn from each other
bullShare your own knowledge expertise or ability to reason and synthesize information Be receptive and appreciative of the contribution of your small group members
Determine priorities for learning
bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue
bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan
bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge
bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career
PBL
bull The problem comes first without advance readings lectures or preparation
bull The problem serves as a stimulus for the need to know
Learning Issues
bull Learning issues are questions that cannot be answered with studentsrsquo current knowledge and that can be explored and answered through systematic self-directed inquiry
bull The use of learning issues in tutorials prepares students to handle similar challenges in clinical practice and life-long learning
Learning Issues in PBL First Session1 Getting Started (Introductions Ground
Rules Expectations)2 Identifying Problem3 Exploring Pre-Existing Knowledge4 Generating Hypotheses and Explaining
Mechanisms5 Unfolding the Case Incrementally6 Re-EvaluatingReprioritizing Hypotheses
Based on New Information7 AssessmentReflection
PBL Second Session
8 Independent Self-Directed Study of Learning Issues
PBL Third Session
bull 9 Discussion of Learning Issues and Application of New Knowledge to the Case
bull 10 Continued Unfolding of the Case Incrementally
bull 11 AssessmentReflection
During Tutorial Session students will
1048708 Come prepared to discuss the case and learning issues researched since the last tutorial
1048708 Actively participate in group discussions and contribute to the learning process in a manner that allows for the balanced participation of everyone in the group
1048708 Develop learning issues at each session phrase them as full-sentence questions write them on the board and post them on the course web page
1048708 Consider biological population behaviormental health issuesexplanations and questions of professional attitudes values and ethics related to the patientrsquos problem(s) described in the case
Tutorial Session contd1048708 Go to the board to diagram outline draw etc in
explanation of mechanisms relatedto hypotheses1048708 Debate evidence related to the case and avoid
personal attacks on others1048708 Comply with ground rules with regard to how
the group will function and how itsmembers treat one another1048708 Participate in end-of-session reflection and
assessment by giving and receivingconstructive criticism regarding self tutor
student and group performance
Between Tutorial Session
1048708 Research key learning issues using a variety of resources
1048708 Critically evaluate the credibility of sources and the validity of the information they have obtained in their research
1048708 Integrate what they have learned through research lectures labs clinical skills Perspectives in Medicine (PIM) etc into what is discussed in tutorials
1048708 Synthesize what they have learned and be prepared to discuss it without reading directly from their materials as much as possible and apply it to the case at the next tutorial session
Determine priorities for learning
bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue
bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan
bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge
bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career
PBL Starting the casebull After the introductions and discussion
are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it
bull Reading the case aloud keeps the group focused
bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here
Problem-based learning is designed to develop
1048708 Integrated context-specific knowledge base
1048708 Decision-makingcritical thinking process and skills
1048708 Self-directed life-long learning skills 1048708 Interpersonal collaboration and
communication skills 1048708 Constructive self and peer
assessment skills 1048708 Professional ethics and behavior
PBL Case (contd)
bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session
What is problem based learning
bull In PBL students use triggers from the problem case or scenario to define their own learning objectives
bull Subsequently they do independent self directed study before returning to the group to discuss and refine their acquired knowledge
bull Thus PBL is not about problem solving per se but rather it uses appropriate problems to increase knowledge and understanding
bull The process is clearly defined
PBL
bull PBL uses clinical cases as the context for students to study basic and clinical sciences
bull 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
bull Possible disadvantages include higher costs both in resources and staff time
PBL
bull An educational method characterized by the use of patient problems as a context for students to learn problem-solving skills and acquire knowledge about the basic and clinical sciences
bull Students usually meet in small groups two or three times a week for PBL tutorials
bull They are presented with a clinical problem (eg a patient with chest pain) and in a series of steps they discuss possible mechanisms and causes develop hypotheses and strategies to test the hypotheses are presented with further information and use this new information to refine their hypotheses finally reaching a conclusion
bull A tutor usually acts as a facilitator guiding students in this group-learning process
bull In the course of this exercise students identify both their existing levels and gaps in their knowledge These gaps form the basis for independent learning outside the PBL tutorials The identification and pursuit of these so-called learning goals is a key element of the PBL process
Rationale for using PBL bull The PBL approach is based on principles of adult
education20 and cognitive psychology21 It differs fundamentally from traditional curricula in which students acquire background knowledge of the basic sciences in the early years of the course and in the later years apply this knowledge to the diagnosis and management of clinical problems This traditional approach has been criticised for a number of reasons42223
bull It creates an artificial divide between the basic and clinical sciences
bull Time is wasted in acquiring knowledge that is subsequently forgotten or found to be irrelevant
bull Application of the acquired knowledge can be difficult bull The acquisition and retention of information that has no
apparent relevance can be boring and even demoralising for students
The group learning process acquiring
desirable learning skills
Generic Skills amp attitudes
bull Teamwork bull Critical evaluation of literature bull Chairing a group bull Self directed learning and use of
resources bull Listening Presentation skills
Recording bull Cooperation bull Respect for colleagues views
bull Group learning facilitates not only the acquisition of knowledge but also several other desirable attributes such as communication skills teamwork problem solving independent responsibility for learning sharing information and respect for others PBL can therefore be thought of as a small group teaching method that combines the acquisition of knowledge with the development of generic skills and attitudes Presentation of clinical material as the stimulus for learning enables students to understand the relevance of underlying scientific knowledge and principles in clinical practice
bull when PBL is introduced into a curriculum several other issues for curriculum design and implementation need to be tackled PBL is generally introduced in the context of a defined core curriculum and integration of basic and clinical sciences It has implications for staffing and learning resources and demands a different approach to timetabling workload and assessment PBL is often used to deliver core material in non-clinical parts of the curriculum Paper based PBL scenarios form the basis of the core curriculum and ensure that all students are exposed to the same problems Recently modified PBL techniques have been introduced into clinical education with real patients being used as the stimulus for learning Despite the essential ad hoc nature of learning clinical medicine a key cases approach can enable PBL to be used to deliver the core clinical curriculum
Copyright copy2003 BMJ Publishing Group Ltd
Wood D F BMJ 2003326328-330
No CRoles of participants in a PBL tutorial aption Found
What happens in a PBL tutorial bull PBL tutorials are conducted in several ways In
this article the examples are modelled on the Maastricht seven jump process but its format of seven steps may be shortened
bull A typical PBL tutorial consists of a group of students (usually eight to 10) and a tutor who facilitates the session The length of time (number of sessions) that a group stays together with each other and with individual tutors varies between institutions A group needs to be together long enough to allow good group dynamics to develop but may need to be changed occasionally if personality clashes or other dysfunctional behaviour emerges
bull Students elect a chair for each PBL scenario and a scribe to record the discussion The roles are rotated for each scenario Suitable flip charts or a whiteboard should be used for recording the proceedings At the start of the session depending on the trigger material either the student chair reads out the scenario or all students study the material If the trigger is a real patient in a ward clinic or surgery then a student may be asked to take a clinical history or identify an abnormal physical sign before the group moves to a tutorial room For each module students may be given a handbook containing the problem scenarios and suggested learning resources or learning materials may be handed out at appropriate times as the tutorials progress
Examples of trigger material for PBL scenarios bull Paper based clinical scenarios bull Experimental or clinical laboratory data bull Photographs bull Video clips bull Newspaper articles bull All or part of an article from a scientific
journal bull A real or simulated patient bull A family tree showing an inherited
disorder
PBL tutorial process ndash Step 1 Identify and clarify unfamiliar terms presented in the scenario
scribe lists those that remain unexplained after discussion ndash Step 2 Define the problem or problems to be discussed students may
have different views on the issues but all should be considered scribe records a list of agreed problems
ndash Step 3 Brainstorming session to discuss the problem(s) suggestingpossible explanations on basis of prior knowledge students draw on each others knowledge and identify areas of incomplete knowledge scribe records all discussion
ndash Step 4 Review steps 2 and 3 and arrange explanations into tentativesolutions scribe organises the explanations and restructures if necessary
ndash Step 5 Formulate learning objectives group reaches consensus onthe learning objectives tutor ensures learning objectives are focused achievable comprehensive and appropriate
ndash Step 6 Private study (all students gather information related to eachlearning objective)
ndash Step 7 Group shares results of private study (students identify theirlearning resources and share their results) tutor checks learning and may assess the group
bull The role of the tutor is to facilitate the proceedings (helping the chair to maintain group dynamics and moving the group through the task) and to ensure that the group achieves appropriate learning objectives in line with those set by the curriculum design team The tutor may need to take a more active role in step 7 of the process to ensure that all the students have done the appropriate work and to help the chair to suggest a suitable format for group members to use to present the results of their private study The tutor should encourage students to check their understanding of the material He or she can do this by encouraging the students to ask open questions and ask each other to explain topics in their own words or by the use of drawings and diagrams
PBL in curriculum design bull PBL may be used either as the mainstay of an entire
curriculum or for the delivery of individual courses In practice PBL is usually part of an integrated curriculum using a systems based approach with non-clinical material delivered in the context of clinical practice A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge skills and attitudes A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios Sufficient time should be allowed each week for students to do the self directed learning required for PBL
bull
Copyright copy2003 BMJ Publishing Group Ltd
Wood D F BMJ 2003326328-330
No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found
Writing PBL scenarios
bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives
bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after
studying the scenario should be consistent with the faculty learning objectives
bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding
bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice
bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge
bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented
bull The problem should be sufficiently open so that discussion is not curtailed too early in the process
bull Scenarios should promote participation by the students in seeking information from various learning resources
bull Adapted from Dolmans et al Med Teacher 199719185-9
Staff development
bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)
A dysfunctional group a dominant character may
make it difficult for other students to be heard
A dysfunctional group a dominant character may make it difficult for other students to be heard
bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties
Advantages of PBL bull Student centred PBLIt fostersactive learning improved
understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks
Disadvantagesbull Tutors who cant teachTutorsenjoy passing on
their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful
Assessment of PBL
bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods
bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL
Conclusion
bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning
bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL
PBL 5 Easy Steps
bull Read the problem
Mrs Paula Embledon
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
2 Brain storm
bull Brainstorm
bull ndash hypotheses
bull - what do we know in support of the hypothesis
bull - what do we need to know to test the hypothesis
ndash learning issues
Brainstorm
bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)
ndash specific issues (for individuals to look up)
ndash overlapping issues
bull 4 Individual Reading - Research - Preparation
bull 5 Return
bull ndash review case so far ndash report and discuss
ndash assess progress - continue pagenext pagecomplete
ndash self-evaluation - How did things go Any suggestions for next time
ndash next problem
bull 5 Return
THE FIRST GROUP SESSION
bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day
bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session
bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr
bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine
bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise
bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator
bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues
bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know
bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)
bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)
bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)
Learn from each other
bullShare your own knowledge expertise or ability to reason and synthesize information Be receptive and appreciative of the contribution of your small group members
Determine priorities for learning
bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue
bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan
bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge
bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career
PBL
bull The problem comes first without advance readings lectures or preparation
bull The problem serves as a stimulus for the need to know
Learning Issues
bull Learning issues are questions that cannot be answered with studentsrsquo current knowledge and that can be explored and answered through systematic self-directed inquiry
bull The use of learning issues in tutorials prepares students to handle similar challenges in clinical practice and life-long learning
Learning Issues in PBL First Session1 Getting Started (Introductions Ground
Rules Expectations)2 Identifying Problem3 Exploring Pre-Existing Knowledge4 Generating Hypotheses and Explaining
Mechanisms5 Unfolding the Case Incrementally6 Re-EvaluatingReprioritizing Hypotheses
Based on New Information7 AssessmentReflection
PBL Second Session
8 Independent Self-Directed Study of Learning Issues
PBL Third Session
bull 9 Discussion of Learning Issues and Application of New Knowledge to the Case
bull 10 Continued Unfolding of the Case Incrementally
bull 11 AssessmentReflection
During Tutorial Session students will
1048708 Come prepared to discuss the case and learning issues researched since the last tutorial
1048708 Actively participate in group discussions and contribute to the learning process in a manner that allows for the balanced participation of everyone in the group
1048708 Develop learning issues at each session phrase them as full-sentence questions write them on the board and post them on the course web page
1048708 Consider biological population behaviormental health issuesexplanations and questions of professional attitudes values and ethics related to the patientrsquos problem(s) described in the case
Tutorial Session contd1048708 Go to the board to diagram outline draw etc in
explanation of mechanisms relatedto hypotheses1048708 Debate evidence related to the case and avoid
personal attacks on others1048708 Comply with ground rules with regard to how
the group will function and how itsmembers treat one another1048708 Participate in end-of-session reflection and
assessment by giving and receivingconstructive criticism regarding self tutor
student and group performance
Between Tutorial Session
1048708 Research key learning issues using a variety of resources
1048708 Critically evaluate the credibility of sources and the validity of the information they have obtained in their research
1048708 Integrate what they have learned through research lectures labs clinical skills Perspectives in Medicine (PIM) etc into what is discussed in tutorials
1048708 Synthesize what they have learned and be prepared to discuss it without reading directly from their materials as much as possible and apply it to the case at the next tutorial session
Determine priorities for learning
bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue
bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan
bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge
bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career
PBL Starting the casebull After the introductions and discussion
are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it
bull Reading the case aloud keeps the group focused
bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here
Problem-based learning is designed to develop
1048708 Integrated context-specific knowledge base
1048708 Decision-makingcritical thinking process and skills
1048708 Self-directed life-long learning skills 1048708 Interpersonal collaboration and
communication skills 1048708 Constructive self and peer
assessment skills 1048708 Professional ethics and behavior
PBL Case (contd)
bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session
What is problem based learning
bull In PBL students use triggers from the problem case or scenario to define their own learning objectives
bull Subsequently they do independent self directed study before returning to the group to discuss and refine their acquired knowledge
bull Thus PBL is not about problem solving per se but rather it uses appropriate problems to increase knowledge and understanding
bull The process is clearly defined
PBL
bull PBL uses clinical cases as the context for students to study basic and clinical sciences
bull 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
bull Possible disadvantages include higher costs both in resources and staff time
PBL
bull An educational method characterized by the use of patient problems as a context for students to learn problem-solving skills and acquire knowledge about the basic and clinical sciences
bull Students usually meet in small groups two or three times a week for PBL tutorials
bull They are presented with a clinical problem (eg a patient with chest pain) and in a series of steps they discuss possible mechanisms and causes develop hypotheses and strategies to test the hypotheses are presented with further information and use this new information to refine their hypotheses finally reaching a conclusion
bull A tutor usually acts as a facilitator guiding students in this group-learning process
bull In the course of this exercise students identify both their existing levels and gaps in their knowledge These gaps form the basis for independent learning outside the PBL tutorials The identification and pursuit of these so-called learning goals is a key element of the PBL process
Rationale for using PBL bull The PBL approach is based on principles of adult
education20 and cognitive psychology21 It differs fundamentally from traditional curricula in which students acquire background knowledge of the basic sciences in the early years of the course and in the later years apply this knowledge to the diagnosis and management of clinical problems This traditional approach has been criticised for a number of reasons42223
bull It creates an artificial divide between the basic and clinical sciences
bull Time is wasted in acquiring knowledge that is subsequently forgotten or found to be irrelevant
bull Application of the acquired knowledge can be difficult bull The acquisition and retention of information that has no
apparent relevance can be boring and even demoralising for students
The group learning process acquiring
desirable learning skills
Generic Skills amp attitudes
bull Teamwork bull Critical evaluation of literature bull Chairing a group bull Self directed learning and use of
resources bull Listening Presentation skills
Recording bull Cooperation bull Respect for colleagues views
bull Group learning facilitates not only the acquisition of knowledge but also several other desirable attributes such as communication skills teamwork problem solving independent responsibility for learning sharing information and respect for others PBL can therefore be thought of as a small group teaching method that combines the acquisition of knowledge with the development of generic skills and attitudes Presentation of clinical material as the stimulus for learning enables students to understand the relevance of underlying scientific knowledge and principles in clinical practice
bull when PBL is introduced into a curriculum several other issues for curriculum design and implementation need to be tackled PBL is generally introduced in the context of a defined core curriculum and integration of basic and clinical sciences It has implications for staffing and learning resources and demands a different approach to timetabling workload and assessment PBL is often used to deliver core material in non-clinical parts of the curriculum Paper based PBL scenarios form the basis of the core curriculum and ensure that all students are exposed to the same problems Recently modified PBL techniques have been introduced into clinical education with real patients being used as the stimulus for learning Despite the essential ad hoc nature of learning clinical medicine a key cases approach can enable PBL to be used to deliver the core clinical curriculum
Copyright copy2003 BMJ Publishing Group Ltd
Wood D F BMJ 2003326328-330
No CRoles of participants in a PBL tutorial aption Found
What happens in a PBL tutorial bull PBL tutorials are conducted in several ways In
this article the examples are modelled on the Maastricht seven jump process but its format of seven steps may be shortened
bull A typical PBL tutorial consists of a group of students (usually eight to 10) and a tutor who facilitates the session The length of time (number of sessions) that a group stays together with each other and with individual tutors varies between institutions A group needs to be together long enough to allow good group dynamics to develop but may need to be changed occasionally if personality clashes or other dysfunctional behaviour emerges
bull Students elect a chair for each PBL scenario and a scribe to record the discussion The roles are rotated for each scenario Suitable flip charts or a whiteboard should be used for recording the proceedings At the start of the session depending on the trigger material either the student chair reads out the scenario or all students study the material If the trigger is a real patient in a ward clinic or surgery then a student may be asked to take a clinical history or identify an abnormal physical sign before the group moves to a tutorial room For each module students may be given a handbook containing the problem scenarios and suggested learning resources or learning materials may be handed out at appropriate times as the tutorials progress
Examples of trigger material for PBL scenarios bull Paper based clinical scenarios bull Experimental or clinical laboratory data bull Photographs bull Video clips bull Newspaper articles bull All or part of an article from a scientific
journal bull A real or simulated patient bull A family tree showing an inherited
disorder
PBL tutorial process ndash Step 1 Identify and clarify unfamiliar terms presented in the scenario
scribe lists those that remain unexplained after discussion ndash Step 2 Define the problem or problems to be discussed students may
have different views on the issues but all should be considered scribe records a list of agreed problems
ndash Step 3 Brainstorming session to discuss the problem(s) suggestingpossible explanations on basis of prior knowledge students draw on each others knowledge and identify areas of incomplete knowledge scribe records all discussion
ndash Step 4 Review steps 2 and 3 and arrange explanations into tentativesolutions scribe organises the explanations and restructures if necessary
ndash Step 5 Formulate learning objectives group reaches consensus onthe learning objectives tutor ensures learning objectives are focused achievable comprehensive and appropriate
ndash Step 6 Private study (all students gather information related to eachlearning objective)
ndash Step 7 Group shares results of private study (students identify theirlearning resources and share their results) tutor checks learning and may assess the group
bull The role of the tutor is to facilitate the proceedings (helping the chair to maintain group dynamics and moving the group through the task) and to ensure that the group achieves appropriate learning objectives in line with those set by the curriculum design team The tutor may need to take a more active role in step 7 of the process to ensure that all the students have done the appropriate work and to help the chair to suggest a suitable format for group members to use to present the results of their private study The tutor should encourage students to check their understanding of the material He or she can do this by encouraging the students to ask open questions and ask each other to explain topics in their own words or by the use of drawings and diagrams
PBL in curriculum design bull PBL may be used either as the mainstay of an entire
curriculum or for the delivery of individual courses In practice PBL is usually part of an integrated curriculum using a systems based approach with non-clinical material delivered in the context of clinical practice A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge skills and attitudes A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios Sufficient time should be allowed each week for students to do the self directed learning required for PBL
bull
Copyright copy2003 BMJ Publishing Group Ltd
Wood D F BMJ 2003326328-330
No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found
Writing PBL scenarios
bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives
bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after
studying the scenario should be consistent with the faculty learning objectives
bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding
bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice
bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge
bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented
bull The problem should be sufficiently open so that discussion is not curtailed too early in the process
bull Scenarios should promote participation by the students in seeking information from various learning resources
bull Adapted from Dolmans et al Med Teacher 199719185-9
Staff development
bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)
A dysfunctional group a dominant character may
make it difficult for other students to be heard
A dysfunctional group a dominant character may make it difficult for other students to be heard
bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties
Advantages of PBL bull Student centred PBLIt fostersactive learning improved
understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks
Disadvantagesbull Tutors who cant teachTutorsenjoy passing on
their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful
Assessment of PBL
bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods
bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL
Conclusion
bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning
bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL
PBL 5 Easy Steps
bull Read the problem
Mrs Paula Embledon
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
2 Brain storm
bull Brainstorm
bull ndash hypotheses
bull - what do we know in support of the hypothesis
bull - what do we need to know to test the hypothesis
ndash learning issues
Brainstorm
bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)
ndash specific issues (for individuals to look up)
ndash overlapping issues
bull 4 Individual Reading - Research - Preparation
bull 5 Return
bull ndash review case so far ndash report and discuss
ndash assess progress - continue pagenext pagecomplete
ndash self-evaluation - How did things go Any suggestions for next time
ndash next problem
bull 5 Return
THE FIRST GROUP SESSION
bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day
bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session
bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr
bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine
bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise
bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator
bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues
bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know
bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)
bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)
bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)
Determine priorities for learning
bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue
bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan
bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge
bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career
PBL
bull The problem comes first without advance readings lectures or preparation
bull The problem serves as a stimulus for the need to know
Learning Issues
bull Learning issues are questions that cannot be answered with studentsrsquo current knowledge and that can be explored and answered through systematic self-directed inquiry
bull The use of learning issues in tutorials prepares students to handle similar challenges in clinical practice and life-long learning
Learning Issues in PBL First Session1 Getting Started (Introductions Ground
Rules Expectations)2 Identifying Problem3 Exploring Pre-Existing Knowledge4 Generating Hypotheses and Explaining
Mechanisms5 Unfolding the Case Incrementally6 Re-EvaluatingReprioritizing Hypotheses
Based on New Information7 AssessmentReflection
PBL Second Session
8 Independent Self-Directed Study of Learning Issues
PBL Third Session
bull 9 Discussion of Learning Issues and Application of New Knowledge to the Case
bull 10 Continued Unfolding of the Case Incrementally
bull 11 AssessmentReflection
During Tutorial Session students will
1048708 Come prepared to discuss the case and learning issues researched since the last tutorial
1048708 Actively participate in group discussions and contribute to the learning process in a manner that allows for the balanced participation of everyone in the group
1048708 Develop learning issues at each session phrase them as full-sentence questions write them on the board and post them on the course web page
1048708 Consider biological population behaviormental health issuesexplanations and questions of professional attitudes values and ethics related to the patientrsquos problem(s) described in the case
Tutorial Session contd1048708 Go to the board to diagram outline draw etc in
explanation of mechanisms relatedto hypotheses1048708 Debate evidence related to the case and avoid
personal attacks on others1048708 Comply with ground rules with regard to how
the group will function and how itsmembers treat one another1048708 Participate in end-of-session reflection and
assessment by giving and receivingconstructive criticism regarding self tutor
student and group performance
Between Tutorial Session
1048708 Research key learning issues using a variety of resources
1048708 Critically evaluate the credibility of sources and the validity of the information they have obtained in their research
1048708 Integrate what they have learned through research lectures labs clinical skills Perspectives in Medicine (PIM) etc into what is discussed in tutorials
1048708 Synthesize what they have learned and be prepared to discuss it without reading directly from their materials as much as possible and apply it to the case at the next tutorial session
Determine priorities for learning
bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue
bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan
bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge
bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career
PBL Starting the casebull After the introductions and discussion
are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it
bull Reading the case aloud keeps the group focused
bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here
Problem-based learning is designed to develop
1048708 Integrated context-specific knowledge base
1048708 Decision-makingcritical thinking process and skills
1048708 Self-directed life-long learning skills 1048708 Interpersonal collaboration and
communication skills 1048708 Constructive self and peer
assessment skills 1048708 Professional ethics and behavior
PBL Case (contd)
bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session
What is problem based learning
bull In PBL students use triggers from the problem case or scenario to define their own learning objectives
bull Subsequently they do independent self directed study before returning to the group to discuss and refine their acquired knowledge
bull Thus PBL is not about problem solving per se but rather it uses appropriate problems to increase knowledge and understanding
bull The process is clearly defined
PBL
bull PBL uses clinical cases as the context for students to study basic and clinical sciences
bull 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
bull Possible disadvantages include higher costs both in resources and staff time
PBL
bull An educational method characterized by the use of patient problems as a context for students to learn problem-solving skills and acquire knowledge about the basic and clinical sciences
bull Students usually meet in small groups two or three times a week for PBL tutorials
bull They are presented with a clinical problem (eg a patient with chest pain) and in a series of steps they discuss possible mechanisms and causes develop hypotheses and strategies to test the hypotheses are presented with further information and use this new information to refine their hypotheses finally reaching a conclusion
bull A tutor usually acts as a facilitator guiding students in this group-learning process
bull In the course of this exercise students identify both their existing levels and gaps in their knowledge These gaps form the basis for independent learning outside the PBL tutorials The identification and pursuit of these so-called learning goals is a key element of the PBL process
Rationale for using PBL bull The PBL approach is based on principles of adult
education20 and cognitive psychology21 It differs fundamentally from traditional curricula in which students acquire background knowledge of the basic sciences in the early years of the course and in the later years apply this knowledge to the diagnosis and management of clinical problems This traditional approach has been criticised for a number of reasons42223
bull It creates an artificial divide between the basic and clinical sciences
bull Time is wasted in acquiring knowledge that is subsequently forgotten or found to be irrelevant
bull Application of the acquired knowledge can be difficult bull The acquisition and retention of information that has no
apparent relevance can be boring and even demoralising for students
The group learning process acquiring
desirable learning skills
Generic Skills amp attitudes
bull Teamwork bull Critical evaluation of literature bull Chairing a group bull Self directed learning and use of
resources bull Listening Presentation skills
Recording bull Cooperation bull Respect for colleagues views
bull Group learning facilitates not only the acquisition of knowledge but also several other desirable attributes such as communication skills teamwork problem solving independent responsibility for learning sharing information and respect for others PBL can therefore be thought of as a small group teaching method that combines the acquisition of knowledge with the development of generic skills and attitudes Presentation of clinical material as the stimulus for learning enables students to understand the relevance of underlying scientific knowledge and principles in clinical practice
bull when PBL is introduced into a curriculum several other issues for curriculum design and implementation need to be tackled PBL is generally introduced in the context of a defined core curriculum and integration of basic and clinical sciences It has implications for staffing and learning resources and demands a different approach to timetabling workload and assessment PBL is often used to deliver core material in non-clinical parts of the curriculum Paper based PBL scenarios form the basis of the core curriculum and ensure that all students are exposed to the same problems Recently modified PBL techniques have been introduced into clinical education with real patients being used as the stimulus for learning Despite the essential ad hoc nature of learning clinical medicine a key cases approach can enable PBL to be used to deliver the core clinical curriculum
Copyright copy2003 BMJ Publishing Group Ltd
Wood D F BMJ 2003326328-330
No CRoles of participants in a PBL tutorial aption Found
What happens in a PBL tutorial bull PBL tutorials are conducted in several ways In
this article the examples are modelled on the Maastricht seven jump process but its format of seven steps may be shortened
bull A typical PBL tutorial consists of a group of students (usually eight to 10) and a tutor who facilitates the session The length of time (number of sessions) that a group stays together with each other and with individual tutors varies between institutions A group needs to be together long enough to allow good group dynamics to develop but may need to be changed occasionally if personality clashes or other dysfunctional behaviour emerges
bull Students elect a chair for each PBL scenario and a scribe to record the discussion The roles are rotated for each scenario Suitable flip charts or a whiteboard should be used for recording the proceedings At the start of the session depending on the trigger material either the student chair reads out the scenario or all students study the material If the trigger is a real patient in a ward clinic or surgery then a student may be asked to take a clinical history or identify an abnormal physical sign before the group moves to a tutorial room For each module students may be given a handbook containing the problem scenarios and suggested learning resources or learning materials may be handed out at appropriate times as the tutorials progress
Examples of trigger material for PBL scenarios bull Paper based clinical scenarios bull Experimental or clinical laboratory data bull Photographs bull Video clips bull Newspaper articles bull All or part of an article from a scientific
journal bull A real or simulated patient bull A family tree showing an inherited
disorder
PBL tutorial process ndash Step 1 Identify and clarify unfamiliar terms presented in the scenario
scribe lists those that remain unexplained after discussion ndash Step 2 Define the problem or problems to be discussed students may
have different views on the issues but all should be considered scribe records a list of agreed problems
ndash Step 3 Brainstorming session to discuss the problem(s) suggestingpossible explanations on basis of prior knowledge students draw on each others knowledge and identify areas of incomplete knowledge scribe records all discussion
ndash Step 4 Review steps 2 and 3 and arrange explanations into tentativesolutions scribe organises the explanations and restructures if necessary
ndash Step 5 Formulate learning objectives group reaches consensus onthe learning objectives tutor ensures learning objectives are focused achievable comprehensive and appropriate
ndash Step 6 Private study (all students gather information related to eachlearning objective)
ndash Step 7 Group shares results of private study (students identify theirlearning resources and share their results) tutor checks learning and may assess the group
bull The role of the tutor is to facilitate the proceedings (helping the chair to maintain group dynamics and moving the group through the task) and to ensure that the group achieves appropriate learning objectives in line with those set by the curriculum design team The tutor may need to take a more active role in step 7 of the process to ensure that all the students have done the appropriate work and to help the chair to suggest a suitable format for group members to use to present the results of their private study The tutor should encourage students to check their understanding of the material He or she can do this by encouraging the students to ask open questions and ask each other to explain topics in their own words or by the use of drawings and diagrams
PBL in curriculum design bull PBL may be used either as the mainstay of an entire
curriculum or for the delivery of individual courses In practice PBL is usually part of an integrated curriculum using a systems based approach with non-clinical material delivered in the context of clinical practice A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge skills and attitudes A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios Sufficient time should be allowed each week for students to do the self directed learning required for PBL
bull
Copyright copy2003 BMJ Publishing Group Ltd
Wood D F BMJ 2003326328-330
No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found
Writing PBL scenarios
bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives
bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after
studying the scenario should be consistent with the faculty learning objectives
bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding
bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice
bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge
bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented
bull The problem should be sufficiently open so that discussion is not curtailed too early in the process
bull Scenarios should promote participation by the students in seeking information from various learning resources
bull Adapted from Dolmans et al Med Teacher 199719185-9
Staff development
bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)
A dysfunctional group a dominant character may
make it difficult for other students to be heard
A dysfunctional group a dominant character may make it difficult for other students to be heard
bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties
Advantages of PBL bull Student centred PBLIt fostersactive learning improved
understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks
Disadvantagesbull Tutors who cant teachTutorsenjoy passing on
their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful
Assessment of PBL
bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods
bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL
Conclusion
bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning
bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL
PBL 5 Easy Steps
bull Read the problem
Mrs Paula Embledon
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
2 Brain storm
bull Brainstorm
bull ndash hypotheses
bull - what do we know in support of the hypothesis
bull - what do we need to know to test the hypothesis
ndash learning issues
Brainstorm
bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)
ndash specific issues (for individuals to look up)
ndash overlapping issues
bull 4 Individual Reading - Research - Preparation
bull 5 Return
bull ndash review case so far ndash report and discuss
ndash assess progress - continue pagenext pagecomplete
ndash self-evaluation - How did things go Any suggestions for next time
ndash next problem
bull 5 Return
THE FIRST GROUP SESSION
bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day
bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session
bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr
bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine
bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise
bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator
bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues
bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know
bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)
bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)
bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)
bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge
bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career
PBL
bull The problem comes first without advance readings lectures or preparation
bull The problem serves as a stimulus for the need to know
Learning Issues
bull Learning issues are questions that cannot be answered with studentsrsquo current knowledge and that can be explored and answered through systematic self-directed inquiry
bull The use of learning issues in tutorials prepares students to handle similar challenges in clinical practice and life-long learning
Learning Issues in PBL First Session1 Getting Started (Introductions Ground
Rules Expectations)2 Identifying Problem3 Exploring Pre-Existing Knowledge4 Generating Hypotheses and Explaining
Mechanisms5 Unfolding the Case Incrementally6 Re-EvaluatingReprioritizing Hypotheses
Based on New Information7 AssessmentReflection
PBL Second Session
8 Independent Self-Directed Study of Learning Issues
PBL Third Session
bull 9 Discussion of Learning Issues and Application of New Knowledge to the Case
bull 10 Continued Unfolding of the Case Incrementally
bull 11 AssessmentReflection
During Tutorial Session students will
1048708 Come prepared to discuss the case and learning issues researched since the last tutorial
1048708 Actively participate in group discussions and contribute to the learning process in a manner that allows for the balanced participation of everyone in the group
1048708 Develop learning issues at each session phrase them as full-sentence questions write them on the board and post them on the course web page
1048708 Consider biological population behaviormental health issuesexplanations and questions of professional attitudes values and ethics related to the patientrsquos problem(s) described in the case
Tutorial Session contd1048708 Go to the board to diagram outline draw etc in
explanation of mechanisms relatedto hypotheses1048708 Debate evidence related to the case and avoid
personal attacks on others1048708 Comply with ground rules with regard to how
the group will function and how itsmembers treat one another1048708 Participate in end-of-session reflection and
assessment by giving and receivingconstructive criticism regarding self tutor
student and group performance
Between Tutorial Session
1048708 Research key learning issues using a variety of resources
1048708 Critically evaluate the credibility of sources and the validity of the information they have obtained in their research
1048708 Integrate what they have learned through research lectures labs clinical skills Perspectives in Medicine (PIM) etc into what is discussed in tutorials
1048708 Synthesize what they have learned and be prepared to discuss it without reading directly from their materials as much as possible and apply it to the case at the next tutorial session
Determine priorities for learning
bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue
bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan
bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge
bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career
PBL Starting the casebull After the introductions and discussion
are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it
bull Reading the case aloud keeps the group focused
bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here
Problem-based learning is designed to develop
1048708 Integrated context-specific knowledge base
1048708 Decision-makingcritical thinking process and skills
1048708 Self-directed life-long learning skills 1048708 Interpersonal collaboration and
communication skills 1048708 Constructive self and peer
assessment skills 1048708 Professional ethics and behavior
PBL Case (contd)
bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session
What is problem based learning
bull In PBL students use triggers from the problem case or scenario to define their own learning objectives
bull Subsequently they do independent self directed study before returning to the group to discuss and refine their acquired knowledge
bull Thus PBL is not about problem solving per se but rather it uses appropriate problems to increase knowledge and understanding
bull The process is clearly defined
PBL
bull PBL uses clinical cases as the context for students to study basic and clinical sciences
bull 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
bull Possible disadvantages include higher costs both in resources and staff time
PBL
bull An educational method characterized by the use of patient problems as a context for students to learn problem-solving skills and acquire knowledge about the basic and clinical sciences
bull Students usually meet in small groups two or three times a week for PBL tutorials
bull They are presented with a clinical problem (eg a patient with chest pain) and in a series of steps they discuss possible mechanisms and causes develop hypotheses and strategies to test the hypotheses are presented with further information and use this new information to refine their hypotheses finally reaching a conclusion
bull A tutor usually acts as a facilitator guiding students in this group-learning process
bull In the course of this exercise students identify both their existing levels and gaps in their knowledge These gaps form the basis for independent learning outside the PBL tutorials The identification and pursuit of these so-called learning goals is a key element of the PBL process
Rationale for using PBL bull The PBL approach is based on principles of adult
education20 and cognitive psychology21 It differs fundamentally from traditional curricula in which students acquire background knowledge of the basic sciences in the early years of the course and in the later years apply this knowledge to the diagnosis and management of clinical problems This traditional approach has been criticised for a number of reasons42223
bull It creates an artificial divide between the basic and clinical sciences
bull Time is wasted in acquiring knowledge that is subsequently forgotten or found to be irrelevant
bull Application of the acquired knowledge can be difficult bull The acquisition and retention of information that has no
apparent relevance can be boring and even demoralising for students
The group learning process acquiring
desirable learning skills
Generic Skills amp attitudes
bull Teamwork bull Critical evaluation of literature bull Chairing a group bull Self directed learning and use of
resources bull Listening Presentation skills
Recording bull Cooperation bull Respect for colleagues views
bull Group learning facilitates not only the acquisition of knowledge but also several other desirable attributes such as communication skills teamwork problem solving independent responsibility for learning sharing information and respect for others PBL can therefore be thought of as a small group teaching method that combines the acquisition of knowledge with the development of generic skills and attitudes Presentation of clinical material as the stimulus for learning enables students to understand the relevance of underlying scientific knowledge and principles in clinical practice
bull when PBL is introduced into a curriculum several other issues for curriculum design and implementation need to be tackled PBL is generally introduced in the context of a defined core curriculum and integration of basic and clinical sciences It has implications for staffing and learning resources and demands a different approach to timetabling workload and assessment PBL is often used to deliver core material in non-clinical parts of the curriculum Paper based PBL scenarios form the basis of the core curriculum and ensure that all students are exposed to the same problems Recently modified PBL techniques have been introduced into clinical education with real patients being used as the stimulus for learning Despite the essential ad hoc nature of learning clinical medicine a key cases approach can enable PBL to be used to deliver the core clinical curriculum
Copyright copy2003 BMJ Publishing Group Ltd
Wood D F BMJ 2003326328-330
No CRoles of participants in a PBL tutorial aption Found
What happens in a PBL tutorial bull PBL tutorials are conducted in several ways In
this article the examples are modelled on the Maastricht seven jump process but its format of seven steps may be shortened
bull A typical PBL tutorial consists of a group of students (usually eight to 10) and a tutor who facilitates the session The length of time (number of sessions) that a group stays together with each other and with individual tutors varies between institutions A group needs to be together long enough to allow good group dynamics to develop but may need to be changed occasionally if personality clashes or other dysfunctional behaviour emerges
bull Students elect a chair for each PBL scenario and a scribe to record the discussion The roles are rotated for each scenario Suitable flip charts or a whiteboard should be used for recording the proceedings At the start of the session depending on the trigger material either the student chair reads out the scenario or all students study the material If the trigger is a real patient in a ward clinic or surgery then a student may be asked to take a clinical history or identify an abnormal physical sign before the group moves to a tutorial room For each module students may be given a handbook containing the problem scenarios and suggested learning resources or learning materials may be handed out at appropriate times as the tutorials progress
Examples of trigger material for PBL scenarios bull Paper based clinical scenarios bull Experimental or clinical laboratory data bull Photographs bull Video clips bull Newspaper articles bull All or part of an article from a scientific
journal bull A real or simulated patient bull A family tree showing an inherited
disorder
PBL tutorial process ndash Step 1 Identify and clarify unfamiliar terms presented in the scenario
scribe lists those that remain unexplained after discussion ndash Step 2 Define the problem or problems to be discussed students may
have different views on the issues but all should be considered scribe records a list of agreed problems
ndash Step 3 Brainstorming session to discuss the problem(s) suggestingpossible explanations on basis of prior knowledge students draw on each others knowledge and identify areas of incomplete knowledge scribe records all discussion
ndash Step 4 Review steps 2 and 3 and arrange explanations into tentativesolutions scribe organises the explanations and restructures if necessary
ndash Step 5 Formulate learning objectives group reaches consensus onthe learning objectives tutor ensures learning objectives are focused achievable comprehensive and appropriate
ndash Step 6 Private study (all students gather information related to eachlearning objective)
ndash Step 7 Group shares results of private study (students identify theirlearning resources and share their results) tutor checks learning and may assess the group
bull The role of the tutor is to facilitate the proceedings (helping the chair to maintain group dynamics and moving the group through the task) and to ensure that the group achieves appropriate learning objectives in line with those set by the curriculum design team The tutor may need to take a more active role in step 7 of the process to ensure that all the students have done the appropriate work and to help the chair to suggest a suitable format for group members to use to present the results of their private study The tutor should encourage students to check their understanding of the material He or she can do this by encouraging the students to ask open questions and ask each other to explain topics in their own words or by the use of drawings and diagrams
PBL in curriculum design bull PBL may be used either as the mainstay of an entire
curriculum or for the delivery of individual courses In practice PBL is usually part of an integrated curriculum using a systems based approach with non-clinical material delivered in the context of clinical practice A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge skills and attitudes A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios Sufficient time should be allowed each week for students to do the self directed learning required for PBL
bull
Copyright copy2003 BMJ Publishing Group Ltd
Wood D F BMJ 2003326328-330
No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found
Writing PBL scenarios
bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives
bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after
studying the scenario should be consistent with the faculty learning objectives
bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding
bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice
bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge
bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented
bull The problem should be sufficiently open so that discussion is not curtailed too early in the process
bull Scenarios should promote participation by the students in seeking information from various learning resources
bull Adapted from Dolmans et al Med Teacher 199719185-9
Staff development
bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)
A dysfunctional group a dominant character may
make it difficult for other students to be heard
A dysfunctional group a dominant character may make it difficult for other students to be heard
bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties
Advantages of PBL bull Student centred PBLIt fostersactive learning improved
understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks
Disadvantagesbull Tutors who cant teachTutorsenjoy passing on
their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful
Assessment of PBL
bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods
bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL
Conclusion
bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning
bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL
PBL 5 Easy Steps
bull Read the problem
Mrs Paula Embledon
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
2 Brain storm
bull Brainstorm
bull ndash hypotheses
bull - what do we know in support of the hypothesis
bull - what do we need to know to test the hypothesis
ndash learning issues
Brainstorm
bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)
ndash specific issues (for individuals to look up)
ndash overlapping issues
bull 4 Individual Reading - Research - Preparation
bull 5 Return
bull ndash review case so far ndash report and discuss
ndash assess progress - continue pagenext pagecomplete
ndash self-evaluation - How did things go Any suggestions for next time
ndash next problem
bull 5 Return
THE FIRST GROUP SESSION
bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day
bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session
bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr
bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine
bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise
bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator
bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues
bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know
bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)
bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)
bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)
PBL
bull The problem comes first without advance readings lectures or preparation
bull The problem serves as a stimulus for the need to know
Learning Issues
bull Learning issues are questions that cannot be answered with studentsrsquo current knowledge and that can be explored and answered through systematic self-directed inquiry
bull The use of learning issues in tutorials prepares students to handle similar challenges in clinical practice and life-long learning
Learning Issues in PBL First Session1 Getting Started (Introductions Ground
Rules Expectations)2 Identifying Problem3 Exploring Pre-Existing Knowledge4 Generating Hypotheses and Explaining
Mechanisms5 Unfolding the Case Incrementally6 Re-EvaluatingReprioritizing Hypotheses
Based on New Information7 AssessmentReflection
PBL Second Session
8 Independent Self-Directed Study of Learning Issues
PBL Third Session
bull 9 Discussion of Learning Issues and Application of New Knowledge to the Case
bull 10 Continued Unfolding of the Case Incrementally
bull 11 AssessmentReflection
During Tutorial Session students will
1048708 Come prepared to discuss the case and learning issues researched since the last tutorial
1048708 Actively participate in group discussions and contribute to the learning process in a manner that allows for the balanced participation of everyone in the group
1048708 Develop learning issues at each session phrase them as full-sentence questions write them on the board and post them on the course web page
1048708 Consider biological population behaviormental health issuesexplanations and questions of professional attitudes values and ethics related to the patientrsquos problem(s) described in the case
Tutorial Session contd1048708 Go to the board to diagram outline draw etc in
explanation of mechanisms relatedto hypotheses1048708 Debate evidence related to the case and avoid
personal attacks on others1048708 Comply with ground rules with regard to how
the group will function and how itsmembers treat one another1048708 Participate in end-of-session reflection and
assessment by giving and receivingconstructive criticism regarding self tutor
student and group performance
Between Tutorial Session
1048708 Research key learning issues using a variety of resources
1048708 Critically evaluate the credibility of sources and the validity of the information they have obtained in their research
1048708 Integrate what they have learned through research lectures labs clinical skills Perspectives in Medicine (PIM) etc into what is discussed in tutorials
1048708 Synthesize what they have learned and be prepared to discuss it without reading directly from their materials as much as possible and apply it to the case at the next tutorial session
Determine priorities for learning
bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue
bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan
bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge
bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career
PBL Starting the casebull After the introductions and discussion
are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it
bull Reading the case aloud keeps the group focused
bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here
Problem-based learning is designed to develop
1048708 Integrated context-specific knowledge base
1048708 Decision-makingcritical thinking process and skills
1048708 Self-directed life-long learning skills 1048708 Interpersonal collaboration and
communication skills 1048708 Constructive self and peer
assessment skills 1048708 Professional ethics and behavior
PBL Case (contd)
bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session
What is problem based learning
bull In PBL students use triggers from the problem case or scenario to define their own learning objectives
bull Subsequently they do independent self directed study before returning to the group to discuss and refine their acquired knowledge
bull Thus PBL is not about problem solving per se but rather it uses appropriate problems to increase knowledge and understanding
bull The process is clearly defined
PBL
bull PBL uses clinical cases as the context for students to study basic and clinical sciences
bull 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
bull Possible disadvantages include higher costs both in resources and staff time
PBL
bull An educational method characterized by the use of patient problems as a context for students to learn problem-solving skills and acquire knowledge about the basic and clinical sciences
bull Students usually meet in small groups two or three times a week for PBL tutorials
bull They are presented with a clinical problem (eg a patient with chest pain) and in a series of steps they discuss possible mechanisms and causes develop hypotheses and strategies to test the hypotheses are presented with further information and use this new information to refine their hypotheses finally reaching a conclusion
bull A tutor usually acts as a facilitator guiding students in this group-learning process
bull In the course of this exercise students identify both their existing levels and gaps in their knowledge These gaps form the basis for independent learning outside the PBL tutorials The identification and pursuit of these so-called learning goals is a key element of the PBL process
Rationale for using PBL bull The PBL approach is based on principles of adult
education20 and cognitive psychology21 It differs fundamentally from traditional curricula in which students acquire background knowledge of the basic sciences in the early years of the course and in the later years apply this knowledge to the diagnosis and management of clinical problems This traditional approach has been criticised for a number of reasons42223
bull It creates an artificial divide between the basic and clinical sciences
bull Time is wasted in acquiring knowledge that is subsequently forgotten or found to be irrelevant
bull Application of the acquired knowledge can be difficult bull The acquisition and retention of information that has no
apparent relevance can be boring and even demoralising for students
The group learning process acquiring
desirable learning skills
Generic Skills amp attitudes
bull Teamwork bull Critical evaluation of literature bull Chairing a group bull Self directed learning and use of
resources bull Listening Presentation skills
Recording bull Cooperation bull Respect for colleagues views
bull Group learning facilitates not only the acquisition of knowledge but also several other desirable attributes such as communication skills teamwork problem solving independent responsibility for learning sharing information and respect for others PBL can therefore be thought of as a small group teaching method that combines the acquisition of knowledge with the development of generic skills and attitudes Presentation of clinical material as the stimulus for learning enables students to understand the relevance of underlying scientific knowledge and principles in clinical practice
bull when PBL is introduced into a curriculum several other issues for curriculum design and implementation need to be tackled PBL is generally introduced in the context of a defined core curriculum and integration of basic and clinical sciences It has implications for staffing and learning resources and demands a different approach to timetabling workload and assessment PBL is often used to deliver core material in non-clinical parts of the curriculum Paper based PBL scenarios form the basis of the core curriculum and ensure that all students are exposed to the same problems Recently modified PBL techniques have been introduced into clinical education with real patients being used as the stimulus for learning Despite the essential ad hoc nature of learning clinical medicine a key cases approach can enable PBL to be used to deliver the core clinical curriculum
Copyright copy2003 BMJ Publishing Group Ltd
Wood D F BMJ 2003326328-330
No CRoles of participants in a PBL tutorial aption Found
What happens in a PBL tutorial bull PBL tutorials are conducted in several ways In
this article the examples are modelled on the Maastricht seven jump process but its format of seven steps may be shortened
bull A typical PBL tutorial consists of a group of students (usually eight to 10) and a tutor who facilitates the session The length of time (number of sessions) that a group stays together with each other and with individual tutors varies between institutions A group needs to be together long enough to allow good group dynamics to develop but may need to be changed occasionally if personality clashes or other dysfunctional behaviour emerges
bull Students elect a chair for each PBL scenario and a scribe to record the discussion The roles are rotated for each scenario Suitable flip charts or a whiteboard should be used for recording the proceedings At the start of the session depending on the trigger material either the student chair reads out the scenario or all students study the material If the trigger is a real patient in a ward clinic or surgery then a student may be asked to take a clinical history or identify an abnormal physical sign before the group moves to a tutorial room For each module students may be given a handbook containing the problem scenarios and suggested learning resources or learning materials may be handed out at appropriate times as the tutorials progress
Examples of trigger material for PBL scenarios bull Paper based clinical scenarios bull Experimental or clinical laboratory data bull Photographs bull Video clips bull Newspaper articles bull All or part of an article from a scientific
journal bull A real or simulated patient bull A family tree showing an inherited
disorder
PBL tutorial process ndash Step 1 Identify and clarify unfamiliar terms presented in the scenario
scribe lists those that remain unexplained after discussion ndash Step 2 Define the problem or problems to be discussed students may
have different views on the issues but all should be considered scribe records a list of agreed problems
ndash Step 3 Brainstorming session to discuss the problem(s) suggestingpossible explanations on basis of prior knowledge students draw on each others knowledge and identify areas of incomplete knowledge scribe records all discussion
ndash Step 4 Review steps 2 and 3 and arrange explanations into tentativesolutions scribe organises the explanations and restructures if necessary
ndash Step 5 Formulate learning objectives group reaches consensus onthe learning objectives tutor ensures learning objectives are focused achievable comprehensive and appropriate
ndash Step 6 Private study (all students gather information related to eachlearning objective)
ndash Step 7 Group shares results of private study (students identify theirlearning resources and share their results) tutor checks learning and may assess the group
bull The role of the tutor is to facilitate the proceedings (helping the chair to maintain group dynamics and moving the group through the task) and to ensure that the group achieves appropriate learning objectives in line with those set by the curriculum design team The tutor may need to take a more active role in step 7 of the process to ensure that all the students have done the appropriate work and to help the chair to suggest a suitable format for group members to use to present the results of their private study The tutor should encourage students to check their understanding of the material He or she can do this by encouraging the students to ask open questions and ask each other to explain topics in their own words or by the use of drawings and diagrams
PBL in curriculum design bull PBL may be used either as the mainstay of an entire
curriculum or for the delivery of individual courses In practice PBL is usually part of an integrated curriculum using a systems based approach with non-clinical material delivered in the context of clinical practice A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge skills and attitudes A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios Sufficient time should be allowed each week for students to do the self directed learning required for PBL
bull
Copyright copy2003 BMJ Publishing Group Ltd
Wood D F BMJ 2003326328-330
No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found
Writing PBL scenarios
bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives
bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after
studying the scenario should be consistent with the faculty learning objectives
bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding
bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice
bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge
bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented
bull The problem should be sufficiently open so that discussion is not curtailed too early in the process
bull Scenarios should promote participation by the students in seeking information from various learning resources
bull Adapted from Dolmans et al Med Teacher 199719185-9
Staff development
bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)
A dysfunctional group a dominant character may
make it difficult for other students to be heard
A dysfunctional group a dominant character may make it difficult for other students to be heard
bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties
Advantages of PBL bull Student centred PBLIt fostersactive learning improved
understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks
Disadvantagesbull Tutors who cant teachTutorsenjoy passing on
their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful
Assessment of PBL
bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods
bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL
Conclusion
bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning
bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL
PBL 5 Easy Steps
bull Read the problem
Mrs Paula Embledon
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
2 Brain storm
bull Brainstorm
bull ndash hypotheses
bull - what do we know in support of the hypothesis
bull - what do we need to know to test the hypothesis
ndash learning issues
Brainstorm
bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)
ndash specific issues (for individuals to look up)
ndash overlapping issues
bull 4 Individual Reading - Research - Preparation
bull 5 Return
bull ndash review case so far ndash report and discuss
ndash assess progress - continue pagenext pagecomplete
ndash self-evaluation - How did things go Any suggestions for next time
ndash next problem
bull 5 Return
THE FIRST GROUP SESSION
bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day
bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session
bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr
bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine
bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise
bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator
bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues
bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know
bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)
bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)
bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)
Learning Issues
bull Learning issues are questions that cannot be answered with studentsrsquo current knowledge and that can be explored and answered through systematic self-directed inquiry
bull The use of learning issues in tutorials prepares students to handle similar challenges in clinical practice and life-long learning
Learning Issues in PBL First Session1 Getting Started (Introductions Ground
Rules Expectations)2 Identifying Problem3 Exploring Pre-Existing Knowledge4 Generating Hypotheses and Explaining
Mechanisms5 Unfolding the Case Incrementally6 Re-EvaluatingReprioritizing Hypotheses
Based on New Information7 AssessmentReflection
PBL Second Session
8 Independent Self-Directed Study of Learning Issues
PBL Third Session
bull 9 Discussion of Learning Issues and Application of New Knowledge to the Case
bull 10 Continued Unfolding of the Case Incrementally
bull 11 AssessmentReflection
During Tutorial Session students will
1048708 Come prepared to discuss the case and learning issues researched since the last tutorial
1048708 Actively participate in group discussions and contribute to the learning process in a manner that allows for the balanced participation of everyone in the group
1048708 Develop learning issues at each session phrase them as full-sentence questions write them on the board and post them on the course web page
1048708 Consider biological population behaviormental health issuesexplanations and questions of professional attitudes values and ethics related to the patientrsquos problem(s) described in the case
Tutorial Session contd1048708 Go to the board to diagram outline draw etc in
explanation of mechanisms relatedto hypotheses1048708 Debate evidence related to the case and avoid
personal attacks on others1048708 Comply with ground rules with regard to how
the group will function and how itsmembers treat one another1048708 Participate in end-of-session reflection and
assessment by giving and receivingconstructive criticism regarding self tutor
student and group performance
Between Tutorial Session
1048708 Research key learning issues using a variety of resources
1048708 Critically evaluate the credibility of sources and the validity of the information they have obtained in their research
1048708 Integrate what they have learned through research lectures labs clinical skills Perspectives in Medicine (PIM) etc into what is discussed in tutorials
1048708 Synthesize what they have learned and be prepared to discuss it without reading directly from their materials as much as possible and apply it to the case at the next tutorial session
Determine priorities for learning
bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue
bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan
bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge
bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career
PBL Starting the casebull After the introductions and discussion
are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it
bull Reading the case aloud keeps the group focused
bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here
Problem-based learning is designed to develop
1048708 Integrated context-specific knowledge base
1048708 Decision-makingcritical thinking process and skills
1048708 Self-directed life-long learning skills 1048708 Interpersonal collaboration and
communication skills 1048708 Constructive self and peer
assessment skills 1048708 Professional ethics and behavior
PBL Case (contd)
bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session
What is problem based learning
bull In PBL students use triggers from the problem case or scenario to define their own learning objectives
bull Subsequently they do independent self directed study before returning to the group to discuss and refine their acquired knowledge
bull Thus PBL is not about problem solving per se but rather it uses appropriate problems to increase knowledge and understanding
bull The process is clearly defined
PBL
bull PBL uses clinical cases as the context for students to study basic and clinical sciences
bull 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
bull Possible disadvantages include higher costs both in resources and staff time
PBL
bull An educational method characterized by the use of patient problems as a context for students to learn problem-solving skills and acquire knowledge about the basic and clinical sciences
bull Students usually meet in small groups two or three times a week for PBL tutorials
bull They are presented with a clinical problem (eg a patient with chest pain) and in a series of steps they discuss possible mechanisms and causes develop hypotheses and strategies to test the hypotheses are presented with further information and use this new information to refine their hypotheses finally reaching a conclusion
bull A tutor usually acts as a facilitator guiding students in this group-learning process
bull In the course of this exercise students identify both their existing levels and gaps in their knowledge These gaps form the basis for independent learning outside the PBL tutorials The identification and pursuit of these so-called learning goals is a key element of the PBL process
Rationale for using PBL bull The PBL approach is based on principles of adult
education20 and cognitive psychology21 It differs fundamentally from traditional curricula in which students acquire background knowledge of the basic sciences in the early years of the course and in the later years apply this knowledge to the diagnosis and management of clinical problems This traditional approach has been criticised for a number of reasons42223
bull It creates an artificial divide between the basic and clinical sciences
bull Time is wasted in acquiring knowledge that is subsequently forgotten or found to be irrelevant
bull Application of the acquired knowledge can be difficult bull The acquisition and retention of information that has no
apparent relevance can be boring and even demoralising for students
The group learning process acquiring
desirable learning skills
Generic Skills amp attitudes
bull Teamwork bull Critical evaluation of literature bull Chairing a group bull Self directed learning and use of
resources bull Listening Presentation skills
Recording bull Cooperation bull Respect for colleagues views
bull Group learning facilitates not only the acquisition of knowledge but also several other desirable attributes such as communication skills teamwork problem solving independent responsibility for learning sharing information and respect for others PBL can therefore be thought of as a small group teaching method that combines the acquisition of knowledge with the development of generic skills and attitudes Presentation of clinical material as the stimulus for learning enables students to understand the relevance of underlying scientific knowledge and principles in clinical practice
bull when PBL is introduced into a curriculum several other issues for curriculum design and implementation need to be tackled PBL is generally introduced in the context of a defined core curriculum and integration of basic and clinical sciences It has implications for staffing and learning resources and demands a different approach to timetabling workload and assessment PBL is often used to deliver core material in non-clinical parts of the curriculum Paper based PBL scenarios form the basis of the core curriculum and ensure that all students are exposed to the same problems Recently modified PBL techniques have been introduced into clinical education with real patients being used as the stimulus for learning Despite the essential ad hoc nature of learning clinical medicine a key cases approach can enable PBL to be used to deliver the core clinical curriculum
Copyright copy2003 BMJ Publishing Group Ltd
Wood D F BMJ 2003326328-330
No CRoles of participants in a PBL tutorial aption Found
What happens in a PBL tutorial bull PBL tutorials are conducted in several ways In
this article the examples are modelled on the Maastricht seven jump process but its format of seven steps may be shortened
bull A typical PBL tutorial consists of a group of students (usually eight to 10) and a tutor who facilitates the session The length of time (number of sessions) that a group stays together with each other and with individual tutors varies between institutions A group needs to be together long enough to allow good group dynamics to develop but may need to be changed occasionally if personality clashes or other dysfunctional behaviour emerges
bull Students elect a chair for each PBL scenario and a scribe to record the discussion The roles are rotated for each scenario Suitable flip charts or a whiteboard should be used for recording the proceedings At the start of the session depending on the trigger material either the student chair reads out the scenario or all students study the material If the trigger is a real patient in a ward clinic or surgery then a student may be asked to take a clinical history or identify an abnormal physical sign before the group moves to a tutorial room For each module students may be given a handbook containing the problem scenarios and suggested learning resources or learning materials may be handed out at appropriate times as the tutorials progress
Examples of trigger material for PBL scenarios bull Paper based clinical scenarios bull Experimental or clinical laboratory data bull Photographs bull Video clips bull Newspaper articles bull All or part of an article from a scientific
journal bull A real or simulated patient bull A family tree showing an inherited
disorder
PBL tutorial process ndash Step 1 Identify and clarify unfamiliar terms presented in the scenario
scribe lists those that remain unexplained after discussion ndash Step 2 Define the problem or problems to be discussed students may
have different views on the issues but all should be considered scribe records a list of agreed problems
ndash Step 3 Brainstorming session to discuss the problem(s) suggestingpossible explanations on basis of prior knowledge students draw on each others knowledge and identify areas of incomplete knowledge scribe records all discussion
ndash Step 4 Review steps 2 and 3 and arrange explanations into tentativesolutions scribe organises the explanations and restructures if necessary
ndash Step 5 Formulate learning objectives group reaches consensus onthe learning objectives tutor ensures learning objectives are focused achievable comprehensive and appropriate
ndash Step 6 Private study (all students gather information related to eachlearning objective)
ndash Step 7 Group shares results of private study (students identify theirlearning resources and share their results) tutor checks learning and may assess the group
bull The role of the tutor is to facilitate the proceedings (helping the chair to maintain group dynamics and moving the group through the task) and to ensure that the group achieves appropriate learning objectives in line with those set by the curriculum design team The tutor may need to take a more active role in step 7 of the process to ensure that all the students have done the appropriate work and to help the chair to suggest a suitable format for group members to use to present the results of their private study The tutor should encourage students to check their understanding of the material He or she can do this by encouraging the students to ask open questions and ask each other to explain topics in their own words or by the use of drawings and diagrams
PBL in curriculum design bull PBL may be used either as the mainstay of an entire
curriculum or for the delivery of individual courses In practice PBL is usually part of an integrated curriculum using a systems based approach with non-clinical material delivered in the context of clinical practice A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge skills and attitudes A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios Sufficient time should be allowed each week for students to do the self directed learning required for PBL
bull
Copyright copy2003 BMJ Publishing Group Ltd
Wood D F BMJ 2003326328-330
No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found
Writing PBL scenarios
bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives
bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after
studying the scenario should be consistent with the faculty learning objectives
bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding
bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice
bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge
bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented
bull The problem should be sufficiently open so that discussion is not curtailed too early in the process
bull Scenarios should promote participation by the students in seeking information from various learning resources
bull Adapted from Dolmans et al Med Teacher 199719185-9
Staff development
bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)
A dysfunctional group a dominant character may
make it difficult for other students to be heard
A dysfunctional group a dominant character may make it difficult for other students to be heard
bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties
Advantages of PBL bull Student centred PBLIt fostersactive learning improved
understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks
Disadvantagesbull Tutors who cant teachTutorsenjoy passing on
their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful
Assessment of PBL
bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods
bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL
Conclusion
bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning
bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL
PBL 5 Easy Steps
bull Read the problem
Mrs Paula Embledon
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
2 Brain storm
bull Brainstorm
bull ndash hypotheses
bull - what do we know in support of the hypothesis
bull - what do we need to know to test the hypothesis
ndash learning issues
Brainstorm
bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)
ndash specific issues (for individuals to look up)
ndash overlapping issues
bull 4 Individual Reading - Research - Preparation
bull 5 Return
bull ndash review case so far ndash report and discuss
ndash assess progress - continue pagenext pagecomplete
ndash self-evaluation - How did things go Any suggestions for next time
ndash next problem
bull 5 Return
THE FIRST GROUP SESSION
bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day
bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session
bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr
bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine
bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise
bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator
bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues
bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know
bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)
bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)
bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)
Learning Issues in PBL First Session1 Getting Started (Introductions Ground
Rules Expectations)2 Identifying Problem3 Exploring Pre-Existing Knowledge4 Generating Hypotheses and Explaining
Mechanisms5 Unfolding the Case Incrementally6 Re-EvaluatingReprioritizing Hypotheses
Based on New Information7 AssessmentReflection
PBL Second Session
8 Independent Self-Directed Study of Learning Issues
PBL Third Session
bull 9 Discussion of Learning Issues and Application of New Knowledge to the Case
bull 10 Continued Unfolding of the Case Incrementally
bull 11 AssessmentReflection
During Tutorial Session students will
1048708 Come prepared to discuss the case and learning issues researched since the last tutorial
1048708 Actively participate in group discussions and contribute to the learning process in a manner that allows for the balanced participation of everyone in the group
1048708 Develop learning issues at each session phrase them as full-sentence questions write them on the board and post them on the course web page
1048708 Consider biological population behaviormental health issuesexplanations and questions of professional attitudes values and ethics related to the patientrsquos problem(s) described in the case
Tutorial Session contd1048708 Go to the board to diagram outline draw etc in
explanation of mechanisms relatedto hypotheses1048708 Debate evidence related to the case and avoid
personal attacks on others1048708 Comply with ground rules with regard to how
the group will function and how itsmembers treat one another1048708 Participate in end-of-session reflection and
assessment by giving and receivingconstructive criticism regarding self tutor
student and group performance
Between Tutorial Session
1048708 Research key learning issues using a variety of resources
1048708 Critically evaluate the credibility of sources and the validity of the information they have obtained in their research
1048708 Integrate what they have learned through research lectures labs clinical skills Perspectives in Medicine (PIM) etc into what is discussed in tutorials
1048708 Synthesize what they have learned and be prepared to discuss it without reading directly from their materials as much as possible and apply it to the case at the next tutorial session
Determine priorities for learning
bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue
bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan
bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge
bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career
PBL Starting the casebull After the introductions and discussion
are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it
bull Reading the case aloud keeps the group focused
bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here
Problem-based learning is designed to develop
1048708 Integrated context-specific knowledge base
1048708 Decision-makingcritical thinking process and skills
1048708 Self-directed life-long learning skills 1048708 Interpersonal collaboration and
communication skills 1048708 Constructive self and peer
assessment skills 1048708 Professional ethics and behavior
PBL Case (contd)
bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session
What is problem based learning
bull In PBL students use triggers from the problem case or scenario to define their own learning objectives
bull Subsequently they do independent self directed study before returning to the group to discuss and refine their acquired knowledge
bull Thus PBL is not about problem solving per se but rather it uses appropriate problems to increase knowledge and understanding
bull The process is clearly defined
PBL
bull PBL uses clinical cases as the context for students to study basic and clinical sciences
bull 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
bull Possible disadvantages include higher costs both in resources and staff time
PBL
bull An educational method characterized by the use of patient problems as a context for students to learn problem-solving skills and acquire knowledge about the basic and clinical sciences
bull Students usually meet in small groups two or three times a week for PBL tutorials
bull They are presented with a clinical problem (eg a patient with chest pain) and in a series of steps they discuss possible mechanisms and causes develop hypotheses and strategies to test the hypotheses are presented with further information and use this new information to refine their hypotheses finally reaching a conclusion
bull A tutor usually acts as a facilitator guiding students in this group-learning process
bull In the course of this exercise students identify both their existing levels and gaps in their knowledge These gaps form the basis for independent learning outside the PBL tutorials The identification and pursuit of these so-called learning goals is a key element of the PBL process
Rationale for using PBL bull The PBL approach is based on principles of adult
education20 and cognitive psychology21 It differs fundamentally from traditional curricula in which students acquire background knowledge of the basic sciences in the early years of the course and in the later years apply this knowledge to the diagnosis and management of clinical problems This traditional approach has been criticised for a number of reasons42223
bull It creates an artificial divide between the basic and clinical sciences
bull Time is wasted in acquiring knowledge that is subsequently forgotten or found to be irrelevant
bull Application of the acquired knowledge can be difficult bull The acquisition and retention of information that has no
apparent relevance can be boring and even demoralising for students
The group learning process acquiring
desirable learning skills
Generic Skills amp attitudes
bull Teamwork bull Critical evaluation of literature bull Chairing a group bull Self directed learning and use of
resources bull Listening Presentation skills
Recording bull Cooperation bull Respect for colleagues views
bull Group learning facilitates not only the acquisition of knowledge but also several other desirable attributes such as communication skills teamwork problem solving independent responsibility for learning sharing information and respect for others PBL can therefore be thought of as a small group teaching method that combines the acquisition of knowledge with the development of generic skills and attitudes Presentation of clinical material as the stimulus for learning enables students to understand the relevance of underlying scientific knowledge and principles in clinical practice
bull when PBL is introduced into a curriculum several other issues for curriculum design and implementation need to be tackled PBL is generally introduced in the context of a defined core curriculum and integration of basic and clinical sciences It has implications for staffing and learning resources and demands a different approach to timetabling workload and assessment PBL is often used to deliver core material in non-clinical parts of the curriculum Paper based PBL scenarios form the basis of the core curriculum and ensure that all students are exposed to the same problems Recently modified PBL techniques have been introduced into clinical education with real patients being used as the stimulus for learning Despite the essential ad hoc nature of learning clinical medicine a key cases approach can enable PBL to be used to deliver the core clinical curriculum
Copyright copy2003 BMJ Publishing Group Ltd
Wood D F BMJ 2003326328-330
No CRoles of participants in a PBL tutorial aption Found
What happens in a PBL tutorial bull PBL tutorials are conducted in several ways In
this article the examples are modelled on the Maastricht seven jump process but its format of seven steps may be shortened
bull A typical PBL tutorial consists of a group of students (usually eight to 10) and a tutor who facilitates the session The length of time (number of sessions) that a group stays together with each other and with individual tutors varies between institutions A group needs to be together long enough to allow good group dynamics to develop but may need to be changed occasionally if personality clashes or other dysfunctional behaviour emerges
bull Students elect a chair for each PBL scenario and a scribe to record the discussion The roles are rotated for each scenario Suitable flip charts or a whiteboard should be used for recording the proceedings At the start of the session depending on the trigger material either the student chair reads out the scenario or all students study the material If the trigger is a real patient in a ward clinic or surgery then a student may be asked to take a clinical history or identify an abnormal physical sign before the group moves to a tutorial room For each module students may be given a handbook containing the problem scenarios and suggested learning resources or learning materials may be handed out at appropriate times as the tutorials progress
Examples of trigger material for PBL scenarios bull Paper based clinical scenarios bull Experimental or clinical laboratory data bull Photographs bull Video clips bull Newspaper articles bull All or part of an article from a scientific
journal bull A real or simulated patient bull A family tree showing an inherited
disorder
PBL tutorial process ndash Step 1 Identify and clarify unfamiliar terms presented in the scenario
scribe lists those that remain unexplained after discussion ndash Step 2 Define the problem or problems to be discussed students may
have different views on the issues but all should be considered scribe records a list of agreed problems
ndash Step 3 Brainstorming session to discuss the problem(s) suggestingpossible explanations on basis of prior knowledge students draw on each others knowledge and identify areas of incomplete knowledge scribe records all discussion
ndash Step 4 Review steps 2 and 3 and arrange explanations into tentativesolutions scribe organises the explanations and restructures if necessary
ndash Step 5 Formulate learning objectives group reaches consensus onthe learning objectives tutor ensures learning objectives are focused achievable comprehensive and appropriate
ndash Step 6 Private study (all students gather information related to eachlearning objective)
ndash Step 7 Group shares results of private study (students identify theirlearning resources and share their results) tutor checks learning and may assess the group
bull The role of the tutor is to facilitate the proceedings (helping the chair to maintain group dynamics and moving the group through the task) and to ensure that the group achieves appropriate learning objectives in line with those set by the curriculum design team The tutor may need to take a more active role in step 7 of the process to ensure that all the students have done the appropriate work and to help the chair to suggest a suitable format for group members to use to present the results of their private study The tutor should encourage students to check their understanding of the material He or she can do this by encouraging the students to ask open questions and ask each other to explain topics in their own words or by the use of drawings and diagrams
PBL in curriculum design bull PBL may be used either as the mainstay of an entire
curriculum or for the delivery of individual courses In practice PBL is usually part of an integrated curriculum using a systems based approach with non-clinical material delivered in the context of clinical practice A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge skills and attitudes A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios Sufficient time should be allowed each week for students to do the self directed learning required for PBL
bull
Copyright copy2003 BMJ Publishing Group Ltd
Wood D F BMJ 2003326328-330
No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found
Writing PBL scenarios
bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives
bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after
studying the scenario should be consistent with the faculty learning objectives
bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding
bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice
bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge
bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented
bull The problem should be sufficiently open so that discussion is not curtailed too early in the process
bull Scenarios should promote participation by the students in seeking information from various learning resources
bull Adapted from Dolmans et al Med Teacher 199719185-9
Staff development
bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)
A dysfunctional group a dominant character may
make it difficult for other students to be heard
A dysfunctional group a dominant character may make it difficult for other students to be heard
bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties
Advantages of PBL bull Student centred PBLIt fostersactive learning improved
understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks
Disadvantagesbull Tutors who cant teachTutorsenjoy passing on
their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful
Assessment of PBL
bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods
bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL
Conclusion
bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning
bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL
PBL 5 Easy Steps
bull Read the problem
Mrs Paula Embledon
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
2 Brain storm
bull Brainstorm
bull ndash hypotheses
bull - what do we know in support of the hypothesis
bull - what do we need to know to test the hypothesis
ndash learning issues
Brainstorm
bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)
ndash specific issues (for individuals to look up)
ndash overlapping issues
bull 4 Individual Reading - Research - Preparation
bull 5 Return
bull ndash review case so far ndash report and discuss
ndash assess progress - continue pagenext pagecomplete
ndash self-evaluation - How did things go Any suggestions for next time
ndash next problem
bull 5 Return
THE FIRST GROUP SESSION
bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day
bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session
bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr
bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine
bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise
bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator
bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues
bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know
bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)
bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)
bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)
PBL Second Session
8 Independent Self-Directed Study of Learning Issues
PBL Third Session
bull 9 Discussion of Learning Issues and Application of New Knowledge to the Case
bull 10 Continued Unfolding of the Case Incrementally
bull 11 AssessmentReflection
During Tutorial Session students will
1048708 Come prepared to discuss the case and learning issues researched since the last tutorial
1048708 Actively participate in group discussions and contribute to the learning process in a manner that allows for the balanced participation of everyone in the group
1048708 Develop learning issues at each session phrase them as full-sentence questions write them on the board and post them on the course web page
1048708 Consider biological population behaviormental health issuesexplanations and questions of professional attitudes values and ethics related to the patientrsquos problem(s) described in the case
Tutorial Session contd1048708 Go to the board to diagram outline draw etc in
explanation of mechanisms relatedto hypotheses1048708 Debate evidence related to the case and avoid
personal attacks on others1048708 Comply with ground rules with regard to how
the group will function and how itsmembers treat one another1048708 Participate in end-of-session reflection and
assessment by giving and receivingconstructive criticism regarding self tutor
student and group performance
Between Tutorial Session
1048708 Research key learning issues using a variety of resources
1048708 Critically evaluate the credibility of sources and the validity of the information they have obtained in their research
1048708 Integrate what they have learned through research lectures labs clinical skills Perspectives in Medicine (PIM) etc into what is discussed in tutorials
1048708 Synthesize what they have learned and be prepared to discuss it without reading directly from their materials as much as possible and apply it to the case at the next tutorial session
Determine priorities for learning
bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue
bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan
bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge
bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career
PBL Starting the casebull After the introductions and discussion
are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it
bull Reading the case aloud keeps the group focused
bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here
Problem-based learning is designed to develop
1048708 Integrated context-specific knowledge base
1048708 Decision-makingcritical thinking process and skills
1048708 Self-directed life-long learning skills 1048708 Interpersonal collaboration and
communication skills 1048708 Constructive self and peer
assessment skills 1048708 Professional ethics and behavior
PBL Case (contd)
bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session
What is problem based learning
bull In PBL students use triggers from the problem case or scenario to define their own learning objectives
bull Subsequently they do independent self directed study before returning to the group to discuss and refine their acquired knowledge
bull Thus PBL is not about problem solving per se but rather it uses appropriate problems to increase knowledge and understanding
bull The process is clearly defined
PBL
bull PBL uses clinical cases as the context for students to study basic and clinical sciences
bull 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
bull Possible disadvantages include higher costs both in resources and staff time
PBL
bull An educational method characterized by the use of patient problems as a context for students to learn problem-solving skills and acquire knowledge about the basic and clinical sciences
bull Students usually meet in small groups two or three times a week for PBL tutorials
bull They are presented with a clinical problem (eg a patient with chest pain) and in a series of steps they discuss possible mechanisms and causes develop hypotheses and strategies to test the hypotheses are presented with further information and use this new information to refine their hypotheses finally reaching a conclusion
bull A tutor usually acts as a facilitator guiding students in this group-learning process
bull In the course of this exercise students identify both their existing levels and gaps in their knowledge These gaps form the basis for independent learning outside the PBL tutorials The identification and pursuit of these so-called learning goals is a key element of the PBL process
Rationale for using PBL bull The PBL approach is based on principles of adult
education20 and cognitive psychology21 It differs fundamentally from traditional curricula in which students acquire background knowledge of the basic sciences in the early years of the course and in the later years apply this knowledge to the diagnosis and management of clinical problems This traditional approach has been criticised for a number of reasons42223
bull It creates an artificial divide between the basic and clinical sciences
bull Time is wasted in acquiring knowledge that is subsequently forgotten or found to be irrelevant
bull Application of the acquired knowledge can be difficult bull The acquisition and retention of information that has no
apparent relevance can be boring and even demoralising for students
The group learning process acquiring
desirable learning skills
Generic Skills amp attitudes
bull Teamwork bull Critical evaluation of literature bull Chairing a group bull Self directed learning and use of
resources bull Listening Presentation skills
Recording bull Cooperation bull Respect for colleagues views
bull Group learning facilitates not only the acquisition of knowledge but also several other desirable attributes such as communication skills teamwork problem solving independent responsibility for learning sharing information and respect for others PBL can therefore be thought of as a small group teaching method that combines the acquisition of knowledge with the development of generic skills and attitudes Presentation of clinical material as the stimulus for learning enables students to understand the relevance of underlying scientific knowledge and principles in clinical practice
bull when PBL is introduced into a curriculum several other issues for curriculum design and implementation need to be tackled PBL is generally introduced in the context of a defined core curriculum and integration of basic and clinical sciences It has implications for staffing and learning resources and demands a different approach to timetabling workload and assessment PBL is often used to deliver core material in non-clinical parts of the curriculum Paper based PBL scenarios form the basis of the core curriculum and ensure that all students are exposed to the same problems Recently modified PBL techniques have been introduced into clinical education with real patients being used as the stimulus for learning Despite the essential ad hoc nature of learning clinical medicine a key cases approach can enable PBL to be used to deliver the core clinical curriculum
Copyright copy2003 BMJ Publishing Group Ltd
Wood D F BMJ 2003326328-330
No CRoles of participants in a PBL tutorial aption Found
What happens in a PBL tutorial bull PBL tutorials are conducted in several ways In
this article the examples are modelled on the Maastricht seven jump process but its format of seven steps may be shortened
bull A typical PBL tutorial consists of a group of students (usually eight to 10) and a tutor who facilitates the session The length of time (number of sessions) that a group stays together with each other and with individual tutors varies between institutions A group needs to be together long enough to allow good group dynamics to develop but may need to be changed occasionally if personality clashes or other dysfunctional behaviour emerges
bull Students elect a chair for each PBL scenario and a scribe to record the discussion The roles are rotated for each scenario Suitable flip charts or a whiteboard should be used for recording the proceedings At the start of the session depending on the trigger material either the student chair reads out the scenario or all students study the material If the trigger is a real patient in a ward clinic or surgery then a student may be asked to take a clinical history or identify an abnormal physical sign before the group moves to a tutorial room For each module students may be given a handbook containing the problem scenarios and suggested learning resources or learning materials may be handed out at appropriate times as the tutorials progress
Examples of trigger material for PBL scenarios bull Paper based clinical scenarios bull Experimental or clinical laboratory data bull Photographs bull Video clips bull Newspaper articles bull All or part of an article from a scientific
journal bull A real or simulated patient bull A family tree showing an inherited
disorder
PBL tutorial process ndash Step 1 Identify and clarify unfamiliar terms presented in the scenario
scribe lists those that remain unexplained after discussion ndash Step 2 Define the problem or problems to be discussed students may
have different views on the issues but all should be considered scribe records a list of agreed problems
ndash Step 3 Brainstorming session to discuss the problem(s) suggestingpossible explanations on basis of prior knowledge students draw on each others knowledge and identify areas of incomplete knowledge scribe records all discussion
ndash Step 4 Review steps 2 and 3 and arrange explanations into tentativesolutions scribe organises the explanations and restructures if necessary
ndash Step 5 Formulate learning objectives group reaches consensus onthe learning objectives tutor ensures learning objectives are focused achievable comprehensive and appropriate
ndash Step 6 Private study (all students gather information related to eachlearning objective)
ndash Step 7 Group shares results of private study (students identify theirlearning resources and share their results) tutor checks learning and may assess the group
bull The role of the tutor is to facilitate the proceedings (helping the chair to maintain group dynamics and moving the group through the task) and to ensure that the group achieves appropriate learning objectives in line with those set by the curriculum design team The tutor may need to take a more active role in step 7 of the process to ensure that all the students have done the appropriate work and to help the chair to suggest a suitable format for group members to use to present the results of their private study The tutor should encourage students to check their understanding of the material He or she can do this by encouraging the students to ask open questions and ask each other to explain topics in their own words or by the use of drawings and diagrams
PBL in curriculum design bull PBL may be used either as the mainstay of an entire
curriculum or for the delivery of individual courses In practice PBL is usually part of an integrated curriculum using a systems based approach with non-clinical material delivered in the context of clinical practice A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge skills and attitudes A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios Sufficient time should be allowed each week for students to do the self directed learning required for PBL
bull
Copyright copy2003 BMJ Publishing Group Ltd
Wood D F BMJ 2003326328-330
No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found
Writing PBL scenarios
bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives
bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after
studying the scenario should be consistent with the faculty learning objectives
bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding
bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice
bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge
bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented
bull The problem should be sufficiently open so that discussion is not curtailed too early in the process
bull Scenarios should promote participation by the students in seeking information from various learning resources
bull Adapted from Dolmans et al Med Teacher 199719185-9
Staff development
bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)
A dysfunctional group a dominant character may
make it difficult for other students to be heard
A dysfunctional group a dominant character may make it difficult for other students to be heard
bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties
Advantages of PBL bull Student centred PBLIt fostersactive learning improved
understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks
Disadvantagesbull Tutors who cant teachTutorsenjoy passing on
their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful
Assessment of PBL
bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods
bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL
Conclusion
bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning
bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL
PBL 5 Easy Steps
bull Read the problem
Mrs Paula Embledon
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
2 Brain storm
bull Brainstorm
bull ndash hypotheses
bull - what do we know in support of the hypothesis
bull - what do we need to know to test the hypothesis
ndash learning issues
Brainstorm
bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)
ndash specific issues (for individuals to look up)
ndash overlapping issues
bull 4 Individual Reading - Research - Preparation
bull 5 Return
bull ndash review case so far ndash report and discuss
ndash assess progress - continue pagenext pagecomplete
ndash self-evaluation - How did things go Any suggestions for next time
ndash next problem
bull 5 Return
THE FIRST GROUP SESSION
bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day
bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session
bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr
bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine
bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise
bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator
bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues
bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know
bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)
bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)
bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)
PBL Third Session
bull 9 Discussion of Learning Issues and Application of New Knowledge to the Case
bull 10 Continued Unfolding of the Case Incrementally
bull 11 AssessmentReflection
During Tutorial Session students will
1048708 Come prepared to discuss the case and learning issues researched since the last tutorial
1048708 Actively participate in group discussions and contribute to the learning process in a manner that allows for the balanced participation of everyone in the group
1048708 Develop learning issues at each session phrase them as full-sentence questions write them on the board and post them on the course web page
1048708 Consider biological population behaviormental health issuesexplanations and questions of professional attitudes values and ethics related to the patientrsquos problem(s) described in the case
Tutorial Session contd1048708 Go to the board to diagram outline draw etc in
explanation of mechanisms relatedto hypotheses1048708 Debate evidence related to the case and avoid
personal attacks on others1048708 Comply with ground rules with regard to how
the group will function and how itsmembers treat one another1048708 Participate in end-of-session reflection and
assessment by giving and receivingconstructive criticism regarding self tutor
student and group performance
Between Tutorial Session
1048708 Research key learning issues using a variety of resources
1048708 Critically evaluate the credibility of sources and the validity of the information they have obtained in their research
1048708 Integrate what they have learned through research lectures labs clinical skills Perspectives in Medicine (PIM) etc into what is discussed in tutorials
1048708 Synthesize what they have learned and be prepared to discuss it without reading directly from their materials as much as possible and apply it to the case at the next tutorial session
Determine priorities for learning
bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue
bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan
bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge
bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career
PBL Starting the casebull After the introductions and discussion
are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it
bull Reading the case aloud keeps the group focused
bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here
Problem-based learning is designed to develop
1048708 Integrated context-specific knowledge base
1048708 Decision-makingcritical thinking process and skills
1048708 Self-directed life-long learning skills 1048708 Interpersonal collaboration and
communication skills 1048708 Constructive self and peer
assessment skills 1048708 Professional ethics and behavior
PBL Case (contd)
bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session
What is problem based learning
bull In PBL students use triggers from the problem case or scenario to define their own learning objectives
bull Subsequently they do independent self directed study before returning to the group to discuss and refine their acquired knowledge
bull Thus PBL is not about problem solving per se but rather it uses appropriate problems to increase knowledge and understanding
bull The process is clearly defined
PBL
bull PBL uses clinical cases as the context for students to study basic and clinical sciences
bull 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
bull Possible disadvantages include higher costs both in resources and staff time
PBL
bull An educational method characterized by the use of patient problems as a context for students to learn problem-solving skills and acquire knowledge about the basic and clinical sciences
bull Students usually meet in small groups two or three times a week for PBL tutorials
bull They are presented with a clinical problem (eg a patient with chest pain) and in a series of steps they discuss possible mechanisms and causes develop hypotheses and strategies to test the hypotheses are presented with further information and use this new information to refine their hypotheses finally reaching a conclusion
bull A tutor usually acts as a facilitator guiding students in this group-learning process
bull In the course of this exercise students identify both their existing levels and gaps in their knowledge These gaps form the basis for independent learning outside the PBL tutorials The identification and pursuit of these so-called learning goals is a key element of the PBL process
Rationale for using PBL bull The PBL approach is based on principles of adult
education20 and cognitive psychology21 It differs fundamentally from traditional curricula in which students acquire background knowledge of the basic sciences in the early years of the course and in the later years apply this knowledge to the diagnosis and management of clinical problems This traditional approach has been criticised for a number of reasons42223
bull It creates an artificial divide between the basic and clinical sciences
bull Time is wasted in acquiring knowledge that is subsequently forgotten or found to be irrelevant
bull Application of the acquired knowledge can be difficult bull The acquisition and retention of information that has no
apparent relevance can be boring and even demoralising for students
The group learning process acquiring
desirable learning skills
Generic Skills amp attitudes
bull Teamwork bull Critical evaluation of literature bull Chairing a group bull Self directed learning and use of
resources bull Listening Presentation skills
Recording bull Cooperation bull Respect for colleagues views
bull Group learning facilitates not only the acquisition of knowledge but also several other desirable attributes such as communication skills teamwork problem solving independent responsibility for learning sharing information and respect for others PBL can therefore be thought of as a small group teaching method that combines the acquisition of knowledge with the development of generic skills and attitudes Presentation of clinical material as the stimulus for learning enables students to understand the relevance of underlying scientific knowledge and principles in clinical practice
bull when PBL is introduced into a curriculum several other issues for curriculum design and implementation need to be tackled PBL is generally introduced in the context of a defined core curriculum and integration of basic and clinical sciences It has implications for staffing and learning resources and demands a different approach to timetabling workload and assessment PBL is often used to deliver core material in non-clinical parts of the curriculum Paper based PBL scenarios form the basis of the core curriculum and ensure that all students are exposed to the same problems Recently modified PBL techniques have been introduced into clinical education with real patients being used as the stimulus for learning Despite the essential ad hoc nature of learning clinical medicine a key cases approach can enable PBL to be used to deliver the core clinical curriculum
Copyright copy2003 BMJ Publishing Group Ltd
Wood D F BMJ 2003326328-330
No CRoles of participants in a PBL tutorial aption Found
What happens in a PBL tutorial bull PBL tutorials are conducted in several ways In
this article the examples are modelled on the Maastricht seven jump process but its format of seven steps may be shortened
bull A typical PBL tutorial consists of a group of students (usually eight to 10) and a tutor who facilitates the session The length of time (number of sessions) that a group stays together with each other and with individual tutors varies between institutions A group needs to be together long enough to allow good group dynamics to develop but may need to be changed occasionally if personality clashes or other dysfunctional behaviour emerges
bull Students elect a chair for each PBL scenario and a scribe to record the discussion The roles are rotated for each scenario Suitable flip charts or a whiteboard should be used for recording the proceedings At the start of the session depending on the trigger material either the student chair reads out the scenario or all students study the material If the trigger is a real patient in a ward clinic or surgery then a student may be asked to take a clinical history or identify an abnormal physical sign before the group moves to a tutorial room For each module students may be given a handbook containing the problem scenarios and suggested learning resources or learning materials may be handed out at appropriate times as the tutorials progress
Examples of trigger material for PBL scenarios bull Paper based clinical scenarios bull Experimental or clinical laboratory data bull Photographs bull Video clips bull Newspaper articles bull All or part of an article from a scientific
journal bull A real or simulated patient bull A family tree showing an inherited
disorder
PBL tutorial process ndash Step 1 Identify and clarify unfamiliar terms presented in the scenario
scribe lists those that remain unexplained after discussion ndash Step 2 Define the problem or problems to be discussed students may
have different views on the issues but all should be considered scribe records a list of agreed problems
ndash Step 3 Brainstorming session to discuss the problem(s) suggestingpossible explanations on basis of prior knowledge students draw on each others knowledge and identify areas of incomplete knowledge scribe records all discussion
ndash Step 4 Review steps 2 and 3 and arrange explanations into tentativesolutions scribe organises the explanations and restructures if necessary
ndash Step 5 Formulate learning objectives group reaches consensus onthe learning objectives tutor ensures learning objectives are focused achievable comprehensive and appropriate
ndash Step 6 Private study (all students gather information related to eachlearning objective)
ndash Step 7 Group shares results of private study (students identify theirlearning resources and share their results) tutor checks learning and may assess the group
bull The role of the tutor is to facilitate the proceedings (helping the chair to maintain group dynamics and moving the group through the task) and to ensure that the group achieves appropriate learning objectives in line with those set by the curriculum design team The tutor may need to take a more active role in step 7 of the process to ensure that all the students have done the appropriate work and to help the chair to suggest a suitable format for group members to use to present the results of their private study The tutor should encourage students to check their understanding of the material He or she can do this by encouraging the students to ask open questions and ask each other to explain topics in their own words or by the use of drawings and diagrams
PBL in curriculum design bull PBL may be used either as the mainstay of an entire
curriculum or for the delivery of individual courses In practice PBL is usually part of an integrated curriculum using a systems based approach with non-clinical material delivered in the context of clinical practice A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge skills and attitudes A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios Sufficient time should be allowed each week for students to do the self directed learning required for PBL
bull
Copyright copy2003 BMJ Publishing Group Ltd
Wood D F BMJ 2003326328-330
No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found
Writing PBL scenarios
bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives
bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after
studying the scenario should be consistent with the faculty learning objectives
bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding
bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice
bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge
bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented
bull The problem should be sufficiently open so that discussion is not curtailed too early in the process
bull Scenarios should promote participation by the students in seeking information from various learning resources
bull Adapted from Dolmans et al Med Teacher 199719185-9
Staff development
bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)
A dysfunctional group a dominant character may
make it difficult for other students to be heard
A dysfunctional group a dominant character may make it difficult for other students to be heard
bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties
Advantages of PBL bull Student centred PBLIt fostersactive learning improved
understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks
Disadvantagesbull Tutors who cant teachTutorsenjoy passing on
their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful
Assessment of PBL
bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods
bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL
Conclusion
bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning
bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL
PBL 5 Easy Steps
bull Read the problem
Mrs Paula Embledon
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
2 Brain storm
bull Brainstorm
bull ndash hypotheses
bull - what do we know in support of the hypothesis
bull - what do we need to know to test the hypothesis
ndash learning issues
Brainstorm
bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)
ndash specific issues (for individuals to look up)
ndash overlapping issues
bull 4 Individual Reading - Research - Preparation
bull 5 Return
bull ndash review case so far ndash report and discuss
ndash assess progress - continue pagenext pagecomplete
ndash self-evaluation - How did things go Any suggestions for next time
ndash next problem
bull 5 Return
THE FIRST GROUP SESSION
bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day
bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session
bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr
bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine
bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise
bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator
bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues
bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know
bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)
bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)
bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)
During Tutorial Session students will
1048708 Come prepared to discuss the case and learning issues researched since the last tutorial
1048708 Actively participate in group discussions and contribute to the learning process in a manner that allows for the balanced participation of everyone in the group
1048708 Develop learning issues at each session phrase them as full-sentence questions write them on the board and post them on the course web page
1048708 Consider biological population behaviormental health issuesexplanations and questions of professional attitudes values and ethics related to the patientrsquos problem(s) described in the case
Tutorial Session contd1048708 Go to the board to diagram outline draw etc in
explanation of mechanisms relatedto hypotheses1048708 Debate evidence related to the case and avoid
personal attacks on others1048708 Comply with ground rules with regard to how
the group will function and how itsmembers treat one another1048708 Participate in end-of-session reflection and
assessment by giving and receivingconstructive criticism regarding self tutor
student and group performance
Between Tutorial Session
1048708 Research key learning issues using a variety of resources
1048708 Critically evaluate the credibility of sources and the validity of the information they have obtained in their research
1048708 Integrate what they have learned through research lectures labs clinical skills Perspectives in Medicine (PIM) etc into what is discussed in tutorials
1048708 Synthesize what they have learned and be prepared to discuss it without reading directly from their materials as much as possible and apply it to the case at the next tutorial session
Determine priorities for learning
bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue
bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan
bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge
bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career
PBL Starting the casebull After the introductions and discussion
are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it
bull Reading the case aloud keeps the group focused
bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here
Problem-based learning is designed to develop
1048708 Integrated context-specific knowledge base
1048708 Decision-makingcritical thinking process and skills
1048708 Self-directed life-long learning skills 1048708 Interpersonal collaboration and
communication skills 1048708 Constructive self and peer
assessment skills 1048708 Professional ethics and behavior
PBL Case (contd)
bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session
What is problem based learning
bull In PBL students use triggers from the problem case or scenario to define their own learning objectives
bull Subsequently they do independent self directed study before returning to the group to discuss and refine their acquired knowledge
bull Thus PBL is not about problem solving per se but rather it uses appropriate problems to increase knowledge and understanding
bull The process is clearly defined
PBL
bull PBL uses clinical cases as the context for students to study basic and clinical sciences
bull 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
bull Possible disadvantages include higher costs both in resources and staff time
PBL
bull An educational method characterized by the use of patient problems as a context for students to learn problem-solving skills and acquire knowledge about the basic and clinical sciences
bull Students usually meet in small groups two or three times a week for PBL tutorials
bull They are presented with a clinical problem (eg a patient with chest pain) and in a series of steps they discuss possible mechanisms and causes develop hypotheses and strategies to test the hypotheses are presented with further information and use this new information to refine their hypotheses finally reaching a conclusion
bull A tutor usually acts as a facilitator guiding students in this group-learning process
bull In the course of this exercise students identify both their existing levels and gaps in their knowledge These gaps form the basis for independent learning outside the PBL tutorials The identification and pursuit of these so-called learning goals is a key element of the PBL process
Rationale for using PBL bull The PBL approach is based on principles of adult
education20 and cognitive psychology21 It differs fundamentally from traditional curricula in which students acquire background knowledge of the basic sciences in the early years of the course and in the later years apply this knowledge to the diagnosis and management of clinical problems This traditional approach has been criticised for a number of reasons42223
bull It creates an artificial divide between the basic and clinical sciences
bull Time is wasted in acquiring knowledge that is subsequently forgotten or found to be irrelevant
bull Application of the acquired knowledge can be difficult bull The acquisition and retention of information that has no
apparent relevance can be boring and even demoralising for students
The group learning process acquiring
desirable learning skills
Generic Skills amp attitudes
bull Teamwork bull Critical evaluation of literature bull Chairing a group bull Self directed learning and use of
resources bull Listening Presentation skills
Recording bull Cooperation bull Respect for colleagues views
bull Group learning facilitates not only the acquisition of knowledge but also several other desirable attributes such as communication skills teamwork problem solving independent responsibility for learning sharing information and respect for others PBL can therefore be thought of as a small group teaching method that combines the acquisition of knowledge with the development of generic skills and attitudes Presentation of clinical material as the stimulus for learning enables students to understand the relevance of underlying scientific knowledge and principles in clinical practice
bull when PBL is introduced into a curriculum several other issues for curriculum design and implementation need to be tackled PBL is generally introduced in the context of a defined core curriculum and integration of basic and clinical sciences It has implications for staffing and learning resources and demands a different approach to timetabling workload and assessment PBL is often used to deliver core material in non-clinical parts of the curriculum Paper based PBL scenarios form the basis of the core curriculum and ensure that all students are exposed to the same problems Recently modified PBL techniques have been introduced into clinical education with real patients being used as the stimulus for learning Despite the essential ad hoc nature of learning clinical medicine a key cases approach can enable PBL to be used to deliver the core clinical curriculum
Copyright copy2003 BMJ Publishing Group Ltd
Wood D F BMJ 2003326328-330
No CRoles of participants in a PBL tutorial aption Found
What happens in a PBL tutorial bull PBL tutorials are conducted in several ways In
this article the examples are modelled on the Maastricht seven jump process but its format of seven steps may be shortened
bull A typical PBL tutorial consists of a group of students (usually eight to 10) and a tutor who facilitates the session The length of time (number of sessions) that a group stays together with each other and with individual tutors varies between institutions A group needs to be together long enough to allow good group dynamics to develop but may need to be changed occasionally if personality clashes or other dysfunctional behaviour emerges
bull Students elect a chair for each PBL scenario and a scribe to record the discussion The roles are rotated for each scenario Suitable flip charts or a whiteboard should be used for recording the proceedings At the start of the session depending on the trigger material either the student chair reads out the scenario or all students study the material If the trigger is a real patient in a ward clinic or surgery then a student may be asked to take a clinical history or identify an abnormal physical sign before the group moves to a tutorial room For each module students may be given a handbook containing the problem scenarios and suggested learning resources or learning materials may be handed out at appropriate times as the tutorials progress
Examples of trigger material for PBL scenarios bull Paper based clinical scenarios bull Experimental or clinical laboratory data bull Photographs bull Video clips bull Newspaper articles bull All or part of an article from a scientific
journal bull A real or simulated patient bull A family tree showing an inherited
disorder
PBL tutorial process ndash Step 1 Identify and clarify unfamiliar terms presented in the scenario
scribe lists those that remain unexplained after discussion ndash Step 2 Define the problem or problems to be discussed students may
have different views on the issues but all should be considered scribe records a list of agreed problems
ndash Step 3 Brainstorming session to discuss the problem(s) suggestingpossible explanations on basis of prior knowledge students draw on each others knowledge and identify areas of incomplete knowledge scribe records all discussion
ndash Step 4 Review steps 2 and 3 and arrange explanations into tentativesolutions scribe organises the explanations and restructures if necessary
ndash Step 5 Formulate learning objectives group reaches consensus onthe learning objectives tutor ensures learning objectives are focused achievable comprehensive and appropriate
ndash Step 6 Private study (all students gather information related to eachlearning objective)
ndash Step 7 Group shares results of private study (students identify theirlearning resources and share their results) tutor checks learning and may assess the group
bull The role of the tutor is to facilitate the proceedings (helping the chair to maintain group dynamics and moving the group through the task) and to ensure that the group achieves appropriate learning objectives in line with those set by the curriculum design team The tutor may need to take a more active role in step 7 of the process to ensure that all the students have done the appropriate work and to help the chair to suggest a suitable format for group members to use to present the results of their private study The tutor should encourage students to check their understanding of the material He or she can do this by encouraging the students to ask open questions and ask each other to explain topics in their own words or by the use of drawings and diagrams
PBL in curriculum design bull PBL may be used either as the mainstay of an entire
curriculum or for the delivery of individual courses In practice PBL is usually part of an integrated curriculum using a systems based approach with non-clinical material delivered in the context of clinical practice A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge skills and attitudes A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios Sufficient time should be allowed each week for students to do the self directed learning required for PBL
bull
Copyright copy2003 BMJ Publishing Group Ltd
Wood D F BMJ 2003326328-330
No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found
Writing PBL scenarios
bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives
bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after
studying the scenario should be consistent with the faculty learning objectives
bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding
bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice
bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge
bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented
bull The problem should be sufficiently open so that discussion is not curtailed too early in the process
bull Scenarios should promote participation by the students in seeking information from various learning resources
bull Adapted from Dolmans et al Med Teacher 199719185-9
Staff development
bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)
A dysfunctional group a dominant character may
make it difficult for other students to be heard
A dysfunctional group a dominant character may make it difficult for other students to be heard
bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties
Advantages of PBL bull Student centred PBLIt fostersactive learning improved
understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks
Disadvantagesbull Tutors who cant teachTutorsenjoy passing on
their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful
Assessment of PBL
bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods
bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL
Conclusion
bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning
bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL
PBL 5 Easy Steps
bull Read the problem
Mrs Paula Embledon
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
2 Brain storm
bull Brainstorm
bull ndash hypotheses
bull - what do we know in support of the hypothesis
bull - what do we need to know to test the hypothesis
ndash learning issues
Brainstorm
bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)
ndash specific issues (for individuals to look up)
ndash overlapping issues
bull 4 Individual Reading - Research - Preparation
bull 5 Return
bull ndash review case so far ndash report and discuss
ndash assess progress - continue pagenext pagecomplete
ndash self-evaluation - How did things go Any suggestions for next time
ndash next problem
bull 5 Return
THE FIRST GROUP SESSION
bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day
bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session
bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr
bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine
bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise
bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator
bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues
bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know
bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)
bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)
bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)
Tutorial Session contd1048708 Go to the board to diagram outline draw etc in
explanation of mechanisms relatedto hypotheses1048708 Debate evidence related to the case and avoid
personal attacks on others1048708 Comply with ground rules with regard to how
the group will function and how itsmembers treat one another1048708 Participate in end-of-session reflection and
assessment by giving and receivingconstructive criticism regarding self tutor
student and group performance
Between Tutorial Session
1048708 Research key learning issues using a variety of resources
1048708 Critically evaluate the credibility of sources and the validity of the information they have obtained in their research
1048708 Integrate what they have learned through research lectures labs clinical skills Perspectives in Medicine (PIM) etc into what is discussed in tutorials
1048708 Synthesize what they have learned and be prepared to discuss it without reading directly from their materials as much as possible and apply it to the case at the next tutorial session
Determine priorities for learning
bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue
bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan
bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge
bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career
PBL Starting the casebull After the introductions and discussion
are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it
bull Reading the case aloud keeps the group focused
bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here
Problem-based learning is designed to develop
1048708 Integrated context-specific knowledge base
1048708 Decision-makingcritical thinking process and skills
1048708 Self-directed life-long learning skills 1048708 Interpersonal collaboration and
communication skills 1048708 Constructive self and peer
assessment skills 1048708 Professional ethics and behavior
PBL Case (contd)
bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session
What is problem based learning
bull In PBL students use triggers from the problem case or scenario to define their own learning objectives
bull Subsequently they do independent self directed study before returning to the group to discuss and refine their acquired knowledge
bull Thus PBL is not about problem solving per se but rather it uses appropriate problems to increase knowledge and understanding
bull The process is clearly defined
PBL
bull PBL uses clinical cases as the context for students to study basic and clinical sciences
bull 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
bull Possible disadvantages include higher costs both in resources and staff time
PBL
bull An educational method characterized by the use of patient problems as a context for students to learn problem-solving skills and acquire knowledge about the basic and clinical sciences
bull Students usually meet in small groups two or three times a week for PBL tutorials
bull They are presented with a clinical problem (eg a patient with chest pain) and in a series of steps they discuss possible mechanisms and causes develop hypotheses and strategies to test the hypotheses are presented with further information and use this new information to refine their hypotheses finally reaching a conclusion
bull A tutor usually acts as a facilitator guiding students in this group-learning process
bull In the course of this exercise students identify both their existing levels and gaps in their knowledge These gaps form the basis for independent learning outside the PBL tutorials The identification and pursuit of these so-called learning goals is a key element of the PBL process
Rationale for using PBL bull The PBL approach is based on principles of adult
education20 and cognitive psychology21 It differs fundamentally from traditional curricula in which students acquire background knowledge of the basic sciences in the early years of the course and in the later years apply this knowledge to the diagnosis and management of clinical problems This traditional approach has been criticised for a number of reasons42223
bull It creates an artificial divide between the basic and clinical sciences
bull Time is wasted in acquiring knowledge that is subsequently forgotten or found to be irrelevant
bull Application of the acquired knowledge can be difficult bull The acquisition and retention of information that has no
apparent relevance can be boring and even demoralising for students
The group learning process acquiring
desirable learning skills
Generic Skills amp attitudes
bull Teamwork bull Critical evaluation of literature bull Chairing a group bull Self directed learning and use of
resources bull Listening Presentation skills
Recording bull Cooperation bull Respect for colleagues views
bull Group learning facilitates not only the acquisition of knowledge but also several other desirable attributes such as communication skills teamwork problem solving independent responsibility for learning sharing information and respect for others PBL can therefore be thought of as a small group teaching method that combines the acquisition of knowledge with the development of generic skills and attitudes Presentation of clinical material as the stimulus for learning enables students to understand the relevance of underlying scientific knowledge and principles in clinical practice
bull when PBL is introduced into a curriculum several other issues for curriculum design and implementation need to be tackled PBL is generally introduced in the context of a defined core curriculum and integration of basic and clinical sciences It has implications for staffing and learning resources and demands a different approach to timetabling workload and assessment PBL is often used to deliver core material in non-clinical parts of the curriculum Paper based PBL scenarios form the basis of the core curriculum and ensure that all students are exposed to the same problems Recently modified PBL techniques have been introduced into clinical education with real patients being used as the stimulus for learning Despite the essential ad hoc nature of learning clinical medicine a key cases approach can enable PBL to be used to deliver the core clinical curriculum
Copyright copy2003 BMJ Publishing Group Ltd
Wood D F BMJ 2003326328-330
No CRoles of participants in a PBL tutorial aption Found
What happens in a PBL tutorial bull PBL tutorials are conducted in several ways In
this article the examples are modelled on the Maastricht seven jump process but its format of seven steps may be shortened
bull A typical PBL tutorial consists of a group of students (usually eight to 10) and a tutor who facilitates the session The length of time (number of sessions) that a group stays together with each other and with individual tutors varies between institutions A group needs to be together long enough to allow good group dynamics to develop but may need to be changed occasionally if personality clashes or other dysfunctional behaviour emerges
bull Students elect a chair for each PBL scenario and a scribe to record the discussion The roles are rotated for each scenario Suitable flip charts or a whiteboard should be used for recording the proceedings At the start of the session depending on the trigger material either the student chair reads out the scenario or all students study the material If the trigger is a real patient in a ward clinic or surgery then a student may be asked to take a clinical history or identify an abnormal physical sign before the group moves to a tutorial room For each module students may be given a handbook containing the problem scenarios and suggested learning resources or learning materials may be handed out at appropriate times as the tutorials progress
Examples of trigger material for PBL scenarios bull Paper based clinical scenarios bull Experimental or clinical laboratory data bull Photographs bull Video clips bull Newspaper articles bull All or part of an article from a scientific
journal bull A real or simulated patient bull A family tree showing an inherited
disorder
PBL tutorial process ndash Step 1 Identify and clarify unfamiliar terms presented in the scenario
scribe lists those that remain unexplained after discussion ndash Step 2 Define the problem or problems to be discussed students may
have different views on the issues but all should be considered scribe records a list of agreed problems
ndash Step 3 Brainstorming session to discuss the problem(s) suggestingpossible explanations on basis of prior knowledge students draw on each others knowledge and identify areas of incomplete knowledge scribe records all discussion
ndash Step 4 Review steps 2 and 3 and arrange explanations into tentativesolutions scribe organises the explanations and restructures if necessary
ndash Step 5 Formulate learning objectives group reaches consensus onthe learning objectives tutor ensures learning objectives are focused achievable comprehensive and appropriate
ndash Step 6 Private study (all students gather information related to eachlearning objective)
ndash Step 7 Group shares results of private study (students identify theirlearning resources and share their results) tutor checks learning and may assess the group
bull The role of the tutor is to facilitate the proceedings (helping the chair to maintain group dynamics and moving the group through the task) and to ensure that the group achieves appropriate learning objectives in line with those set by the curriculum design team The tutor may need to take a more active role in step 7 of the process to ensure that all the students have done the appropriate work and to help the chair to suggest a suitable format for group members to use to present the results of their private study The tutor should encourage students to check their understanding of the material He or she can do this by encouraging the students to ask open questions and ask each other to explain topics in their own words or by the use of drawings and diagrams
PBL in curriculum design bull PBL may be used either as the mainstay of an entire
curriculum or for the delivery of individual courses In practice PBL is usually part of an integrated curriculum using a systems based approach with non-clinical material delivered in the context of clinical practice A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge skills and attitudes A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios Sufficient time should be allowed each week for students to do the self directed learning required for PBL
bull
Copyright copy2003 BMJ Publishing Group Ltd
Wood D F BMJ 2003326328-330
No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found
Writing PBL scenarios
bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives
bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after
studying the scenario should be consistent with the faculty learning objectives
bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding
bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice
bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge
bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented
bull The problem should be sufficiently open so that discussion is not curtailed too early in the process
bull Scenarios should promote participation by the students in seeking information from various learning resources
bull Adapted from Dolmans et al Med Teacher 199719185-9
Staff development
bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)
A dysfunctional group a dominant character may
make it difficult for other students to be heard
A dysfunctional group a dominant character may make it difficult for other students to be heard
bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties
Advantages of PBL bull Student centred PBLIt fostersactive learning improved
understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks
Disadvantagesbull Tutors who cant teachTutorsenjoy passing on
their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful
Assessment of PBL
bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods
bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL
Conclusion
bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning
bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL
PBL 5 Easy Steps
bull Read the problem
Mrs Paula Embledon
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
2 Brain storm
bull Brainstorm
bull ndash hypotheses
bull - what do we know in support of the hypothesis
bull - what do we need to know to test the hypothesis
ndash learning issues
Brainstorm
bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)
ndash specific issues (for individuals to look up)
ndash overlapping issues
bull 4 Individual Reading - Research - Preparation
bull 5 Return
bull ndash review case so far ndash report and discuss
ndash assess progress - continue pagenext pagecomplete
ndash self-evaluation - How did things go Any suggestions for next time
ndash next problem
bull 5 Return
THE FIRST GROUP SESSION
bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day
bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session
bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr
bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine
bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise
bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator
bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues
bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know
bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)
bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)
bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)
Between Tutorial Session
1048708 Research key learning issues using a variety of resources
1048708 Critically evaluate the credibility of sources and the validity of the information they have obtained in their research
1048708 Integrate what they have learned through research lectures labs clinical skills Perspectives in Medicine (PIM) etc into what is discussed in tutorials
1048708 Synthesize what they have learned and be prepared to discuss it without reading directly from their materials as much as possible and apply it to the case at the next tutorial session
Determine priorities for learning
bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue
bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan
bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge
bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career
PBL Starting the casebull After the introductions and discussion
are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it
bull Reading the case aloud keeps the group focused
bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here
Problem-based learning is designed to develop
1048708 Integrated context-specific knowledge base
1048708 Decision-makingcritical thinking process and skills
1048708 Self-directed life-long learning skills 1048708 Interpersonal collaboration and
communication skills 1048708 Constructive self and peer
assessment skills 1048708 Professional ethics and behavior
PBL Case (contd)
bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session
What is problem based learning
bull In PBL students use triggers from the problem case or scenario to define their own learning objectives
bull Subsequently they do independent self directed study before returning to the group to discuss and refine their acquired knowledge
bull Thus PBL is not about problem solving per se but rather it uses appropriate problems to increase knowledge and understanding
bull The process is clearly defined
PBL
bull PBL uses clinical cases as the context for students to study basic and clinical sciences
bull 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
bull Possible disadvantages include higher costs both in resources and staff time
PBL
bull An educational method characterized by the use of patient problems as a context for students to learn problem-solving skills and acquire knowledge about the basic and clinical sciences
bull Students usually meet in small groups two or three times a week for PBL tutorials
bull They are presented with a clinical problem (eg a patient with chest pain) and in a series of steps they discuss possible mechanisms and causes develop hypotheses and strategies to test the hypotheses are presented with further information and use this new information to refine their hypotheses finally reaching a conclusion
bull A tutor usually acts as a facilitator guiding students in this group-learning process
bull In the course of this exercise students identify both their existing levels and gaps in their knowledge These gaps form the basis for independent learning outside the PBL tutorials The identification and pursuit of these so-called learning goals is a key element of the PBL process
Rationale for using PBL bull The PBL approach is based on principles of adult
education20 and cognitive psychology21 It differs fundamentally from traditional curricula in which students acquire background knowledge of the basic sciences in the early years of the course and in the later years apply this knowledge to the diagnosis and management of clinical problems This traditional approach has been criticised for a number of reasons42223
bull It creates an artificial divide between the basic and clinical sciences
bull Time is wasted in acquiring knowledge that is subsequently forgotten or found to be irrelevant
bull Application of the acquired knowledge can be difficult bull The acquisition and retention of information that has no
apparent relevance can be boring and even demoralising for students
The group learning process acquiring
desirable learning skills
Generic Skills amp attitudes
bull Teamwork bull Critical evaluation of literature bull Chairing a group bull Self directed learning and use of
resources bull Listening Presentation skills
Recording bull Cooperation bull Respect for colleagues views
bull Group learning facilitates not only the acquisition of knowledge but also several other desirable attributes such as communication skills teamwork problem solving independent responsibility for learning sharing information and respect for others PBL can therefore be thought of as a small group teaching method that combines the acquisition of knowledge with the development of generic skills and attitudes Presentation of clinical material as the stimulus for learning enables students to understand the relevance of underlying scientific knowledge and principles in clinical practice
bull when PBL is introduced into a curriculum several other issues for curriculum design and implementation need to be tackled PBL is generally introduced in the context of a defined core curriculum and integration of basic and clinical sciences It has implications for staffing and learning resources and demands a different approach to timetabling workload and assessment PBL is often used to deliver core material in non-clinical parts of the curriculum Paper based PBL scenarios form the basis of the core curriculum and ensure that all students are exposed to the same problems Recently modified PBL techniques have been introduced into clinical education with real patients being used as the stimulus for learning Despite the essential ad hoc nature of learning clinical medicine a key cases approach can enable PBL to be used to deliver the core clinical curriculum
Copyright copy2003 BMJ Publishing Group Ltd
Wood D F BMJ 2003326328-330
No CRoles of participants in a PBL tutorial aption Found
What happens in a PBL tutorial bull PBL tutorials are conducted in several ways In
this article the examples are modelled on the Maastricht seven jump process but its format of seven steps may be shortened
bull A typical PBL tutorial consists of a group of students (usually eight to 10) and a tutor who facilitates the session The length of time (number of sessions) that a group stays together with each other and with individual tutors varies between institutions A group needs to be together long enough to allow good group dynamics to develop but may need to be changed occasionally if personality clashes or other dysfunctional behaviour emerges
bull Students elect a chair for each PBL scenario and a scribe to record the discussion The roles are rotated for each scenario Suitable flip charts or a whiteboard should be used for recording the proceedings At the start of the session depending on the trigger material either the student chair reads out the scenario or all students study the material If the trigger is a real patient in a ward clinic or surgery then a student may be asked to take a clinical history or identify an abnormal physical sign before the group moves to a tutorial room For each module students may be given a handbook containing the problem scenarios and suggested learning resources or learning materials may be handed out at appropriate times as the tutorials progress
Examples of trigger material for PBL scenarios bull Paper based clinical scenarios bull Experimental or clinical laboratory data bull Photographs bull Video clips bull Newspaper articles bull All or part of an article from a scientific
journal bull A real or simulated patient bull A family tree showing an inherited
disorder
PBL tutorial process ndash Step 1 Identify and clarify unfamiliar terms presented in the scenario
scribe lists those that remain unexplained after discussion ndash Step 2 Define the problem or problems to be discussed students may
have different views on the issues but all should be considered scribe records a list of agreed problems
ndash Step 3 Brainstorming session to discuss the problem(s) suggestingpossible explanations on basis of prior knowledge students draw on each others knowledge and identify areas of incomplete knowledge scribe records all discussion
ndash Step 4 Review steps 2 and 3 and arrange explanations into tentativesolutions scribe organises the explanations and restructures if necessary
ndash Step 5 Formulate learning objectives group reaches consensus onthe learning objectives tutor ensures learning objectives are focused achievable comprehensive and appropriate
ndash Step 6 Private study (all students gather information related to eachlearning objective)
ndash Step 7 Group shares results of private study (students identify theirlearning resources and share their results) tutor checks learning and may assess the group
bull The role of the tutor is to facilitate the proceedings (helping the chair to maintain group dynamics and moving the group through the task) and to ensure that the group achieves appropriate learning objectives in line with those set by the curriculum design team The tutor may need to take a more active role in step 7 of the process to ensure that all the students have done the appropriate work and to help the chair to suggest a suitable format for group members to use to present the results of their private study The tutor should encourage students to check their understanding of the material He or she can do this by encouraging the students to ask open questions and ask each other to explain topics in their own words or by the use of drawings and diagrams
PBL in curriculum design bull PBL may be used either as the mainstay of an entire
curriculum or for the delivery of individual courses In practice PBL is usually part of an integrated curriculum using a systems based approach with non-clinical material delivered in the context of clinical practice A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge skills and attitudes A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios Sufficient time should be allowed each week for students to do the self directed learning required for PBL
bull
Copyright copy2003 BMJ Publishing Group Ltd
Wood D F BMJ 2003326328-330
No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found
Writing PBL scenarios
bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives
bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after
studying the scenario should be consistent with the faculty learning objectives
bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding
bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice
bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge
bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented
bull The problem should be sufficiently open so that discussion is not curtailed too early in the process
bull Scenarios should promote participation by the students in seeking information from various learning resources
bull Adapted from Dolmans et al Med Teacher 199719185-9
Staff development
bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)
A dysfunctional group a dominant character may
make it difficult for other students to be heard
A dysfunctional group a dominant character may make it difficult for other students to be heard
bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties
Advantages of PBL bull Student centred PBLIt fostersactive learning improved
understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks
Disadvantagesbull Tutors who cant teachTutorsenjoy passing on
their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful
Assessment of PBL
bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods
bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL
Conclusion
bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning
bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL
PBL 5 Easy Steps
bull Read the problem
Mrs Paula Embledon
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
2 Brain storm
bull Brainstorm
bull ndash hypotheses
bull - what do we know in support of the hypothesis
bull - what do we need to know to test the hypothesis
ndash learning issues
Brainstorm
bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)
ndash specific issues (for individuals to look up)
ndash overlapping issues
bull 4 Individual Reading - Research - Preparation
bull 5 Return
bull ndash review case so far ndash report and discuss
ndash assess progress - continue pagenext pagecomplete
ndash self-evaluation - How did things go Any suggestions for next time
ndash next problem
bull 5 Return
THE FIRST GROUP SESSION
bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day
bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session
bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr
bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine
bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise
bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator
bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues
bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know
bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)
bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)
bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)
Determine priorities for learning
bull Consider time resources and objectives and set priorities regarding the relative importance of each learning issue
bull Remember that the primary task of each problem is to provide a springboard to learning not to make a quick diagnosis and work out a management plan
bull The problem is a stimulus for discussion asking questions and a framework for organizing your knowledge
bull It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career
PBL Starting the casebull After the introductions and discussion
are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it
bull Reading the case aloud keeps the group focused
bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here
Problem-based learning is designed to develop
1048708 Integrated context-specific knowledge base
1048708 Decision-makingcritical thinking process and skills
1048708 Self-directed life-long learning skills 1048708 Interpersonal collaboration and
communication skills 1048708 Constructive self and peer
assessment skills 1048708 Professional ethics and behavior
PBL Case (contd)
bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session
What is problem based learning
bull In PBL students use triggers from the problem case or scenario to define their own learning objectives
bull Subsequently they do independent self directed study before returning to the group to discuss and refine their acquired knowledge
bull Thus PBL is not about problem solving per se but rather it uses appropriate problems to increase knowledge and understanding
bull The process is clearly defined
PBL
bull PBL uses clinical cases as the context for students to study basic and clinical sciences
bull 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
bull Possible disadvantages include higher costs both in resources and staff time
PBL
bull An educational method characterized by the use of patient problems as a context for students to learn problem-solving skills and acquire knowledge about the basic and clinical sciences
bull Students usually meet in small groups two or three times a week for PBL tutorials
bull They are presented with a clinical problem (eg a patient with chest pain) and in a series of steps they discuss possible mechanisms and causes develop hypotheses and strategies to test the hypotheses are presented with further information and use this new information to refine their hypotheses finally reaching a conclusion
bull A tutor usually acts as a facilitator guiding students in this group-learning process
bull In the course of this exercise students identify both their existing levels and gaps in their knowledge These gaps form the basis for independent learning outside the PBL tutorials The identification and pursuit of these so-called learning goals is a key element of the PBL process
Rationale for using PBL bull The PBL approach is based on principles of adult
education20 and cognitive psychology21 It differs fundamentally from traditional curricula in which students acquire background knowledge of the basic sciences in the early years of the course and in the later years apply this knowledge to the diagnosis and management of clinical problems This traditional approach has been criticised for a number of reasons42223
bull It creates an artificial divide between the basic and clinical sciences
bull Time is wasted in acquiring knowledge that is subsequently forgotten or found to be irrelevant
bull Application of the acquired knowledge can be difficult bull The acquisition and retention of information that has no
apparent relevance can be boring and even demoralising for students
The group learning process acquiring
desirable learning skills
Generic Skills amp attitudes
bull Teamwork bull Critical evaluation of literature bull Chairing a group bull Self directed learning and use of
resources bull Listening Presentation skills
Recording bull Cooperation bull Respect for colleagues views
bull Group learning facilitates not only the acquisition of knowledge but also several other desirable attributes such as communication skills teamwork problem solving independent responsibility for learning sharing information and respect for others PBL can therefore be thought of as a small group teaching method that combines the acquisition of knowledge with the development of generic skills and attitudes Presentation of clinical material as the stimulus for learning enables students to understand the relevance of underlying scientific knowledge and principles in clinical practice
bull when PBL is introduced into a curriculum several other issues for curriculum design and implementation need to be tackled PBL is generally introduced in the context of a defined core curriculum and integration of basic and clinical sciences It has implications for staffing and learning resources and demands a different approach to timetabling workload and assessment PBL is often used to deliver core material in non-clinical parts of the curriculum Paper based PBL scenarios form the basis of the core curriculum and ensure that all students are exposed to the same problems Recently modified PBL techniques have been introduced into clinical education with real patients being used as the stimulus for learning Despite the essential ad hoc nature of learning clinical medicine a key cases approach can enable PBL to be used to deliver the core clinical curriculum
Copyright copy2003 BMJ Publishing Group Ltd
Wood D F BMJ 2003326328-330
No CRoles of participants in a PBL tutorial aption Found
What happens in a PBL tutorial bull PBL tutorials are conducted in several ways In
this article the examples are modelled on the Maastricht seven jump process but its format of seven steps may be shortened
bull A typical PBL tutorial consists of a group of students (usually eight to 10) and a tutor who facilitates the session The length of time (number of sessions) that a group stays together with each other and with individual tutors varies between institutions A group needs to be together long enough to allow good group dynamics to develop but may need to be changed occasionally if personality clashes or other dysfunctional behaviour emerges
bull Students elect a chair for each PBL scenario and a scribe to record the discussion The roles are rotated for each scenario Suitable flip charts or a whiteboard should be used for recording the proceedings At the start of the session depending on the trigger material either the student chair reads out the scenario or all students study the material If the trigger is a real patient in a ward clinic or surgery then a student may be asked to take a clinical history or identify an abnormal physical sign before the group moves to a tutorial room For each module students may be given a handbook containing the problem scenarios and suggested learning resources or learning materials may be handed out at appropriate times as the tutorials progress
Examples of trigger material for PBL scenarios bull Paper based clinical scenarios bull Experimental or clinical laboratory data bull Photographs bull Video clips bull Newspaper articles bull All or part of an article from a scientific
journal bull A real or simulated patient bull A family tree showing an inherited
disorder
PBL tutorial process ndash Step 1 Identify and clarify unfamiliar terms presented in the scenario
scribe lists those that remain unexplained after discussion ndash Step 2 Define the problem or problems to be discussed students may
have different views on the issues but all should be considered scribe records a list of agreed problems
ndash Step 3 Brainstorming session to discuss the problem(s) suggestingpossible explanations on basis of prior knowledge students draw on each others knowledge and identify areas of incomplete knowledge scribe records all discussion
ndash Step 4 Review steps 2 and 3 and arrange explanations into tentativesolutions scribe organises the explanations and restructures if necessary
ndash Step 5 Formulate learning objectives group reaches consensus onthe learning objectives tutor ensures learning objectives are focused achievable comprehensive and appropriate
ndash Step 6 Private study (all students gather information related to eachlearning objective)
ndash Step 7 Group shares results of private study (students identify theirlearning resources and share their results) tutor checks learning and may assess the group
bull The role of the tutor is to facilitate the proceedings (helping the chair to maintain group dynamics and moving the group through the task) and to ensure that the group achieves appropriate learning objectives in line with those set by the curriculum design team The tutor may need to take a more active role in step 7 of the process to ensure that all the students have done the appropriate work and to help the chair to suggest a suitable format for group members to use to present the results of their private study The tutor should encourage students to check their understanding of the material He or she can do this by encouraging the students to ask open questions and ask each other to explain topics in their own words or by the use of drawings and diagrams
PBL in curriculum design bull PBL may be used either as the mainstay of an entire
curriculum or for the delivery of individual courses In practice PBL is usually part of an integrated curriculum using a systems based approach with non-clinical material delivered in the context of clinical practice A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge skills and attitudes A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios Sufficient time should be allowed each week for students to do the self directed learning required for PBL
bull
Copyright copy2003 BMJ Publishing Group Ltd
Wood D F BMJ 2003326328-330
No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found
Writing PBL scenarios
bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives
bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after
studying the scenario should be consistent with the faculty learning objectives
bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding
bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice
bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge
bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented
bull The problem should be sufficiently open so that discussion is not curtailed too early in the process
bull Scenarios should promote participation by the students in seeking information from various learning resources
bull Adapted from Dolmans et al Med Teacher 199719185-9
Staff development
bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)
A dysfunctional group a dominant character may
make it difficult for other students to be heard
A dysfunctional group a dominant character may make it difficult for other students to be heard
bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties
Advantages of PBL bull Student centred PBLIt fostersactive learning improved
understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks
Disadvantagesbull Tutors who cant teachTutorsenjoy passing on
their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful
Assessment of PBL
bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods
bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL
Conclusion
bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning
bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL
PBL 5 Easy Steps
bull Read the problem
Mrs Paula Embledon
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
2 Brain storm
bull Brainstorm
bull ndash hypotheses
bull - what do we know in support of the hypothesis
bull - what do we need to know to test the hypothesis
ndash learning issues
Brainstorm
bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)
ndash specific issues (for individuals to look up)
ndash overlapping issues
bull 4 Individual Reading - Research - Preparation
bull 5 Return
bull ndash review case so far ndash report and discuss
ndash assess progress - continue pagenext pagecomplete
ndash self-evaluation - How did things go Any suggestions for next time
ndash next problem
bull 5 Return
THE FIRST GROUP SESSION
bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day
bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session
bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr
bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine
bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise
bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator
bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues
bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know
bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)
bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)
bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)
PBL Starting the casebull After the introductions and discussion
are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it
bull Reading the case aloud keeps the group focused
bull Before moving on to the second page of the session the group should have formed a clear idea of the problem so far what is known what is needed to know and where to go from here
Problem-based learning is designed to develop
1048708 Integrated context-specific knowledge base
1048708 Decision-makingcritical thinking process and skills
1048708 Self-directed life-long learning skills 1048708 Interpersonal collaboration and
communication skills 1048708 Constructive self and peer
assessment skills 1048708 Professional ethics and behavior
PBL Case (contd)
bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session
What is problem based learning
bull In PBL students use triggers from the problem case or scenario to define their own learning objectives
bull Subsequently they do independent self directed study before returning to the group to discuss and refine their acquired knowledge
bull Thus PBL is not about problem solving per se but rather it uses appropriate problems to increase knowledge and understanding
bull The process is clearly defined
PBL
bull PBL uses clinical cases as the context for students to study basic and clinical sciences
bull 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
bull Possible disadvantages include higher costs both in resources and staff time
PBL
bull An educational method characterized by the use of patient problems as a context for students to learn problem-solving skills and acquire knowledge about the basic and clinical sciences
bull Students usually meet in small groups two or three times a week for PBL tutorials
bull They are presented with a clinical problem (eg a patient with chest pain) and in a series of steps they discuss possible mechanisms and causes develop hypotheses and strategies to test the hypotheses are presented with further information and use this new information to refine their hypotheses finally reaching a conclusion
bull A tutor usually acts as a facilitator guiding students in this group-learning process
bull In the course of this exercise students identify both their existing levels and gaps in their knowledge These gaps form the basis for independent learning outside the PBL tutorials The identification and pursuit of these so-called learning goals is a key element of the PBL process
Rationale for using PBL bull The PBL approach is based on principles of adult
education20 and cognitive psychology21 It differs fundamentally from traditional curricula in which students acquire background knowledge of the basic sciences in the early years of the course and in the later years apply this knowledge to the diagnosis and management of clinical problems This traditional approach has been criticised for a number of reasons42223
bull It creates an artificial divide between the basic and clinical sciences
bull Time is wasted in acquiring knowledge that is subsequently forgotten or found to be irrelevant
bull Application of the acquired knowledge can be difficult bull The acquisition and retention of information that has no
apparent relevance can be boring and even demoralising for students
The group learning process acquiring
desirable learning skills
Generic Skills amp attitudes
bull Teamwork bull Critical evaluation of literature bull Chairing a group bull Self directed learning and use of
resources bull Listening Presentation skills
Recording bull Cooperation bull Respect for colleagues views
bull Group learning facilitates not only the acquisition of knowledge but also several other desirable attributes such as communication skills teamwork problem solving independent responsibility for learning sharing information and respect for others PBL can therefore be thought of as a small group teaching method that combines the acquisition of knowledge with the development of generic skills and attitudes Presentation of clinical material as the stimulus for learning enables students to understand the relevance of underlying scientific knowledge and principles in clinical practice
bull when PBL is introduced into a curriculum several other issues for curriculum design and implementation need to be tackled PBL is generally introduced in the context of a defined core curriculum and integration of basic and clinical sciences It has implications for staffing and learning resources and demands a different approach to timetabling workload and assessment PBL is often used to deliver core material in non-clinical parts of the curriculum Paper based PBL scenarios form the basis of the core curriculum and ensure that all students are exposed to the same problems Recently modified PBL techniques have been introduced into clinical education with real patients being used as the stimulus for learning Despite the essential ad hoc nature of learning clinical medicine a key cases approach can enable PBL to be used to deliver the core clinical curriculum
Copyright copy2003 BMJ Publishing Group Ltd
Wood D F BMJ 2003326328-330
No CRoles of participants in a PBL tutorial aption Found
What happens in a PBL tutorial bull PBL tutorials are conducted in several ways In
this article the examples are modelled on the Maastricht seven jump process but its format of seven steps may be shortened
bull A typical PBL tutorial consists of a group of students (usually eight to 10) and a tutor who facilitates the session The length of time (number of sessions) that a group stays together with each other and with individual tutors varies between institutions A group needs to be together long enough to allow good group dynamics to develop but may need to be changed occasionally if personality clashes or other dysfunctional behaviour emerges
bull Students elect a chair for each PBL scenario and a scribe to record the discussion The roles are rotated for each scenario Suitable flip charts or a whiteboard should be used for recording the proceedings At the start of the session depending on the trigger material either the student chair reads out the scenario or all students study the material If the trigger is a real patient in a ward clinic or surgery then a student may be asked to take a clinical history or identify an abnormal physical sign before the group moves to a tutorial room For each module students may be given a handbook containing the problem scenarios and suggested learning resources or learning materials may be handed out at appropriate times as the tutorials progress
Examples of trigger material for PBL scenarios bull Paper based clinical scenarios bull Experimental or clinical laboratory data bull Photographs bull Video clips bull Newspaper articles bull All or part of an article from a scientific
journal bull A real or simulated patient bull A family tree showing an inherited
disorder
PBL tutorial process ndash Step 1 Identify and clarify unfamiliar terms presented in the scenario
scribe lists those that remain unexplained after discussion ndash Step 2 Define the problem or problems to be discussed students may
have different views on the issues but all should be considered scribe records a list of agreed problems
ndash Step 3 Brainstorming session to discuss the problem(s) suggestingpossible explanations on basis of prior knowledge students draw on each others knowledge and identify areas of incomplete knowledge scribe records all discussion
ndash Step 4 Review steps 2 and 3 and arrange explanations into tentativesolutions scribe organises the explanations and restructures if necessary
ndash Step 5 Formulate learning objectives group reaches consensus onthe learning objectives tutor ensures learning objectives are focused achievable comprehensive and appropriate
ndash Step 6 Private study (all students gather information related to eachlearning objective)
ndash Step 7 Group shares results of private study (students identify theirlearning resources and share their results) tutor checks learning and may assess the group
bull The role of the tutor is to facilitate the proceedings (helping the chair to maintain group dynamics and moving the group through the task) and to ensure that the group achieves appropriate learning objectives in line with those set by the curriculum design team The tutor may need to take a more active role in step 7 of the process to ensure that all the students have done the appropriate work and to help the chair to suggest a suitable format for group members to use to present the results of their private study The tutor should encourage students to check their understanding of the material He or she can do this by encouraging the students to ask open questions and ask each other to explain topics in their own words or by the use of drawings and diagrams
PBL in curriculum design bull PBL may be used either as the mainstay of an entire
curriculum or for the delivery of individual courses In practice PBL is usually part of an integrated curriculum using a systems based approach with non-clinical material delivered in the context of clinical practice A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge skills and attitudes A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios Sufficient time should be allowed each week for students to do the self directed learning required for PBL
bull
Copyright copy2003 BMJ Publishing Group Ltd
Wood D F BMJ 2003326328-330
No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found
Writing PBL scenarios
bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives
bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after
studying the scenario should be consistent with the faculty learning objectives
bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding
bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice
bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge
bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented
bull The problem should be sufficiently open so that discussion is not curtailed too early in the process
bull Scenarios should promote participation by the students in seeking information from various learning resources
bull Adapted from Dolmans et al Med Teacher 199719185-9
Staff development
bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)
A dysfunctional group a dominant character may
make it difficult for other students to be heard
A dysfunctional group a dominant character may make it difficult for other students to be heard
bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties
Advantages of PBL bull Student centred PBLIt fostersactive learning improved
understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks
Disadvantagesbull Tutors who cant teachTutorsenjoy passing on
their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful
Assessment of PBL
bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods
bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL
Conclusion
bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning
bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL
PBL 5 Easy Steps
bull Read the problem
Mrs Paula Embledon
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
2 Brain storm
bull Brainstorm
bull ndash hypotheses
bull - what do we know in support of the hypothesis
bull - what do we need to know to test the hypothesis
ndash learning issues
Brainstorm
bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)
ndash specific issues (for individuals to look up)
ndash overlapping issues
bull 4 Individual Reading - Research - Preparation
bull 5 Return
bull ndash review case so far ndash report and discuss
ndash assess progress - continue pagenext pagecomplete
ndash self-evaluation - How did things go Any suggestions for next time
ndash next problem
bull 5 Return
THE FIRST GROUP SESSION
bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day
bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session
bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr
bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine
bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise
bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator
bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues
bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know
bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)
bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)
bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)
Problem-based learning is designed to develop
1048708 Integrated context-specific knowledge base
1048708 Decision-makingcritical thinking process and skills
1048708 Self-directed life-long learning skills 1048708 Interpersonal collaboration and
communication skills 1048708 Constructive self and peer
assessment skills 1048708 Professional ethics and behavior
PBL Case (contd)
bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session
What is problem based learning
bull In PBL students use triggers from the problem case or scenario to define their own learning objectives
bull Subsequently they do independent self directed study before returning to the group to discuss and refine their acquired knowledge
bull Thus PBL is not about problem solving per se but rather it uses appropriate problems to increase knowledge and understanding
bull The process is clearly defined
PBL
bull PBL uses clinical cases as the context for students to study basic and clinical sciences
bull 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
bull Possible disadvantages include higher costs both in resources and staff time
PBL
bull An educational method characterized by the use of patient problems as a context for students to learn problem-solving skills and acquire knowledge about the basic and clinical sciences
bull Students usually meet in small groups two or three times a week for PBL tutorials
bull They are presented with a clinical problem (eg a patient with chest pain) and in a series of steps they discuss possible mechanisms and causes develop hypotheses and strategies to test the hypotheses are presented with further information and use this new information to refine their hypotheses finally reaching a conclusion
bull A tutor usually acts as a facilitator guiding students in this group-learning process
bull In the course of this exercise students identify both their existing levels and gaps in their knowledge These gaps form the basis for independent learning outside the PBL tutorials The identification and pursuit of these so-called learning goals is a key element of the PBL process
Rationale for using PBL bull The PBL approach is based on principles of adult
education20 and cognitive psychology21 It differs fundamentally from traditional curricula in which students acquire background knowledge of the basic sciences in the early years of the course and in the later years apply this knowledge to the diagnosis and management of clinical problems This traditional approach has been criticised for a number of reasons42223
bull It creates an artificial divide between the basic and clinical sciences
bull Time is wasted in acquiring knowledge that is subsequently forgotten or found to be irrelevant
bull Application of the acquired knowledge can be difficult bull The acquisition and retention of information that has no
apparent relevance can be boring and even demoralising for students
The group learning process acquiring
desirable learning skills
Generic Skills amp attitudes
bull Teamwork bull Critical evaluation of literature bull Chairing a group bull Self directed learning and use of
resources bull Listening Presentation skills
Recording bull Cooperation bull Respect for colleagues views
bull Group learning facilitates not only the acquisition of knowledge but also several other desirable attributes such as communication skills teamwork problem solving independent responsibility for learning sharing information and respect for others PBL can therefore be thought of as a small group teaching method that combines the acquisition of knowledge with the development of generic skills and attitudes Presentation of clinical material as the stimulus for learning enables students to understand the relevance of underlying scientific knowledge and principles in clinical practice
bull when PBL is introduced into a curriculum several other issues for curriculum design and implementation need to be tackled PBL is generally introduced in the context of a defined core curriculum and integration of basic and clinical sciences It has implications for staffing and learning resources and demands a different approach to timetabling workload and assessment PBL is often used to deliver core material in non-clinical parts of the curriculum Paper based PBL scenarios form the basis of the core curriculum and ensure that all students are exposed to the same problems Recently modified PBL techniques have been introduced into clinical education with real patients being used as the stimulus for learning Despite the essential ad hoc nature of learning clinical medicine a key cases approach can enable PBL to be used to deliver the core clinical curriculum
Copyright copy2003 BMJ Publishing Group Ltd
Wood D F BMJ 2003326328-330
No CRoles of participants in a PBL tutorial aption Found
What happens in a PBL tutorial bull PBL tutorials are conducted in several ways In
this article the examples are modelled on the Maastricht seven jump process but its format of seven steps may be shortened
bull A typical PBL tutorial consists of a group of students (usually eight to 10) and a tutor who facilitates the session The length of time (number of sessions) that a group stays together with each other and with individual tutors varies between institutions A group needs to be together long enough to allow good group dynamics to develop but may need to be changed occasionally if personality clashes or other dysfunctional behaviour emerges
bull Students elect a chair for each PBL scenario and a scribe to record the discussion The roles are rotated for each scenario Suitable flip charts or a whiteboard should be used for recording the proceedings At the start of the session depending on the trigger material either the student chair reads out the scenario or all students study the material If the trigger is a real patient in a ward clinic or surgery then a student may be asked to take a clinical history or identify an abnormal physical sign before the group moves to a tutorial room For each module students may be given a handbook containing the problem scenarios and suggested learning resources or learning materials may be handed out at appropriate times as the tutorials progress
Examples of trigger material for PBL scenarios bull Paper based clinical scenarios bull Experimental or clinical laboratory data bull Photographs bull Video clips bull Newspaper articles bull All or part of an article from a scientific
journal bull A real or simulated patient bull A family tree showing an inherited
disorder
PBL tutorial process ndash Step 1 Identify and clarify unfamiliar terms presented in the scenario
scribe lists those that remain unexplained after discussion ndash Step 2 Define the problem or problems to be discussed students may
have different views on the issues but all should be considered scribe records a list of agreed problems
ndash Step 3 Brainstorming session to discuss the problem(s) suggestingpossible explanations on basis of prior knowledge students draw on each others knowledge and identify areas of incomplete knowledge scribe records all discussion
ndash Step 4 Review steps 2 and 3 and arrange explanations into tentativesolutions scribe organises the explanations and restructures if necessary
ndash Step 5 Formulate learning objectives group reaches consensus onthe learning objectives tutor ensures learning objectives are focused achievable comprehensive and appropriate
ndash Step 6 Private study (all students gather information related to eachlearning objective)
ndash Step 7 Group shares results of private study (students identify theirlearning resources and share their results) tutor checks learning and may assess the group
bull The role of the tutor is to facilitate the proceedings (helping the chair to maintain group dynamics and moving the group through the task) and to ensure that the group achieves appropriate learning objectives in line with those set by the curriculum design team The tutor may need to take a more active role in step 7 of the process to ensure that all the students have done the appropriate work and to help the chair to suggest a suitable format for group members to use to present the results of their private study The tutor should encourage students to check their understanding of the material He or she can do this by encouraging the students to ask open questions and ask each other to explain topics in their own words or by the use of drawings and diagrams
PBL in curriculum design bull PBL may be used either as the mainstay of an entire
curriculum or for the delivery of individual courses In practice PBL is usually part of an integrated curriculum using a systems based approach with non-clinical material delivered in the context of clinical practice A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge skills and attitudes A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios Sufficient time should be allowed each week for students to do the self directed learning required for PBL
bull
Copyright copy2003 BMJ Publishing Group Ltd
Wood D F BMJ 2003326328-330
No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found
Writing PBL scenarios
bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives
bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after
studying the scenario should be consistent with the faculty learning objectives
bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding
bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice
bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge
bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented
bull The problem should be sufficiently open so that discussion is not curtailed too early in the process
bull Scenarios should promote participation by the students in seeking information from various learning resources
bull Adapted from Dolmans et al Med Teacher 199719185-9
Staff development
bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)
A dysfunctional group a dominant character may
make it difficult for other students to be heard
A dysfunctional group a dominant character may make it difficult for other students to be heard
bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties
Advantages of PBL bull Student centred PBLIt fostersactive learning improved
understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks
Disadvantagesbull Tutors who cant teachTutorsenjoy passing on
their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful
Assessment of PBL
bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods
bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL
Conclusion
bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning
bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL
PBL 5 Easy Steps
bull Read the problem
Mrs Paula Embledon
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
2 Brain storm
bull Brainstorm
bull ndash hypotheses
bull - what do we know in support of the hypothesis
bull - what do we need to know to test the hypothesis
ndash learning issues
Brainstorm
bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)
ndash specific issues (for individuals to look up)
ndash overlapping issues
bull 4 Individual Reading - Research - Preparation
bull 5 Return
bull ndash review case so far ndash report and discuss
ndash assess progress - continue pagenext pagecomplete
ndash self-evaluation - How did things go Any suggestions for next time
ndash next problem
bull 5 Return
THE FIRST GROUP SESSION
bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day
bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session
bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr
bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine
bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise
bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator
bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues
bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know
bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)
bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)
bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)
PBL Case (contd)
bull By the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
ndashFIRST identifying all of the significant issues and settle on a do-able list of learning tasks for the next session
What is problem based learning
bull In PBL students use triggers from the problem case or scenario to define their own learning objectives
bull Subsequently they do independent self directed study before returning to the group to discuss and refine their acquired knowledge
bull Thus PBL is not about problem solving per se but rather it uses appropriate problems to increase knowledge and understanding
bull The process is clearly defined
PBL
bull PBL uses clinical cases as the context for students to study basic and clinical sciences
bull 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
bull Possible disadvantages include higher costs both in resources and staff time
PBL
bull An educational method characterized by the use of patient problems as a context for students to learn problem-solving skills and acquire knowledge about the basic and clinical sciences
bull Students usually meet in small groups two or three times a week for PBL tutorials
bull They are presented with a clinical problem (eg a patient with chest pain) and in a series of steps they discuss possible mechanisms and causes develop hypotheses and strategies to test the hypotheses are presented with further information and use this new information to refine their hypotheses finally reaching a conclusion
bull A tutor usually acts as a facilitator guiding students in this group-learning process
bull In the course of this exercise students identify both their existing levels and gaps in their knowledge These gaps form the basis for independent learning outside the PBL tutorials The identification and pursuit of these so-called learning goals is a key element of the PBL process
Rationale for using PBL bull The PBL approach is based on principles of adult
education20 and cognitive psychology21 It differs fundamentally from traditional curricula in which students acquire background knowledge of the basic sciences in the early years of the course and in the later years apply this knowledge to the diagnosis and management of clinical problems This traditional approach has been criticised for a number of reasons42223
bull It creates an artificial divide between the basic and clinical sciences
bull Time is wasted in acquiring knowledge that is subsequently forgotten or found to be irrelevant
bull Application of the acquired knowledge can be difficult bull The acquisition and retention of information that has no
apparent relevance can be boring and even demoralising for students
The group learning process acquiring
desirable learning skills
Generic Skills amp attitudes
bull Teamwork bull Critical evaluation of literature bull Chairing a group bull Self directed learning and use of
resources bull Listening Presentation skills
Recording bull Cooperation bull Respect for colleagues views
bull Group learning facilitates not only the acquisition of knowledge but also several other desirable attributes such as communication skills teamwork problem solving independent responsibility for learning sharing information and respect for others PBL can therefore be thought of as a small group teaching method that combines the acquisition of knowledge with the development of generic skills and attitudes Presentation of clinical material as the stimulus for learning enables students to understand the relevance of underlying scientific knowledge and principles in clinical practice
bull when PBL is introduced into a curriculum several other issues for curriculum design and implementation need to be tackled PBL is generally introduced in the context of a defined core curriculum and integration of basic and clinical sciences It has implications for staffing and learning resources and demands a different approach to timetabling workload and assessment PBL is often used to deliver core material in non-clinical parts of the curriculum Paper based PBL scenarios form the basis of the core curriculum and ensure that all students are exposed to the same problems Recently modified PBL techniques have been introduced into clinical education with real patients being used as the stimulus for learning Despite the essential ad hoc nature of learning clinical medicine a key cases approach can enable PBL to be used to deliver the core clinical curriculum
Copyright copy2003 BMJ Publishing Group Ltd
Wood D F BMJ 2003326328-330
No CRoles of participants in a PBL tutorial aption Found
What happens in a PBL tutorial bull PBL tutorials are conducted in several ways In
this article the examples are modelled on the Maastricht seven jump process but its format of seven steps may be shortened
bull A typical PBL tutorial consists of a group of students (usually eight to 10) and a tutor who facilitates the session The length of time (number of sessions) that a group stays together with each other and with individual tutors varies between institutions A group needs to be together long enough to allow good group dynamics to develop but may need to be changed occasionally if personality clashes or other dysfunctional behaviour emerges
bull Students elect a chair for each PBL scenario and a scribe to record the discussion The roles are rotated for each scenario Suitable flip charts or a whiteboard should be used for recording the proceedings At the start of the session depending on the trigger material either the student chair reads out the scenario or all students study the material If the trigger is a real patient in a ward clinic or surgery then a student may be asked to take a clinical history or identify an abnormal physical sign before the group moves to a tutorial room For each module students may be given a handbook containing the problem scenarios and suggested learning resources or learning materials may be handed out at appropriate times as the tutorials progress
Examples of trigger material for PBL scenarios bull Paper based clinical scenarios bull Experimental or clinical laboratory data bull Photographs bull Video clips bull Newspaper articles bull All or part of an article from a scientific
journal bull A real or simulated patient bull A family tree showing an inherited
disorder
PBL tutorial process ndash Step 1 Identify and clarify unfamiliar terms presented in the scenario
scribe lists those that remain unexplained after discussion ndash Step 2 Define the problem or problems to be discussed students may
have different views on the issues but all should be considered scribe records a list of agreed problems
ndash Step 3 Brainstorming session to discuss the problem(s) suggestingpossible explanations on basis of prior knowledge students draw on each others knowledge and identify areas of incomplete knowledge scribe records all discussion
ndash Step 4 Review steps 2 and 3 and arrange explanations into tentativesolutions scribe organises the explanations and restructures if necessary
ndash Step 5 Formulate learning objectives group reaches consensus onthe learning objectives tutor ensures learning objectives are focused achievable comprehensive and appropriate
ndash Step 6 Private study (all students gather information related to eachlearning objective)
ndash Step 7 Group shares results of private study (students identify theirlearning resources and share their results) tutor checks learning and may assess the group
bull The role of the tutor is to facilitate the proceedings (helping the chair to maintain group dynamics and moving the group through the task) and to ensure that the group achieves appropriate learning objectives in line with those set by the curriculum design team The tutor may need to take a more active role in step 7 of the process to ensure that all the students have done the appropriate work and to help the chair to suggest a suitable format for group members to use to present the results of their private study The tutor should encourage students to check their understanding of the material He or she can do this by encouraging the students to ask open questions and ask each other to explain topics in their own words or by the use of drawings and diagrams
PBL in curriculum design bull PBL may be used either as the mainstay of an entire
curriculum or for the delivery of individual courses In practice PBL is usually part of an integrated curriculum using a systems based approach with non-clinical material delivered in the context of clinical practice A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge skills and attitudes A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios Sufficient time should be allowed each week for students to do the self directed learning required for PBL
bull
Copyright copy2003 BMJ Publishing Group Ltd
Wood D F BMJ 2003326328-330
No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found
Writing PBL scenarios
bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives
bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after
studying the scenario should be consistent with the faculty learning objectives
bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding
bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice
bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge
bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented
bull The problem should be sufficiently open so that discussion is not curtailed too early in the process
bull Scenarios should promote participation by the students in seeking information from various learning resources
bull Adapted from Dolmans et al Med Teacher 199719185-9
Staff development
bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)
A dysfunctional group a dominant character may
make it difficult for other students to be heard
A dysfunctional group a dominant character may make it difficult for other students to be heard
bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties
Advantages of PBL bull Student centred PBLIt fostersactive learning improved
understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks
Disadvantagesbull Tutors who cant teachTutorsenjoy passing on
their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful
Assessment of PBL
bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods
bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL
Conclusion
bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning
bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL
PBL 5 Easy Steps
bull Read the problem
Mrs Paula Embledon
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
2 Brain storm
bull Brainstorm
bull ndash hypotheses
bull - what do we know in support of the hypothesis
bull - what do we need to know to test the hypothesis
ndash learning issues
Brainstorm
bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)
ndash specific issues (for individuals to look up)
ndash overlapping issues
bull 4 Individual Reading - Research - Preparation
bull 5 Return
bull ndash review case so far ndash report and discuss
ndash assess progress - continue pagenext pagecomplete
ndash self-evaluation - How did things go Any suggestions for next time
ndash next problem
bull 5 Return
THE FIRST GROUP SESSION
bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day
bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session
bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr
bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine
bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise
bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator
bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues
bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know
bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)
bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)
bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)
What is problem based learning
bull In PBL students use triggers from the problem case or scenario to define their own learning objectives
bull Subsequently they do independent self directed study before returning to the group to discuss and refine their acquired knowledge
bull Thus PBL is not about problem solving per se but rather it uses appropriate problems to increase knowledge and understanding
bull The process is clearly defined
PBL
bull PBL uses clinical cases as the context for students to study basic and clinical sciences
bull 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
bull Possible disadvantages include higher costs both in resources and staff time
PBL
bull An educational method characterized by the use of patient problems as a context for students to learn problem-solving skills and acquire knowledge about the basic and clinical sciences
bull Students usually meet in small groups two or three times a week for PBL tutorials
bull They are presented with a clinical problem (eg a patient with chest pain) and in a series of steps they discuss possible mechanisms and causes develop hypotheses and strategies to test the hypotheses are presented with further information and use this new information to refine their hypotheses finally reaching a conclusion
bull A tutor usually acts as a facilitator guiding students in this group-learning process
bull In the course of this exercise students identify both their existing levels and gaps in their knowledge These gaps form the basis for independent learning outside the PBL tutorials The identification and pursuit of these so-called learning goals is a key element of the PBL process
Rationale for using PBL bull The PBL approach is based on principles of adult
education20 and cognitive psychology21 It differs fundamentally from traditional curricula in which students acquire background knowledge of the basic sciences in the early years of the course and in the later years apply this knowledge to the diagnosis and management of clinical problems This traditional approach has been criticised for a number of reasons42223
bull It creates an artificial divide between the basic and clinical sciences
bull Time is wasted in acquiring knowledge that is subsequently forgotten or found to be irrelevant
bull Application of the acquired knowledge can be difficult bull The acquisition and retention of information that has no
apparent relevance can be boring and even demoralising for students
The group learning process acquiring
desirable learning skills
Generic Skills amp attitudes
bull Teamwork bull Critical evaluation of literature bull Chairing a group bull Self directed learning and use of
resources bull Listening Presentation skills
Recording bull Cooperation bull Respect for colleagues views
bull Group learning facilitates not only the acquisition of knowledge but also several other desirable attributes such as communication skills teamwork problem solving independent responsibility for learning sharing information and respect for others PBL can therefore be thought of as a small group teaching method that combines the acquisition of knowledge with the development of generic skills and attitudes Presentation of clinical material as the stimulus for learning enables students to understand the relevance of underlying scientific knowledge and principles in clinical practice
bull when PBL is introduced into a curriculum several other issues for curriculum design and implementation need to be tackled PBL is generally introduced in the context of a defined core curriculum and integration of basic and clinical sciences It has implications for staffing and learning resources and demands a different approach to timetabling workload and assessment PBL is often used to deliver core material in non-clinical parts of the curriculum Paper based PBL scenarios form the basis of the core curriculum and ensure that all students are exposed to the same problems Recently modified PBL techniques have been introduced into clinical education with real patients being used as the stimulus for learning Despite the essential ad hoc nature of learning clinical medicine a key cases approach can enable PBL to be used to deliver the core clinical curriculum
Copyright copy2003 BMJ Publishing Group Ltd
Wood D F BMJ 2003326328-330
No CRoles of participants in a PBL tutorial aption Found
What happens in a PBL tutorial bull PBL tutorials are conducted in several ways In
this article the examples are modelled on the Maastricht seven jump process but its format of seven steps may be shortened
bull A typical PBL tutorial consists of a group of students (usually eight to 10) and a tutor who facilitates the session The length of time (number of sessions) that a group stays together with each other and with individual tutors varies between institutions A group needs to be together long enough to allow good group dynamics to develop but may need to be changed occasionally if personality clashes or other dysfunctional behaviour emerges
bull Students elect a chair for each PBL scenario and a scribe to record the discussion The roles are rotated for each scenario Suitable flip charts or a whiteboard should be used for recording the proceedings At the start of the session depending on the trigger material either the student chair reads out the scenario or all students study the material If the trigger is a real patient in a ward clinic or surgery then a student may be asked to take a clinical history or identify an abnormal physical sign before the group moves to a tutorial room For each module students may be given a handbook containing the problem scenarios and suggested learning resources or learning materials may be handed out at appropriate times as the tutorials progress
Examples of trigger material for PBL scenarios bull Paper based clinical scenarios bull Experimental or clinical laboratory data bull Photographs bull Video clips bull Newspaper articles bull All or part of an article from a scientific
journal bull A real or simulated patient bull A family tree showing an inherited
disorder
PBL tutorial process ndash Step 1 Identify and clarify unfamiliar terms presented in the scenario
scribe lists those that remain unexplained after discussion ndash Step 2 Define the problem or problems to be discussed students may
have different views on the issues but all should be considered scribe records a list of agreed problems
ndash Step 3 Brainstorming session to discuss the problem(s) suggestingpossible explanations on basis of prior knowledge students draw on each others knowledge and identify areas of incomplete knowledge scribe records all discussion
ndash Step 4 Review steps 2 and 3 and arrange explanations into tentativesolutions scribe organises the explanations and restructures if necessary
ndash Step 5 Formulate learning objectives group reaches consensus onthe learning objectives tutor ensures learning objectives are focused achievable comprehensive and appropriate
ndash Step 6 Private study (all students gather information related to eachlearning objective)
ndash Step 7 Group shares results of private study (students identify theirlearning resources and share their results) tutor checks learning and may assess the group
bull The role of the tutor is to facilitate the proceedings (helping the chair to maintain group dynamics and moving the group through the task) and to ensure that the group achieves appropriate learning objectives in line with those set by the curriculum design team The tutor may need to take a more active role in step 7 of the process to ensure that all the students have done the appropriate work and to help the chair to suggest a suitable format for group members to use to present the results of their private study The tutor should encourage students to check their understanding of the material He or she can do this by encouraging the students to ask open questions and ask each other to explain topics in their own words or by the use of drawings and diagrams
PBL in curriculum design bull PBL may be used either as the mainstay of an entire
curriculum or for the delivery of individual courses In practice PBL is usually part of an integrated curriculum using a systems based approach with non-clinical material delivered in the context of clinical practice A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge skills and attitudes A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios Sufficient time should be allowed each week for students to do the self directed learning required for PBL
bull
Copyright copy2003 BMJ Publishing Group Ltd
Wood D F BMJ 2003326328-330
No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found
Writing PBL scenarios
bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives
bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after
studying the scenario should be consistent with the faculty learning objectives
bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding
bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice
bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge
bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented
bull The problem should be sufficiently open so that discussion is not curtailed too early in the process
bull Scenarios should promote participation by the students in seeking information from various learning resources
bull Adapted from Dolmans et al Med Teacher 199719185-9
Staff development
bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)
A dysfunctional group a dominant character may
make it difficult for other students to be heard
A dysfunctional group a dominant character may make it difficult for other students to be heard
bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties
Advantages of PBL bull Student centred PBLIt fostersactive learning improved
understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks
Disadvantagesbull Tutors who cant teachTutorsenjoy passing on
their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful
Assessment of PBL
bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods
bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL
Conclusion
bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning
bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL
PBL 5 Easy Steps
bull Read the problem
Mrs Paula Embledon
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
2 Brain storm
bull Brainstorm
bull ndash hypotheses
bull - what do we know in support of the hypothesis
bull - what do we need to know to test the hypothesis
ndash learning issues
Brainstorm
bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)
ndash specific issues (for individuals to look up)
ndash overlapping issues
bull 4 Individual Reading - Research - Preparation
bull 5 Return
bull ndash review case so far ndash report and discuss
ndash assess progress - continue pagenext pagecomplete
ndash self-evaluation - How did things go Any suggestions for next time
ndash next problem
bull 5 Return
THE FIRST GROUP SESSION
bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day
bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session
bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr
bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine
bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise
bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator
bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues
bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know
bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)
bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)
bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)
PBL
bull PBL uses clinical cases as the context for students to study basic and clinical sciences
bull 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
bull Possible disadvantages include higher costs both in resources and staff time
PBL
bull An educational method characterized by the use of patient problems as a context for students to learn problem-solving skills and acquire knowledge about the basic and clinical sciences
bull Students usually meet in small groups two or three times a week for PBL tutorials
bull They are presented with a clinical problem (eg a patient with chest pain) and in a series of steps they discuss possible mechanisms and causes develop hypotheses and strategies to test the hypotheses are presented with further information and use this new information to refine their hypotheses finally reaching a conclusion
bull A tutor usually acts as a facilitator guiding students in this group-learning process
bull In the course of this exercise students identify both their existing levels and gaps in their knowledge These gaps form the basis for independent learning outside the PBL tutorials The identification and pursuit of these so-called learning goals is a key element of the PBL process
Rationale for using PBL bull The PBL approach is based on principles of adult
education20 and cognitive psychology21 It differs fundamentally from traditional curricula in which students acquire background knowledge of the basic sciences in the early years of the course and in the later years apply this knowledge to the diagnosis and management of clinical problems This traditional approach has been criticised for a number of reasons42223
bull It creates an artificial divide between the basic and clinical sciences
bull Time is wasted in acquiring knowledge that is subsequently forgotten or found to be irrelevant
bull Application of the acquired knowledge can be difficult bull The acquisition and retention of information that has no
apparent relevance can be boring and even demoralising for students
The group learning process acquiring
desirable learning skills
Generic Skills amp attitudes
bull Teamwork bull Critical evaluation of literature bull Chairing a group bull Self directed learning and use of
resources bull Listening Presentation skills
Recording bull Cooperation bull Respect for colleagues views
bull Group learning facilitates not only the acquisition of knowledge but also several other desirable attributes such as communication skills teamwork problem solving independent responsibility for learning sharing information and respect for others PBL can therefore be thought of as a small group teaching method that combines the acquisition of knowledge with the development of generic skills and attitudes Presentation of clinical material as the stimulus for learning enables students to understand the relevance of underlying scientific knowledge and principles in clinical practice
bull when PBL is introduced into a curriculum several other issues for curriculum design and implementation need to be tackled PBL is generally introduced in the context of a defined core curriculum and integration of basic and clinical sciences It has implications for staffing and learning resources and demands a different approach to timetabling workload and assessment PBL is often used to deliver core material in non-clinical parts of the curriculum Paper based PBL scenarios form the basis of the core curriculum and ensure that all students are exposed to the same problems Recently modified PBL techniques have been introduced into clinical education with real patients being used as the stimulus for learning Despite the essential ad hoc nature of learning clinical medicine a key cases approach can enable PBL to be used to deliver the core clinical curriculum
Copyright copy2003 BMJ Publishing Group Ltd
Wood D F BMJ 2003326328-330
No CRoles of participants in a PBL tutorial aption Found
What happens in a PBL tutorial bull PBL tutorials are conducted in several ways In
this article the examples are modelled on the Maastricht seven jump process but its format of seven steps may be shortened
bull A typical PBL tutorial consists of a group of students (usually eight to 10) and a tutor who facilitates the session The length of time (number of sessions) that a group stays together with each other and with individual tutors varies between institutions A group needs to be together long enough to allow good group dynamics to develop but may need to be changed occasionally if personality clashes or other dysfunctional behaviour emerges
bull Students elect a chair for each PBL scenario and a scribe to record the discussion The roles are rotated for each scenario Suitable flip charts or a whiteboard should be used for recording the proceedings At the start of the session depending on the trigger material either the student chair reads out the scenario or all students study the material If the trigger is a real patient in a ward clinic or surgery then a student may be asked to take a clinical history or identify an abnormal physical sign before the group moves to a tutorial room For each module students may be given a handbook containing the problem scenarios and suggested learning resources or learning materials may be handed out at appropriate times as the tutorials progress
Examples of trigger material for PBL scenarios bull Paper based clinical scenarios bull Experimental or clinical laboratory data bull Photographs bull Video clips bull Newspaper articles bull All or part of an article from a scientific
journal bull A real or simulated patient bull A family tree showing an inherited
disorder
PBL tutorial process ndash Step 1 Identify and clarify unfamiliar terms presented in the scenario
scribe lists those that remain unexplained after discussion ndash Step 2 Define the problem or problems to be discussed students may
have different views on the issues but all should be considered scribe records a list of agreed problems
ndash Step 3 Brainstorming session to discuss the problem(s) suggestingpossible explanations on basis of prior knowledge students draw on each others knowledge and identify areas of incomplete knowledge scribe records all discussion
ndash Step 4 Review steps 2 and 3 and arrange explanations into tentativesolutions scribe organises the explanations and restructures if necessary
ndash Step 5 Formulate learning objectives group reaches consensus onthe learning objectives tutor ensures learning objectives are focused achievable comprehensive and appropriate
ndash Step 6 Private study (all students gather information related to eachlearning objective)
ndash Step 7 Group shares results of private study (students identify theirlearning resources and share their results) tutor checks learning and may assess the group
bull The role of the tutor is to facilitate the proceedings (helping the chair to maintain group dynamics and moving the group through the task) and to ensure that the group achieves appropriate learning objectives in line with those set by the curriculum design team The tutor may need to take a more active role in step 7 of the process to ensure that all the students have done the appropriate work and to help the chair to suggest a suitable format for group members to use to present the results of their private study The tutor should encourage students to check their understanding of the material He or she can do this by encouraging the students to ask open questions and ask each other to explain topics in their own words or by the use of drawings and diagrams
PBL in curriculum design bull PBL may be used either as the mainstay of an entire
curriculum or for the delivery of individual courses In practice PBL is usually part of an integrated curriculum using a systems based approach with non-clinical material delivered in the context of clinical practice A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge skills and attitudes A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios Sufficient time should be allowed each week for students to do the self directed learning required for PBL
bull
Copyright copy2003 BMJ Publishing Group Ltd
Wood D F BMJ 2003326328-330
No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found
Writing PBL scenarios
bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives
bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after
studying the scenario should be consistent with the faculty learning objectives
bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding
bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice
bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge
bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented
bull The problem should be sufficiently open so that discussion is not curtailed too early in the process
bull Scenarios should promote participation by the students in seeking information from various learning resources
bull Adapted from Dolmans et al Med Teacher 199719185-9
Staff development
bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)
A dysfunctional group a dominant character may
make it difficult for other students to be heard
A dysfunctional group a dominant character may make it difficult for other students to be heard
bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties
Advantages of PBL bull Student centred PBLIt fostersactive learning improved
understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks
Disadvantagesbull Tutors who cant teachTutorsenjoy passing on
their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful
Assessment of PBL
bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods
bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL
Conclusion
bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning
bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL
PBL 5 Easy Steps
bull Read the problem
Mrs Paula Embledon
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
2 Brain storm
bull Brainstorm
bull ndash hypotheses
bull - what do we know in support of the hypothesis
bull - what do we need to know to test the hypothesis
ndash learning issues
Brainstorm
bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)
ndash specific issues (for individuals to look up)
ndash overlapping issues
bull 4 Individual Reading - Research - Preparation
bull 5 Return
bull ndash review case so far ndash report and discuss
ndash assess progress - continue pagenext pagecomplete
ndash self-evaluation - How did things go Any suggestions for next time
ndash next problem
bull 5 Return
THE FIRST GROUP SESSION
bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day
bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session
bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr
bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine
bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise
bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator
bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues
bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know
bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)
bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)
bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)
PBL
bull An educational method characterized by the use of patient problems as a context for students to learn problem-solving skills and acquire knowledge about the basic and clinical sciences
bull Students usually meet in small groups two or three times a week for PBL tutorials
bull They are presented with a clinical problem (eg a patient with chest pain) and in a series of steps they discuss possible mechanisms and causes develop hypotheses and strategies to test the hypotheses are presented with further information and use this new information to refine their hypotheses finally reaching a conclusion
bull A tutor usually acts as a facilitator guiding students in this group-learning process
bull In the course of this exercise students identify both their existing levels and gaps in their knowledge These gaps form the basis for independent learning outside the PBL tutorials The identification and pursuit of these so-called learning goals is a key element of the PBL process
Rationale for using PBL bull The PBL approach is based on principles of adult
education20 and cognitive psychology21 It differs fundamentally from traditional curricula in which students acquire background knowledge of the basic sciences in the early years of the course and in the later years apply this knowledge to the diagnosis and management of clinical problems This traditional approach has been criticised for a number of reasons42223
bull It creates an artificial divide between the basic and clinical sciences
bull Time is wasted in acquiring knowledge that is subsequently forgotten or found to be irrelevant
bull Application of the acquired knowledge can be difficult bull The acquisition and retention of information that has no
apparent relevance can be boring and even demoralising for students
The group learning process acquiring
desirable learning skills
Generic Skills amp attitudes
bull Teamwork bull Critical evaluation of literature bull Chairing a group bull Self directed learning and use of
resources bull Listening Presentation skills
Recording bull Cooperation bull Respect for colleagues views
bull Group learning facilitates not only the acquisition of knowledge but also several other desirable attributes such as communication skills teamwork problem solving independent responsibility for learning sharing information and respect for others PBL can therefore be thought of as a small group teaching method that combines the acquisition of knowledge with the development of generic skills and attitudes Presentation of clinical material as the stimulus for learning enables students to understand the relevance of underlying scientific knowledge and principles in clinical practice
bull when PBL is introduced into a curriculum several other issues for curriculum design and implementation need to be tackled PBL is generally introduced in the context of a defined core curriculum and integration of basic and clinical sciences It has implications for staffing and learning resources and demands a different approach to timetabling workload and assessment PBL is often used to deliver core material in non-clinical parts of the curriculum Paper based PBL scenarios form the basis of the core curriculum and ensure that all students are exposed to the same problems Recently modified PBL techniques have been introduced into clinical education with real patients being used as the stimulus for learning Despite the essential ad hoc nature of learning clinical medicine a key cases approach can enable PBL to be used to deliver the core clinical curriculum
Copyright copy2003 BMJ Publishing Group Ltd
Wood D F BMJ 2003326328-330
No CRoles of participants in a PBL tutorial aption Found
What happens in a PBL tutorial bull PBL tutorials are conducted in several ways In
this article the examples are modelled on the Maastricht seven jump process but its format of seven steps may be shortened
bull A typical PBL tutorial consists of a group of students (usually eight to 10) and a tutor who facilitates the session The length of time (number of sessions) that a group stays together with each other and with individual tutors varies between institutions A group needs to be together long enough to allow good group dynamics to develop but may need to be changed occasionally if personality clashes or other dysfunctional behaviour emerges
bull Students elect a chair for each PBL scenario and a scribe to record the discussion The roles are rotated for each scenario Suitable flip charts or a whiteboard should be used for recording the proceedings At the start of the session depending on the trigger material either the student chair reads out the scenario or all students study the material If the trigger is a real patient in a ward clinic or surgery then a student may be asked to take a clinical history or identify an abnormal physical sign before the group moves to a tutorial room For each module students may be given a handbook containing the problem scenarios and suggested learning resources or learning materials may be handed out at appropriate times as the tutorials progress
Examples of trigger material for PBL scenarios bull Paper based clinical scenarios bull Experimental or clinical laboratory data bull Photographs bull Video clips bull Newspaper articles bull All or part of an article from a scientific
journal bull A real or simulated patient bull A family tree showing an inherited
disorder
PBL tutorial process ndash Step 1 Identify and clarify unfamiliar terms presented in the scenario
scribe lists those that remain unexplained after discussion ndash Step 2 Define the problem or problems to be discussed students may
have different views on the issues but all should be considered scribe records a list of agreed problems
ndash Step 3 Brainstorming session to discuss the problem(s) suggestingpossible explanations on basis of prior knowledge students draw on each others knowledge and identify areas of incomplete knowledge scribe records all discussion
ndash Step 4 Review steps 2 and 3 and arrange explanations into tentativesolutions scribe organises the explanations and restructures if necessary
ndash Step 5 Formulate learning objectives group reaches consensus onthe learning objectives tutor ensures learning objectives are focused achievable comprehensive and appropriate
ndash Step 6 Private study (all students gather information related to eachlearning objective)
ndash Step 7 Group shares results of private study (students identify theirlearning resources and share their results) tutor checks learning and may assess the group
bull The role of the tutor is to facilitate the proceedings (helping the chair to maintain group dynamics and moving the group through the task) and to ensure that the group achieves appropriate learning objectives in line with those set by the curriculum design team The tutor may need to take a more active role in step 7 of the process to ensure that all the students have done the appropriate work and to help the chair to suggest a suitable format for group members to use to present the results of their private study The tutor should encourage students to check their understanding of the material He or she can do this by encouraging the students to ask open questions and ask each other to explain topics in their own words or by the use of drawings and diagrams
PBL in curriculum design bull PBL may be used either as the mainstay of an entire
curriculum or for the delivery of individual courses In practice PBL is usually part of an integrated curriculum using a systems based approach with non-clinical material delivered in the context of clinical practice A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge skills and attitudes A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios Sufficient time should be allowed each week for students to do the self directed learning required for PBL
bull
Copyright copy2003 BMJ Publishing Group Ltd
Wood D F BMJ 2003326328-330
No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found
Writing PBL scenarios
bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives
bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after
studying the scenario should be consistent with the faculty learning objectives
bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding
bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice
bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge
bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented
bull The problem should be sufficiently open so that discussion is not curtailed too early in the process
bull Scenarios should promote participation by the students in seeking information from various learning resources
bull Adapted from Dolmans et al Med Teacher 199719185-9
Staff development
bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)
A dysfunctional group a dominant character may
make it difficult for other students to be heard
A dysfunctional group a dominant character may make it difficult for other students to be heard
bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties
Advantages of PBL bull Student centred PBLIt fostersactive learning improved
understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks
Disadvantagesbull Tutors who cant teachTutorsenjoy passing on
their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful
Assessment of PBL
bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods
bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL
Conclusion
bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning
bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL
PBL 5 Easy Steps
bull Read the problem
Mrs Paula Embledon
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
2 Brain storm
bull Brainstorm
bull ndash hypotheses
bull - what do we know in support of the hypothesis
bull - what do we need to know to test the hypothesis
ndash learning issues
Brainstorm
bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)
ndash specific issues (for individuals to look up)
ndash overlapping issues
bull 4 Individual Reading - Research - Preparation
bull 5 Return
bull ndash review case so far ndash report and discuss
ndash assess progress - continue pagenext pagecomplete
ndash self-evaluation - How did things go Any suggestions for next time
ndash next problem
bull 5 Return
THE FIRST GROUP SESSION
bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day
bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session
bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr
bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine
bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise
bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator
bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues
bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know
bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)
bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)
bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)
bull In the course of this exercise students identify both their existing levels and gaps in their knowledge These gaps form the basis for independent learning outside the PBL tutorials The identification and pursuit of these so-called learning goals is a key element of the PBL process
Rationale for using PBL bull The PBL approach is based on principles of adult
education20 and cognitive psychology21 It differs fundamentally from traditional curricula in which students acquire background knowledge of the basic sciences in the early years of the course and in the later years apply this knowledge to the diagnosis and management of clinical problems This traditional approach has been criticised for a number of reasons42223
bull It creates an artificial divide between the basic and clinical sciences
bull Time is wasted in acquiring knowledge that is subsequently forgotten or found to be irrelevant
bull Application of the acquired knowledge can be difficult bull The acquisition and retention of information that has no
apparent relevance can be boring and even demoralising for students
The group learning process acquiring
desirable learning skills
Generic Skills amp attitudes
bull Teamwork bull Critical evaluation of literature bull Chairing a group bull Self directed learning and use of
resources bull Listening Presentation skills
Recording bull Cooperation bull Respect for colleagues views
bull Group learning facilitates not only the acquisition of knowledge but also several other desirable attributes such as communication skills teamwork problem solving independent responsibility for learning sharing information and respect for others PBL can therefore be thought of as a small group teaching method that combines the acquisition of knowledge with the development of generic skills and attitudes Presentation of clinical material as the stimulus for learning enables students to understand the relevance of underlying scientific knowledge and principles in clinical practice
bull when PBL is introduced into a curriculum several other issues for curriculum design and implementation need to be tackled PBL is generally introduced in the context of a defined core curriculum and integration of basic and clinical sciences It has implications for staffing and learning resources and demands a different approach to timetabling workload and assessment PBL is often used to deliver core material in non-clinical parts of the curriculum Paper based PBL scenarios form the basis of the core curriculum and ensure that all students are exposed to the same problems Recently modified PBL techniques have been introduced into clinical education with real patients being used as the stimulus for learning Despite the essential ad hoc nature of learning clinical medicine a key cases approach can enable PBL to be used to deliver the core clinical curriculum
Copyright copy2003 BMJ Publishing Group Ltd
Wood D F BMJ 2003326328-330
No CRoles of participants in a PBL tutorial aption Found
What happens in a PBL tutorial bull PBL tutorials are conducted in several ways In
this article the examples are modelled on the Maastricht seven jump process but its format of seven steps may be shortened
bull A typical PBL tutorial consists of a group of students (usually eight to 10) and a tutor who facilitates the session The length of time (number of sessions) that a group stays together with each other and with individual tutors varies between institutions A group needs to be together long enough to allow good group dynamics to develop but may need to be changed occasionally if personality clashes or other dysfunctional behaviour emerges
bull Students elect a chair for each PBL scenario and a scribe to record the discussion The roles are rotated for each scenario Suitable flip charts or a whiteboard should be used for recording the proceedings At the start of the session depending on the trigger material either the student chair reads out the scenario or all students study the material If the trigger is a real patient in a ward clinic or surgery then a student may be asked to take a clinical history or identify an abnormal physical sign before the group moves to a tutorial room For each module students may be given a handbook containing the problem scenarios and suggested learning resources or learning materials may be handed out at appropriate times as the tutorials progress
Examples of trigger material for PBL scenarios bull Paper based clinical scenarios bull Experimental or clinical laboratory data bull Photographs bull Video clips bull Newspaper articles bull All or part of an article from a scientific
journal bull A real or simulated patient bull A family tree showing an inherited
disorder
PBL tutorial process ndash Step 1 Identify and clarify unfamiliar terms presented in the scenario
scribe lists those that remain unexplained after discussion ndash Step 2 Define the problem or problems to be discussed students may
have different views on the issues but all should be considered scribe records a list of agreed problems
ndash Step 3 Brainstorming session to discuss the problem(s) suggestingpossible explanations on basis of prior knowledge students draw on each others knowledge and identify areas of incomplete knowledge scribe records all discussion
ndash Step 4 Review steps 2 and 3 and arrange explanations into tentativesolutions scribe organises the explanations and restructures if necessary
ndash Step 5 Formulate learning objectives group reaches consensus onthe learning objectives tutor ensures learning objectives are focused achievable comprehensive and appropriate
ndash Step 6 Private study (all students gather information related to eachlearning objective)
ndash Step 7 Group shares results of private study (students identify theirlearning resources and share their results) tutor checks learning and may assess the group
bull The role of the tutor is to facilitate the proceedings (helping the chair to maintain group dynamics and moving the group through the task) and to ensure that the group achieves appropriate learning objectives in line with those set by the curriculum design team The tutor may need to take a more active role in step 7 of the process to ensure that all the students have done the appropriate work and to help the chair to suggest a suitable format for group members to use to present the results of their private study The tutor should encourage students to check their understanding of the material He or she can do this by encouraging the students to ask open questions and ask each other to explain topics in their own words or by the use of drawings and diagrams
PBL in curriculum design bull PBL may be used either as the mainstay of an entire
curriculum or for the delivery of individual courses In practice PBL is usually part of an integrated curriculum using a systems based approach with non-clinical material delivered in the context of clinical practice A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge skills and attitudes A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios Sufficient time should be allowed each week for students to do the self directed learning required for PBL
bull
Copyright copy2003 BMJ Publishing Group Ltd
Wood D F BMJ 2003326328-330
No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found
Writing PBL scenarios
bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives
bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after
studying the scenario should be consistent with the faculty learning objectives
bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding
bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice
bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge
bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented
bull The problem should be sufficiently open so that discussion is not curtailed too early in the process
bull Scenarios should promote participation by the students in seeking information from various learning resources
bull Adapted from Dolmans et al Med Teacher 199719185-9
Staff development
bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)
A dysfunctional group a dominant character may
make it difficult for other students to be heard
A dysfunctional group a dominant character may make it difficult for other students to be heard
bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties
Advantages of PBL bull Student centred PBLIt fostersactive learning improved
understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks
Disadvantagesbull Tutors who cant teachTutorsenjoy passing on
their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful
Assessment of PBL
bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods
bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL
Conclusion
bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning
bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL
PBL 5 Easy Steps
bull Read the problem
Mrs Paula Embledon
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
2 Brain storm
bull Brainstorm
bull ndash hypotheses
bull - what do we know in support of the hypothesis
bull - what do we need to know to test the hypothesis
ndash learning issues
Brainstorm
bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)
ndash specific issues (for individuals to look up)
ndash overlapping issues
bull 4 Individual Reading - Research - Preparation
bull 5 Return
bull ndash review case so far ndash report and discuss
ndash assess progress - continue pagenext pagecomplete
ndash self-evaluation - How did things go Any suggestions for next time
ndash next problem
bull 5 Return
THE FIRST GROUP SESSION
bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day
bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session
bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr
bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine
bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise
bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator
bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues
bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know
bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)
bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)
bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)
Rationale for using PBL bull The PBL approach is based on principles of adult
education20 and cognitive psychology21 It differs fundamentally from traditional curricula in which students acquire background knowledge of the basic sciences in the early years of the course and in the later years apply this knowledge to the diagnosis and management of clinical problems This traditional approach has been criticised for a number of reasons42223
bull It creates an artificial divide between the basic and clinical sciences
bull Time is wasted in acquiring knowledge that is subsequently forgotten or found to be irrelevant
bull Application of the acquired knowledge can be difficult bull The acquisition and retention of information that has no
apparent relevance can be boring and even demoralising for students
The group learning process acquiring
desirable learning skills
Generic Skills amp attitudes
bull Teamwork bull Critical evaluation of literature bull Chairing a group bull Self directed learning and use of
resources bull Listening Presentation skills
Recording bull Cooperation bull Respect for colleagues views
bull Group learning facilitates not only the acquisition of knowledge but also several other desirable attributes such as communication skills teamwork problem solving independent responsibility for learning sharing information and respect for others PBL can therefore be thought of as a small group teaching method that combines the acquisition of knowledge with the development of generic skills and attitudes Presentation of clinical material as the stimulus for learning enables students to understand the relevance of underlying scientific knowledge and principles in clinical practice
bull when PBL is introduced into a curriculum several other issues for curriculum design and implementation need to be tackled PBL is generally introduced in the context of a defined core curriculum and integration of basic and clinical sciences It has implications for staffing and learning resources and demands a different approach to timetabling workload and assessment PBL is often used to deliver core material in non-clinical parts of the curriculum Paper based PBL scenarios form the basis of the core curriculum and ensure that all students are exposed to the same problems Recently modified PBL techniques have been introduced into clinical education with real patients being used as the stimulus for learning Despite the essential ad hoc nature of learning clinical medicine a key cases approach can enable PBL to be used to deliver the core clinical curriculum
Copyright copy2003 BMJ Publishing Group Ltd
Wood D F BMJ 2003326328-330
No CRoles of participants in a PBL tutorial aption Found
What happens in a PBL tutorial bull PBL tutorials are conducted in several ways In
this article the examples are modelled on the Maastricht seven jump process but its format of seven steps may be shortened
bull A typical PBL tutorial consists of a group of students (usually eight to 10) and a tutor who facilitates the session The length of time (number of sessions) that a group stays together with each other and with individual tutors varies between institutions A group needs to be together long enough to allow good group dynamics to develop but may need to be changed occasionally if personality clashes or other dysfunctional behaviour emerges
bull Students elect a chair for each PBL scenario and a scribe to record the discussion The roles are rotated for each scenario Suitable flip charts or a whiteboard should be used for recording the proceedings At the start of the session depending on the trigger material either the student chair reads out the scenario or all students study the material If the trigger is a real patient in a ward clinic or surgery then a student may be asked to take a clinical history or identify an abnormal physical sign before the group moves to a tutorial room For each module students may be given a handbook containing the problem scenarios and suggested learning resources or learning materials may be handed out at appropriate times as the tutorials progress
Examples of trigger material for PBL scenarios bull Paper based clinical scenarios bull Experimental or clinical laboratory data bull Photographs bull Video clips bull Newspaper articles bull All or part of an article from a scientific
journal bull A real or simulated patient bull A family tree showing an inherited
disorder
PBL tutorial process ndash Step 1 Identify and clarify unfamiliar terms presented in the scenario
scribe lists those that remain unexplained after discussion ndash Step 2 Define the problem or problems to be discussed students may
have different views on the issues but all should be considered scribe records a list of agreed problems
ndash Step 3 Brainstorming session to discuss the problem(s) suggestingpossible explanations on basis of prior knowledge students draw on each others knowledge and identify areas of incomplete knowledge scribe records all discussion
ndash Step 4 Review steps 2 and 3 and arrange explanations into tentativesolutions scribe organises the explanations and restructures if necessary
ndash Step 5 Formulate learning objectives group reaches consensus onthe learning objectives tutor ensures learning objectives are focused achievable comprehensive and appropriate
ndash Step 6 Private study (all students gather information related to eachlearning objective)
ndash Step 7 Group shares results of private study (students identify theirlearning resources and share their results) tutor checks learning and may assess the group
bull The role of the tutor is to facilitate the proceedings (helping the chair to maintain group dynamics and moving the group through the task) and to ensure that the group achieves appropriate learning objectives in line with those set by the curriculum design team The tutor may need to take a more active role in step 7 of the process to ensure that all the students have done the appropriate work and to help the chair to suggest a suitable format for group members to use to present the results of their private study The tutor should encourage students to check their understanding of the material He or she can do this by encouraging the students to ask open questions and ask each other to explain topics in their own words or by the use of drawings and diagrams
PBL in curriculum design bull PBL may be used either as the mainstay of an entire
curriculum or for the delivery of individual courses In practice PBL is usually part of an integrated curriculum using a systems based approach with non-clinical material delivered in the context of clinical practice A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge skills and attitudes A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios Sufficient time should be allowed each week for students to do the self directed learning required for PBL
bull
Copyright copy2003 BMJ Publishing Group Ltd
Wood D F BMJ 2003326328-330
No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found
Writing PBL scenarios
bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives
bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after
studying the scenario should be consistent with the faculty learning objectives
bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding
bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice
bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge
bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented
bull The problem should be sufficiently open so that discussion is not curtailed too early in the process
bull Scenarios should promote participation by the students in seeking information from various learning resources
bull Adapted from Dolmans et al Med Teacher 199719185-9
Staff development
bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)
A dysfunctional group a dominant character may
make it difficult for other students to be heard
A dysfunctional group a dominant character may make it difficult for other students to be heard
bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties
Advantages of PBL bull Student centred PBLIt fostersactive learning improved
understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks
Disadvantagesbull Tutors who cant teachTutorsenjoy passing on
their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful
Assessment of PBL
bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods
bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL
Conclusion
bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning
bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL
PBL 5 Easy Steps
bull Read the problem
Mrs Paula Embledon
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
2 Brain storm
bull Brainstorm
bull ndash hypotheses
bull - what do we know in support of the hypothesis
bull - what do we need to know to test the hypothesis
ndash learning issues
Brainstorm
bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)
ndash specific issues (for individuals to look up)
ndash overlapping issues
bull 4 Individual Reading - Research - Preparation
bull 5 Return
bull ndash review case so far ndash report and discuss
ndash assess progress - continue pagenext pagecomplete
ndash self-evaluation - How did things go Any suggestions for next time
ndash next problem
bull 5 Return
THE FIRST GROUP SESSION
bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day
bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session
bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr
bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine
bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise
bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator
bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues
bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know
bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)
bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)
bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)
The group learning process acquiring
desirable learning skills
Generic Skills amp attitudes
bull Teamwork bull Critical evaluation of literature bull Chairing a group bull Self directed learning and use of
resources bull Listening Presentation skills
Recording bull Cooperation bull Respect for colleagues views
bull Group learning facilitates not only the acquisition of knowledge but also several other desirable attributes such as communication skills teamwork problem solving independent responsibility for learning sharing information and respect for others PBL can therefore be thought of as a small group teaching method that combines the acquisition of knowledge with the development of generic skills and attitudes Presentation of clinical material as the stimulus for learning enables students to understand the relevance of underlying scientific knowledge and principles in clinical practice
bull when PBL is introduced into a curriculum several other issues for curriculum design and implementation need to be tackled PBL is generally introduced in the context of a defined core curriculum and integration of basic and clinical sciences It has implications for staffing and learning resources and demands a different approach to timetabling workload and assessment PBL is often used to deliver core material in non-clinical parts of the curriculum Paper based PBL scenarios form the basis of the core curriculum and ensure that all students are exposed to the same problems Recently modified PBL techniques have been introduced into clinical education with real patients being used as the stimulus for learning Despite the essential ad hoc nature of learning clinical medicine a key cases approach can enable PBL to be used to deliver the core clinical curriculum
Copyright copy2003 BMJ Publishing Group Ltd
Wood D F BMJ 2003326328-330
No CRoles of participants in a PBL tutorial aption Found
What happens in a PBL tutorial bull PBL tutorials are conducted in several ways In
this article the examples are modelled on the Maastricht seven jump process but its format of seven steps may be shortened
bull A typical PBL tutorial consists of a group of students (usually eight to 10) and a tutor who facilitates the session The length of time (number of sessions) that a group stays together with each other and with individual tutors varies between institutions A group needs to be together long enough to allow good group dynamics to develop but may need to be changed occasionally if personality clashes or other dysfunctional behaviour emerges
bull Students elect a chair for each PBL scenario and a scribe to record the discussion The roles are rotated for each scenario Suitable flip charts or a whiteboard should be used for recording the proceedings At the start of the session depending on the trigger material either the student chair reads out the scenario or all students study the material If the trigger is a real patient in a ward clinic or surgery then a student may be asked to take a clinical history or identify an abnormal physical sign before the group moves to a tutorial room For each module students may be given a handbook containing the problem scenarios and suggested learning resources or learning materials may be handed out at appropriate times as the tutorials progress
Examples of trigger material for PBL scenarios bull Paper based clinical scenarios bull Experimental or clinical laboratory data bull Photographs bull Video clips bull Newspaper articles bull All or part of an article from a scientific
journal bull A real or simulated patient bull A family tree showing an inherited
disorder
PBL tutorial process ndash Step 1 Identify and clarify unfamiliar terms presented in the scenario
scribe lists those that remain unexplained after discussion ndash Step 2 Define the problem or problems to be discussed students may
have different views on the issues but all should be considered scribe records a list of agreed problems
ndash Step 3 Brainstorming session to discuss the problem(s) suggestingpossible explanations on basis of prior knowledge students draw on each others knowledge and identify areas of incomplete knowledge scribe records all discussion
ndash Step 4 Review steps 2 and 3 and arrange explanations into tentativesolutions scribe organises the explanations and restructures if necessary
ndash Step 5 Formulate learning objectives group reaches consensus onthe learning objectives tutor ensures learning objectives are focused achievable comprehensive and appropriate
ndash Step 6 Private study (all students gather information related to eachlearning objective)
ndash Step 7 Group shares results of private study (students identify theirlearning resources and share their results) tutor checks learning and may assess the group
bull The role of the tutor is to facilitate the proceedings (helping the chair to maintain group dynamics and moving the group through the task) and to ensure that the group achieves appropriate learning objectives in line with those set by the curriculum design team The tutor may need to take a more active role in step 7 of the process to ensure that all the students have done the appropriate work and to help the chair to suggest a suitable format for group members to use to present the results of their private study The tutor should encourage students to check their understanding of the material He or she can do this by encouraging the students to ask open questions and ask each other to explain topics in their own words or by the use of drawings and diagrams
PBL in curriculum design bull PBL may be used either as the mainstay of an entire
curriculum or for the delivery of individual courses In practice PBL is usually part of an integrated curriculum using a systems based approach with non-clinical material delivered in the context of clinical practice A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge skills and attitudes A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios Sufficient time should be allowed each week for students to do the self directed learning required for PBL
bull
Copyright copy2003 BMJ Publishing Group Ltd
Wood D F BMJ 2003326328-330
No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found
Writing PBL scenarios
bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives
bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after
studying the scenario should be consistent with the faculty learning objectives
bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding
bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice
bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge
bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented
bull The problem should be sufficiently open so that discussion is not curtailed too early in the process
bull Scenarios should promote participation by the students in seeking information from various learning resources
bull Adapted from Dolmans et al Med Teacher 199719185-9
Staff development
bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)
A dysfunctional group a dominant character may
make it difficult for other students to be heard
A dysfunctional group a dominant character may make it difficult for other students to be heard
bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties
Advantages of PBL bull Student centred PBLIt fostersactive learning improved
understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks
Disadvantagesbull Tutors who cant teachTutorsenjoy passing on
their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful
Assessment of PBL
bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods
bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL
Conclusion
bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning
bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL
PBL 5 Easy Steps
bull Read the problem
Mrs Paula Embledon
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
2 Brain storm
bull Brainstorm
bull ndash hypotheses
bull - what do we know in support of the hypothesis
bull - what do we need to know to test the hypothesis
ndash learning issues
Brainstorm
bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)
ndash specific issues (for individuals to look up)
ndash overlapping issues
bull 4 Individual Reading - Research - Preparation
bull 5 Return
bull ndash review case so far ndash report and discuss
ndash assess progress - continue pagenext pagecomplete
ndash self-evaluation - How did things go Any suggestions for next time
ndash next problem
bull 5 Return
THE FIRST GROUP SESSION
bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day
bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session
bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr
bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine
bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise
bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator
bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues
bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know
bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)
bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)
bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)
Generic Skills amp attitudes
bull Teamwork bull Critical evaluation of literature bull Chairing a group bull Self directed learning and use of
resources bull Listening Presentation skills
Recording bull Cooperation bull Respect for colleagues views
bull Group learning facilitates not only the acquisition of knowledge but also several other desirable attributes such as communication skills teamwork problem solving independent responsibility for learning sharing information and respect for others PBL can therefore be thought of as a small group teaching method that combines the acquisition of knowledge with the development of generic skills and attitudes Presentation of clinical material as the stimulus for learning enables students to understand the relevance of underlying scientific knowledge and principles in clinical practice
bull when PBL is introduced into a curriculum several other issues for curriculum design and implementation need to be tackled PBL is generally introduced in the context of a defined core curriculum and integration of basic and clinical sciences It has implications for staffing and learning resources and demands a different approach to timetabling workload and assessment PBL is often used to deliver core material in non-clinical parts of the curriculum Paper based PBL scenarios form the basis of the core curriculum and ensure that all students are exposed to the same problems Recently modified PBL techniques have been introduced into clinical education with real patients being used as the stimulus for learning Despite the essential ad hoc nature of learning clinical medicine a key cases approach can enable PBL to be used to deliver the core clinical curriculum
Copyright copy2003 BMJ Publishing Group Ltd
Wood D F BMJ 2003326328-330
No CRoles of participants in a PBL tutorial aption Found
What happens in a PBL tutorial bull PBL tutorials are conducted in several ways In
this article the examples are modelled on the Maastricht seven jump process but its format of seven steps may be shortened
bull A typical PBL tutorial consists of a group of students (usually eight to 10) and a tutor who facilitates the session The length of time (number of sessions) that a group stays together with each other and with individual tutors varies between institutions A group needs to be together long enough to allow good group dynamics to develop but may need to be changed occasionally if personality clashes or other dysfunctional behaviour emerges
bull Students elect a chair for each PBL scenario and a scribe to record the discussion The roles are rotated for each scenario Suitable flip charts or a whiteboard should be used for recording the proceedings At the start of the session depending on the trigger material either the student chair reads out the scenario or all students study the material If the trigger is a real patient in a ward clinic or surgery then a student may be asked to take a clinical history or identify an abnormal physical sign before the group moves to a tutorial room For each module students may be given a handbook containing the problem scenarios and suggested learning resources or learning materials may be handed out at appropriate times as the tutorials progress
Examples of trigger material for PBL scenarios bull Paper based clinical scenarios bull Experimental or clinical laboratory data bull Photographs bull Video clips bull Newspaper articles bull All or part of an article from a scientific
journal bull A real or simulated patient bull A family tree showing an inherited
disorder
PBL tutorial process ndash Step 1 Identify and clarify unfamiliar terms presented in the scenario
scribe lists those that remain unexplained after discussion ndash Step 2 Define the problem or problems to be discussed students may
have different views on the issues but all should be considered scribe records a list of agreed problems
ndash Step 3 Brainstorming session to discuss the problem(s) suggestingpossible explanations on basis of prior knowledge students draw on each others knowledge and identify areas of incomplete knowledge scribe records all discussion
ndash Step 4 Review steps 2 and 3 and arrange explanations into tentativesolutions scribe organises the explanations and restructures if necessary
ndash Step 5 Formulate learning objectives group reaches consensus onthe learning objectives tutor ensures learning objectives are focused achievable comprehensive and appropriate
ndash Step 6 Private study (all students gather information related to eachlearning objective)
ndash Step 7 Group shares results of private study (students identify theirlearning resources and share their results) tutor checks learning and may assess the group
bull The role of the tutor is to facilitate the proceedings (helping the chair to maintain group dynamics and moving the group through the task) and to ensure that the group achieves appropriate learning objectives in line with those set by the curriculum design team The tutor may need to take a more active role in step 7 of the process to ensure that all the students have done the appropriate work and to help the chair to suggest a suitable format for group members to use to present the results of their private study The tutor should encourage students to check their understanding of the material He or she can do this by encouraging the students to ask open questions and ask each other to explain topics in their own words or by the use of drawings and diagrams
PBL in curriculum design bull PBL may be used either as the mainstay of an entire
curriculum or for the delivery of individual courses In practice PBL is usually part of an integrated curriculum using a systems based approach with non-clinical material delivered in the context of clinical practice A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge skills and attitudes A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios Sufficient time should be allowed each week for students to do the self directed learning required for PBL
bull
Copyright copy2003 BMJ Publishing Group Ltd
Wood D F BMJ 2003326328-330
No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found
Writing PBL scenarios
bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives
bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after
studying the scenario should be consistent with the faculty learning objectives
bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding
bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice
bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge
bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented
bull The problem should be sufficiently open so that discussion is not curtailed too early in the process
bull Scenarios should promote participation by the students in seeking information from various learning resources
bull Adapted from Dolmans et al Med Teacher 199719185-9
Staff development
bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)
A dysfunctional group a dominant character may
make it difficult for other students to be heard
A dysfunctional group a dominant character may make it difficult for other students to be heard
bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties
Advantages of PBL bull Student centred PBLIt fostersactive learning improved
understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks
Disadvantagesbull Tutors who cant teachTutorsenjoy passing on
their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful
Assessment of PBL
bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods
bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL
Conclusion
bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning
bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL
PBL 5 Easy Steps
bull Read the problem
Mrs Paula Embledon
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
2 Brain storm
bull Brainstorm
bull ndash hypotheses
bull - what do we know in support of the hypothesis
bull - what do we need to know to test the hypothesis
ndash learning issues
Brainstorm
bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)
ndash specific issues (for individuals to look up)
ndash overlapping issues
bull 4 Individual Reading - Research - Preparation
bull 5 Return
bull ndash review case so far ndash report and discuss
ndash assess progress - continue pagenext pagecomplete
ndash self-evaluation - How did things go Any suggestions for next time
ndash next problem
bull 5 Return
THE FIRST GROUP SESSION
bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day
bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session
bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr
bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine
bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise
bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator
bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues
bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know
bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)
bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)
bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)
bull Group learning facilitates not only the acquisition of knowledge but also several other desirable attributes such as communication skills teamwork problem solving independent responsibility for learning sharing information and respect for others PBL can therefore be thought of as a small group teaching method that combines the acquisition of knowledge with the development of generic skills and attitudes Presentation of clinical material as the stimulus for learning enables students to understand the relevance of underlying scientific knowledge and principles in clinical practice
bull when PBL is introduced into a curriculum several other issues for curriculum design and implementation need to be tackled PBL is generally introduced in the context of a defined core curriculum and integration of basic and clinical sciences It has implications for staffing and learning resources and demands a different approach to timetabling workload and assessment PBL is often used to deliver core material in non-clinical parts of the curriculum Paper based PBL scenarios form the basis of the core curriculum and ensure that all students are exposed to the same problems Recently modified PBL techniques have been introduced into clinical education with real patients being used as the stimulus for learning Despite the essential ad hoc nature of learning clinical medicine a key cases approach can enable PBL to be used to deliver the core clinical curriculum
Copyright copy2003 BMJ Publishing Group Ltd
Wood D F BMJ 2003326328-330
No CRoles of participants in a PBL tutorial aption Found
What happens in a PBL tutorial bull PBL tutorials are conducted in several ways In
this article the examples are modelled on the Maastricht seven jump process but its format of seven steps may be shortened
bull A typical PBL tutorial consists of a group of students (usually eight to 10) and a tutor who facilitates the session The length of time (number of sessions) that a group stays together with each other and with individual tutors varies between institutions A group needs to be together long enough to allow good group dynamics to develop but may need to be changed occasionally if personality clashes or other dysfunctional behaviour emerges
bull Students elect a chair for each PBL scenario and a scribe to record the discussion The roles are rotated for each scenario Suitable flip charts or a whiteboard should be used for recording the proceedings At the start of the session depending on the trigger material either the student chair reads out the scenario or all students study the material If the trigger is a real patient in a ward clinic or surgery then a student may be asked to take a clinical history or identify an abnormal physical sign before the group moves to a tutorial room For each module students may be given a handbook containing the problem scenarios and suggested learning resources or learning materials may be handed out at appropriate times as the tutorials progress
Examples of trigger material for PBL scenarios bull Paper based clinical scenarios bull Experimental or clinical laboratory data bull Photographs bull Video clips bull Newspaper articles bull All or part of an article from a scientific
journal bull A real or simulated patient bull A family tree showing an inherited
disorder
PBL tutorial process ndash Step 1 Identify and clarify unfamiliar terms presented in the scenario
scribe lists those that remain unexplained after discussion ndash Step 2 Define the problem or problems to be discussed students may
have different views on the issues but all should be considered scribe records a list of agreed problems
ndash Step 3 Brainstorming session to discuss the problem(s) suggestingpossible explanations on basis of prior knowledge students draw on each others knowledge and identify areas of incomplete knowledge scribe records all discussion
ndash Step 4 Review steps 2 and 3 and arrange explanations into tentativesolutions scribe organises the explanations and restructures if necessary
ndash Step 5 Formulate learning objectives group reaches consensus onthe learning objectives tutor ensures learning objectives are focused achievable comprehensive and appropriate
ndash Step 6 Private study (all students gather information related to eachlearning objective)
ndash Step 7 Group shares results of private study (students identify theirlearning resources and share their results) tutor checks learning and may assess the group
bull The role of the tutor is to facilitate the proceedings (helping the chair to maintain group dynamics and moving the group through the task) and to ensure that the group achieves appropriate learning objectives in line with those set by the curriculum design team The tutor may need to take a more active role in step 7 of the process to ensure that all the students have done the appropriate work and to help the chair to suggest a suitable format for group members to use to present the results of their private study The tutor should encourage students to check their understanding of the material He or she can do this by encouraging the students to ask open questions and ask each other to explain topics in their own words or by the use of drawings and diagrams
PBL in curriculum design bull PBL may be used either as the mainstay of an entire
curriculum or for the delivery of individual courses In practice PBL is usually part of an integrated curriculum using a systems based approach with non-clinical material delivered in the context of clinical practice A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge skills and attitudes A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios Sufficient time should be allowed each week for students to do the self directed learning required for PBL
bull
Copyright copy2003 BMJ Publishing Group Ltd
Wood D F BMJ 2003326328-330
No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found
Writing PBL scenarios
bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives
bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after
studying the scenario should be consistent with the faculty learning objectives
bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding
bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice
bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge
bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented
bull The problem should be sufficiently open so that discussion is not curtailed too early in the process
bull Scenarios should promote participation by the students in seeking information from various learning resources
bull Adapted from Dolmans et al Med Teacher 199719185-9
Staff development
bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)
A dysfunctional group a dominant character may
make it difficult for other students to be heard
A dysfunctional group a dominant character may make it difficult for other students to be heard
bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties
Advantages of PBL bull Student centred PBLIt fostersactive learning improved
understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks
Disadvantagesbull Tutors who cant teachTutorsenjoy passing on
their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful
Assessment of PBL
bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods
bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL
Conclusion
bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning
bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL
PBL 5 Easy Steps
bull Read the problem
Mrs Paula Embledon
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
2 Brain storm
bull Brainstorm
bull ndash hypotheses
bull - what do we know in support of the hypothesis
bull - what do we need to know to test the hypothesis
ndash learning issues
Brainstorm
bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)
ndash specific issues (for individuals to look up)
ndash overlapping issues
bull 4 Individual Reading - Research - Preparation
bull 5 Return
bull ndash review case so far ndash report and discuss
ndash assess progress - continue pagenext pagecomplete
ndash self-evaluation - How did things go Any suggestions for next time
ndash next problem
bull 5 Return
THE FIRST GROUP SESSION
bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day
bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session
bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr
bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine
bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise
bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator
bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues
bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know
bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)
bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)
bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)
bull when PBL is introduced into a curriculum several other issues for curriculum design and implementation need to be tackled PBL is generally introduced in the context of a defined core curriculum and integration of basic and clinical sciences It has implications for staffing and learning resources and demands a different approach to timetabling workload and assessment PBL is often used to deliver core material in non-clinical parts of the curriculum Paper based PBL scenarios form the basis of the core curriculum and ensure that all students are exposed to the same problems Recently modified PBL techniques have been introduced into clinical education with real patients being used as the stimulus for learning Despite the essential ad hoc nature of learning clinical medicine a key cases approach can enable PBL to be used to deliver the core clinical curriculum
Copyright copy2003 BMJ Publishing Group Ltd
Wood D F BMJ 2003326328-330
No CRoles of participants in a PBL tutorial aption Found
What happens in a PBL tutorial bull PBL tutorials are conducted in several ways In
this article the examples are modelled on the Maastricht seven jump process but its format of seven steps may be shortened
bull A typical PBL tutorial consists of a group of students (usually eight to 10) and a tutor who facilitates the session The length of time (number of sessions) that a group stays together with each other and with individual tutors varies between institutions A group needs to be together long enough to allow good group dynamics to develop but may need to be changed occasionally if personality clashes or other dysfunctional behaviour emerges
bull Students elect a chair for each PBL scenario and a scribe to record the discussion The roles are rotated for each scenario Suitable flip charts or a whiteboard should be used for recording the proceedings At the start of the session depending on the trigger material either the student chair reads out the scenario or all students study the material If the trigger is a real patient in a ward clinic or surgery then a student may be asked to take a clinical history or identify an abnormal physical sign before the group moves to a tutorial room For each module students may be given a handbook containing the problem scenarios and suggested learning resources or learning materials may be handed out at appropriate times as the tutorials progress
Examples of trigger material for PBL scenarios bull Paper based clinical scenarios bull Experimental or clinical laboratory data bull Photographs bull Video clips bull Newspaper articles bull All or part of an article from a scientific
journal bull A real or simulated patient bull A family tree showing an inherited
disorder
PBL tutorial process ndash Step 1 Identify and clarify unfamiliar terms presented in the scenario
scribe lists those that remain unexplained after discussion ndash Step 2 Define the problem or problems to be discussed students may
have different views on the issues but all should be considered scribe records a list of agreed problems
ndash Step 3 Brainstorming session to discuss the problem(s) suggestingpossible explanations on basis of prior knowledge students draw on each others knowledge and identify areas of incomplete knowledge scribe records all discussion
ndash Step 4 Review steps 2 and 3 and arrange explanations into tentativesolutions scribe organises the explanations and restructures if necessary
ndash Step 5 Formulate learning objectives group reaches consensus onthe learning objectives tutor ensures learning objectives are focused achievable comprehensive and appropriate
ndash Step 6 Private study (all students gather information related to eachlearning objective)
ndash Step 7 Group shares results of private study (students identify theirlearning resources and share their results) tutor checks learning and may assess the group
bull The role of the tutor is to facilitate the proceedings (helping the chair to maintain group dynamics and moving the group through the task) and to ensure that the group achieves appropriate learning objectives in line with those set by the curriculum design team The tutor may need to take a more active role in step 7 of the process to ensure that all the students have done the appropriate work and to help the chair to suggest a suitable format for group members to use to present the results of their private study The tutor should encourage students to check their understanding of the material He or she can do this by encouraging the students to ask open questions and ask each other to explain topics in their own words or by the use of drawings and diagrams
PBL in curriculum design bull PBL may be used either as the mainstay of an entire
curriculum or for the delivery of individual courses In practice PBL is usually part of an integrated curriculum using a systems based approach with non-clinical material delivered in the context of clinical practice A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge skills and attitudes A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios Sufficient time should be allowed each week for students to do the self directed learning required for PBL
bull
Copyright copy2003 BMJ Publishing Group Ltd
Wood D F BMJ 2003326328-330
No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found
Writing PBL scenarios
bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives
bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after
studying the scenario should be consistent with the faculty learning objectives
bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding
bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice
bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge
bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented
bull The problem should be sufficiently open so that discussion is not curtailed too early in the process
bull Scenarios should promote participation by the students in seeking information from various learning resources
bull Adapted from Dolmans et al Med Teacher 199719185-9
Staff development
bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)
A dysfunctional group a dominant character may
make it difficult for other students to be heard
A dysfunctional group a dominant character may make it difficult for other students to be heard
bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties
Advantages of PBL bull Student centred PBLIt fostersactive learning improved
understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks
Disadvantagesbull Tutors who cant teachTutorsenjoy passing on
their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful
Assessment of PBL
bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods
bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL
Conclusion
bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning
bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL
PBL 5 Easy Steps
bull Read the problem
Mrs Paula Embledon
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
2 Brain storm
bull Brainstorm
bull ndash hypotheses
bull - what do we know in support of the hypothesis
bull - what do we need to know to test the hypothesis
ndash learning issues
Brainstorm
bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)
ndash specific issues (for individuals to look up)
ndash overlapping issues
bull 4 Individual Reading - Research - Preparation
bull 5 Return
bull ndash review case so far ndash report and discuss
ndash assess progress - continue pagenext pagecomplete
ndash self-evaluation - How did things go Any suggestions for next time
ndash next problem
bull 5 Return
THE FIRST GROUP SESSION
bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day
bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session
bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr
bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine
bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise
bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator
bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues
bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know
bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)
bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)
bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)
Copyright copy2003 BMJ Publishing Group Ltd
Wood D F BMJ 2003326328-330
No CRoles of participants in a PBL tutorial aption Found
What happens in a PBL tutorial bull PBL tutorials are conducted in several ways In
this article the examples are modelled on the Maastricht seven jump process but its format of seven steps may be shortened
bull A typical PBL tutorial consists of a group of students (usually eight to 10) and a tutor who facilitates the session The length of time (number of sessions) that a group stays together with each other and with individual tutors varies between institutions A group needs to be together long enough to allow good group dynamics to develop but may need to be changed occasionally if personality clashes or other dysfunctional behaviour emerges
bull Students elect a chair for each PBL scenario and a scribe to record the discussion The roles are rotated for each scenario Suitable flip charts or a whiteboard should be used for recording the proceedings At the start of the session depending on the trigger material either the student chair reads out the scenario or all students study the material If the trigger is a real patient in a ward clinic or surgery then a student may be asked to take a clinical history or identify an abnormal physical sign before the group moves to a tutorial room For each module students may be given a handbook containing the problem scenarios and suggested learning resources or learning materials may be handed out at appropriate times as the tutorials progress
Examples of trigger material for PBL scenarios bull Paper based clinical scenarios bull Experimental or clinical laboratory data bull Photographs bull Video clips bull Newspaper articles bull All or part of an article from a scientific
journal bull A real or simulated patient bull A family tree showing an inherited
disorder
PBL tutorial process ndash Step 1 Identify and clarify unfamiliar terms presented in the scenario
scribe lists those that remain unexplained after discussion ndash Step 2 Define the problem or problems to be discussed students may
have different views on the issues but all should be considered scribe records a list of agreed problems
ndash Step 3 Brainstorming session to discuss the problem(s) suggestingpossible explanations on basis of prior knowledge students draw on each others knowledge and identify areas of incomplete knowledge scribe records all discussion
ndash Step 4 Review steps 2 and 3 and arrange explanations into tentativesolutions scribe organises the explanations and restructures if necessary
ndash Step 5 Formulate learning objectives group reaches consensus onthe learning objectives tutor ensures learning objectives are focused achievable comprehensive and appropriate
ndash Step 6 Private study (all students gather information related to eachlearning objective)
ndash Step 7 Group shares results of private study (students identify theirlearning resources and share their results) tutor checks learning and may assess the group
bull The role of the tutor is to facilitate the proceedings (helping the chair to maintain group dynamics and moving the group through the task) and to ensure that the group achieves appropriate learning objectives in line with those set by the curriculum design team The tutor may need to take a more active role in step 7 of the process to ensure that all the students have done the appropriate work and to help the chair to suggest a suitable format for group members to use to present the results of their private study The tutor should encourage students to check their understanding of the material He or she can do this by encouraging the students to ask open questions and ask each other to explain topics in their own words or by the use of drawings and diagrams
PBL in curriculum design bull PBL may be used either as the mainstay of an entire
curriculum or for the delivery of individual courses In practice PBL is usually part of an integrated curriculum using a systems based approach with non-clinical material delivered in the context of clinical practice A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge skills and attitudes A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios Sufficient time should be allowed each week for students to do the self directed learning required for PBL
bull
Copyright copy2003 BMJ Publishing Group Ltd
Wood D F BMJ 2003326328-330
No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found
Writing PBL scenarios
bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives
bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after
studying the scenario should be consistent with the faculty learning objectives
bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding
bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice
bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge
bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented
bull The problem should be sufficiently open so that discussion is not curtailed too early in the process
bull Scenarios should promote participation by the students in seeking information from various learning resources
bull Adapted from Dolmans et al Med Teacher 199719185-9
Staff development
bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)
A dysfunctional group a dominant character may
make it difficult for other students to be heard
A dysfunctional group a dominant character may make it difficult for other students to be heard
bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties
Advantages of PBL bull Student centred PBLIt fostersactive learning improved
understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks
Disadvantagesbull Tutors who cant teachTutorsenjoy passing on
their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful
Assessment of PBL
bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods
bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL
Conclusion
bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning
bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL
PBL 5 Easy Steps
bull Read the problem
Mrs Paula Embledon
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
2 Brain storm
bull Brainstorm
bull ndash hypotheses
bull - what do we know in support of the hypothesis
bull - what do we need to know to test the hypothesis
ndash learning issues
Brainstorm
bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)
ndash specific issues (for individuals to look up)
ndash overlapping issues
bull 4 Individual Reading - Research - Preparation
bull 5 Return
bull ndash review case so far ndash report and discuss
ndash assess progress - continue pagenext pagecomplete
ndash self-evaluation - How did things go Any suggestions for next time
ndash next problem
bull 5 Return
THE FIRST GROUP SESSION
bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day
bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session
bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr
bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine
bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise
bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator
bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues
bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know
bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)
bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)
bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)
What happens in a PBL tutorial bull PBL tutorials are conducted in several ways In
this article the examples are modelled on the Maastricht seven jump process but its format of seven steps may be shortened
bull A typical PBL tutorial consists of a group of students (usually eight to 10) and a tutor who facilitates the session The length of time (number of sessions) that a group stays together with each other and with individual tutors varies between institutions A group needs to be together long enough to allow good group dynamics to develop but may need to be changed occasionally if personality clashes or other dysfunctional behaviour emerges
bull Students elect a chair for each PBL scenario and a scribe to record the discussion The roles are rotated for each scenario Suitable flip charts or a whiteboard should be used for recording the proceedings At the start of the session depending on the trigger material either the student chair reads out the scenario or all students study the material If the trigger is a real patient in a ward clinic or surgery then a student may be asked to take a clinical history or identify an abnormal physical sign before the group moves to a tutorial room For each module students may be given a handbook containing the problem scenarios and suggested learning resources or learning materials may be handed out at appropriate times as the tutorials progress
Examples of trigger material for PBL scenarios bull Paper based clinical scenarios bull Experimental or clinical laboratory data bull Photographs bull Video clips bull Newspaper articles bull All or part of an article from a scientific
journal bull A real or simulated patient bull A family tree showing an inherited
disorder
PBL tutorial process ndash Step 1 Identify and clarify unfamiliar terms presented in the scenario
scribe lists those that remain unexplained after discussion ndash Step 2 Define the problem or problems to be discussed students may
have different views on the issues but all should be considered scribe records a list of agreed problems
ndash Step 3 Brainstorming session to discuss the problem(s) suggestingpossible explanations on basis of prior knowledge students draw on each others knowledge and identify areas of incomplete knowledge scribe records all discussion
ndash Step 4 Review steps 2 and 3 and arrange explanations into tentativesolutions scribe organises the explanations and restructures if necessary
ndash Step 5 Formulate learning objectives group reaches consensus onthe learning objectives tutor ensures learning objectives are focused achievable comprehensive and appropriate
ndash Step 6 Private study (all students gather information related to eachlearning objective)
ndash Step 7 Group shares results of private study (students identify theirlearning resources and share their results) tutor checks learning and may assess the group
bull The role of the tutor is to facilitate the proceedings (helping the chair to maintain group dynamics and moving the group through the task) and to ensure that the group achieves appropriate learning objectives in line with those set by the curriculum design team The tutor may need to take a more active role in step 7 of the process to ensure that all the students have done the appropriate work and to help the chair to suggest a suitable format for group members to use to present the results of their private study The tutor should encourage students to check their understanding of the material He or she can do this by encouraging the students to ask open questions and ask each other to explain topics in their own words or by the use of drawings and diagrams
PBL in curriculum design bull PBL may be used either as the mainstay of an entire
curriculum or for the delivery of individual courses In practice PBL is usually part of an integrated curriculum using a systems based approach with non-clinical material delivered in the context of clinical practice A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge skills and attitudes A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios Sufficient time should be allowed each week for students to do the self directed learning required for PBL
bull
Copyright copy2003 BMJ Publishing Group Ltd
Wood D F BMJ 2003326328-330
No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found
Writing PBL scenarios
bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives
bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after
studying the scenario should be consistent with the faculty learning objectives
bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding
bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice
bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge
bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented
bull The problem should be sufficiently open so that discussion is not curtailed too early in the process
bull Scenarios should promote participation by the students in seeking information from various learning resources
bull Adapted from Dolmans et al Med Teacher 199719185-9
Staff development
bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)
A dysfunctional group a dominant character may
make it difficult for other students to be heard
A dysfunctional group a dominant character may make it difficult for other students to be heard
bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties
Advantages of PBL bull Student centred PBLIt fostersactive learning improved
understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks
Disadvantagesbull Tutors who cant teachTutorsenjoy passing on
their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful
Assessment of PBL
bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods
bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL
Conclusion
bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning
bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL
PBL 5 Easy Steps
bull Read the problem
Mrs Paula Embledon
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
2 Brain storm
bull Brainstorm
bull ndash hypotheses
bull - what do we know in support of the hypothesis
bull - what do we need to know to test the hypothesis
ndash learning issues
Brainstorm
bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)
ndash specific issues (for individuals to look up)
ndash overlapping issues
bull 4 Individual Reading - Research - Preparation
bull 5 Return
bull ndash review case so far ndash report and discuss
ndash assess progress - continue pagenext pagecomplete
ndash self-evaluation - How did things go Any suggestions for next time
ndash next problem
bull 5 Return
THE FIRST GROUP SESSION
bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day
bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session
bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr
bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine
bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise
bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator
bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues
bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know
bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)
bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)
bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)
bull Students elect a chair for each PBL scenario and a scribe to record the discussion The roles are rotated for each scenario Suitable flip charts or a whiteboard should be used for recording the proceedings At the start of the session depending on the trigger material either the student chair reads out the scenario or all students study the material If the trigger is a real patient in a ward clinic or surgery then a student may be asked to take a clinical history or identify an abnormal physical sign before the group moves to a tutorial room For each module students may be given a handbook containing the problem scenarios and suggested learning resources or learning materials may be handed out at appropriate times as the tutorials progress
Examples of trigger material for PBL scenarios bull Paper based clinical scenarios bull Experimental or clinical laboratory data bull Photographs bull Video clips bull Newspaper articles bull All or part of an article from a scientific
journal bull A real or simulated patient bull A family tree showing an inherited
disorder
PBL tutorial process ndash Step 1 Identify and clarify unfamiliar terms presented in the scenario
scribe lists those that remain unexplained after discussion ndash Step 2 Define the problem or problems to be discussed students may
have different views on the issues but all should be considered scribe records a list of agreed problems
ndash Step 3 Brainstorming session to discuss the problem(s) suggestingpossible explanations on basis of prior knowledge students draw on each others knowledge and identify areas of incomplete knowledge scribe records all discussion
ndash Step 4 Review steps 2 and 3 and arrange explanations into tentativesolutions scribe organises the explanations and restructures if necessary
ndash Step 5 Formulate learning objectives group reaches consensus onthe learning objectives tutor ensures learning objectives are focused achievable comprehensive and appropriate
ndash Step 6 Private study (all students gather information related to eachlearning objective)
ndash Step 7 Group shares results of private study (students identify theirlearning resources and share their results) tutor checks learning and may assess the group
bull The role of the tutor is to facilitate the proceedings (helping the chair to maintain group dynamics and moving the group through the task) and to ensure that the group achieves appropriate learning objectives in line with those set by the curriculum design team The tutor may need to take a more active role in step 7 of the process to ensure that all the students have done the appropriate work and to help the chair to suggest a suitable format for group members to use to present the results of their private study The tutor should encourage students to check their understanding of the material He or she can do this by encouraging the students to ask open questions and ask each other to explain topics in their own words or by the use of drawings and diagrams
PBL in curriculum design bull PBL may be used either as the mainstay of an entire
curriculum or for the delivery of individual courses In practice PBL is usually part of an integrated curriculum using a systems based approach with non-clinical material delivered in the context of clinical practice A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge skills and attitudes A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios Sufficient time should be allowed each week for students to do the self directed learning required for PBL
bull
Copyright copy2003 BMJ Publishing Group Ltd
Wood D F BMJ 2003326328-330
No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found
Writing PBL scenarios
bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives
bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after
studying the scenario should be consistent with the faculty learning objectives
bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding
bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice
bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge
bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented
bull The problem should be sufficiently open so that discussion is not curtailed too early in the process
bull Scenarios should promote participation by the students in seeking information from various learning resources
bull Adapted from Dolmans et al Med Teacher 199719185-9
Staff development
bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)
A dysfunctional group a dominant character may
make it difficult for other students to be heard
A dysfunctional group a dominant character may make it difficult for other students to be heard
bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties
Advantages of PBL bull Student centred PBLIt fostersactive learning improved
understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks
Disadvantagesbull Tutors who cant teachTutorsenjoy passing on
their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful
Assessment of PBL
bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods
bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL
Conclusion
bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning
bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL
PBL 5 Easy Steps
bull Read the problem
Mrs Paula Embledon
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
2 Brain storm
bull Brainstorm
bull ndash hypotheses
bull - what do we know in support of the hypothesis
bull - what do we need to know to test the hypothesis
ndash learning issues
Brainstorm
bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)
ndash specific issues (for individuals to look up)
ndash overlapping issues
bull 4 Individual Reading - Research - Preparation
bull 5 Return
bull ndash review case so far ndash report and discuss
ndash assess progress - continue pagenext pagecomplete
ndash self-evaluation - How did things go Any suggestions for next time
ndash next problem
bull 5 Return
THE FIRST GROUP SESSION
bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day
bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session
bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr
bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine
bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise
bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator
bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues
bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know
bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)
bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)
bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)
Examples of trigger material for PBL scenarios bull Paper based clinical scenarios bull Experimental or clinical laboratory data bull Photographs bull Video clips bull Newspaper articles bull All or part of an article from a scientific
journal bull A real or simulated patient bull A family tree showing an inherited
disorder
PBL tutorial process ndash Step 1 Identify and clarify unfamiliar terms presented in the scenario
scribe lists those that remain unexplained after discussion ndash Step 2 Define the problem or problems to be discussed students may
have different views on the issues but all should be considered scribe records a list of agreed problems
ndash Step 3 Brainstorming session to discuss the problem(s) suggestingpossible explanations on basis of prior knowledge students draw on each others knowledge and identify areas of incomplete knowledge scribe records all discussion
ndash Step 4 Review steps 2 and 3 and arrange explanations into tentativesolutions scribe organises the explanations and restructures if necessary
ndash Step 5 Formulate learning objectives group reaches consensus onthe learning objectives tutor ensures learning objectives are focused achievable comprehensive and appropriate
ndash Step 6 Private study (all students gather information related to eachlearning objective)
ndash Step 7 Group shares results of private study (students identify theirlearning resources and share their results) tutor checks learning and may assess the group
bull The role of the tutor is to facilitate the proceedings (helping the chair to maintain group dynamics and moving the group through the task) and to ensure that the group achieves appropriate learning objectives in line with those set by the curriculum design team The tutor may need to take a more active role in step 7 of the process to ensure that all the students have done the appropriate work and to help the chair to suggest a suitable format for group members to use to present the results of their private study The tutor should encourage students to check their understanding of the material He or she can do this by encouraging the students to ask open questions and ask each other to explain topics in their own words or by the use of drawings and diagrams
PBL in curriculum design bull PBL may be used either as the mainstay of an entire
curriculum or for the delivery of individual courses In practice PBL is usually part of an integrated curriculum using a systems based approach with non-clinical material delivered in the context of clinical practice A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge skills and attitudes A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios Sufficient time should be allowed each week for students to do the self directed learning required for PBL
bull
Copyright copy2003 BMJ Publishing Group Ltd
Wood D F BMJ 2003326328-330
No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found
Writing PBL scenarios
bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives
bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after
studying the scenario should be consistent with the faculty learning objectives
bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding
bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice
bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge
bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented
bull The problem should be sufficiently open so that discussion is not curtailed too early in the process
bull Scenarios should promote participation by the students in seeking information from various learning resources
bull Adapted from Dolmans et al Med Teacher 199719185-9
Staff development
bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)
A dysfunctional group a dominant character may
make it difficult for other students to be heard
A dysfunctional group a dominant character may make it difficult for other students to be heard
bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties
Advantages of PBL bull Student centred PBLIt fostersactive learning improved
understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks
Disadvantagesbull Tutors who cant teachTutorsenjoy passing on
their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful
Assessment of PBL
bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods
bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL
Conclusion
bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning
bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL
PBL 5 Easy Steps
bull Read the problem
Mrs Paula Embledon
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
2 Brain storm
bull Brainstorm
bull ndash hypotheses
bull - what do we know in support of the hypothesis
bull - what do we need to know to test the hypothesis
ndash learning issues
Brainstorm
bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)
ndash specific issues (for individuals to look up)
ndash overlapping issues
bull 4 Individual Reading - Research - Preparation
bull 5 Return
bull ndash review case so far ndash report and discuss
ndash assess progress - continue pagenext pagecomplete
ndash self-evaluation - How did things go Any suggestions for next time
ndash next problem
bull 5 Return
THE FIRST GROUP SESSION
bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day
bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session
bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr
bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine
bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise
bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator
bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues
bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know
bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)
bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)
bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)
PBL tutorial process ndash Step 1 Identify and clarify unfamiliar terms presented in the scenario
scribe lists those that remain unexplained after discussion ndash Step 2 Define the problem or problems to be discussed students may
have different views on the issues but all should be considered scribe records a list of agreed problems
ndash Step 3 Brainstorming session to discuss the problem(s) suggestingpossible explanations on basis of prior knowledge students draw on each others knowledge and identify areas of incomplete knowledge scribe records all discussion
ndash Step 4 Review steps 2 and 3 and arrange explanations into tentativesolutions scribe organises the explanations and restructures if necessary
ndash Step 5 Formulate learning objectives group reaches consensus onthe learning objectives tutor ensures learning objectives are focused achievable comprehensive and appropriate
ndash Step 6 Private study (all students gather information related to eachlearning objective)
ndash Step 7 Group shares results of private study (students identify theirlearning resources and share their results) tutor checks learning and may assess the group
bull The role of the tutor is to facilitate the proceedings (helping the chair to maintain group dynamics and moving the group through the task) and to ensure that the group achieves appropriate learning objectives in line with those set by the curriculum design team The tutor may need to take a more active role in step 7 of the process to ensure that all the students have done the appropriate work and to help the chair to suggest a suitable format for group members to use to present the results of their private study The tutor should encourage students to check their understanding of the material He or she can do this by encouraging the students to ask open questions and ask each other to explain topics in their own words or by the use of drawings and diagrams
PBL in curriculum design bull PBL may be used either as the mainstay of an entire
curriculum or for the delivery of individual courses In practice PBL is usually part of an integrated curriculum using a systems based approach with non-clinical material delivered in the context of clinical practice A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge skills and attitudes A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios Sufficient time should be allowed each week for students to do the self directed learning required for PBL
bull
Copyright copy2003 BMJ Publishing Group Ltd
Wood D F BMJ 2003326328-330
No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found
Writing PBL scenarios
bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives
bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after
studying the scenario should be consistent with the faculty learning objectives
bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding
bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice
bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge
bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented
bull The problem should be sufficiently open so that discussion is not curtailed too early in the process
bull Scenarios should promote participation by the students in seeking information from various learning resources
bull Adapted from Dolmans et al Med Teacher 199719185-9
Staff development
bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)
A dysfunctional group a dominant character may
make it difficult for other students to be heard
A dysfunctional group a dominant character may make it difficult for other students to be heard
bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties
Advantages of PBL bull Student centred PBLIt fostersactive learning improved
understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks
Disadvantagesbull Tutors who cant teachTutorsenjoy passing on
their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful
Assessment of PBL
bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods
bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL
Conclusion
bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning
bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL
PBL 5 Easy Steps
bull Read the problem
Mrs Paula Embledon
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
2 Brain storm
bull Brainstorm
bull ndash hypotheses
bull - what do we know in support of the hypothesis
bull - what do we need to know to test the hypothesis
ndash learning issues
Brainstorm
bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)
ndash specific issues (for individuals to look up)
ndash overlapping issues
bull 4 Individual Reading - Research - Preparation
bull 5 Return
bull ndash review case so far ndash report and discuss
ndash assess progress - continue pagenext pagecomplete
ndash self-evaluation - How did things go Any suggestions for next time
ndash next problem
bull 5 Return
THE FIRST GROUP SESSION
bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day
bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session
bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr
bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine
bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise
bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator
bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues
bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know
bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)
bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)
bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)
bull The role of the tutor is to facilitate the proceedings (helping the chair to maintain group dynamics and moving the group through the task) and to ensure that the group achieves appropriate learning objectives in line with those set by the curriculum design team The tutor may need to take a more active role in step 7 of the process to ensure that all the students have done the appropriate work and to help the chair to suggest a suitable format for group members to use to present the results of their private study The tutor should encourage students to check their understanding of the material He or she can do this by encouraging the students to ask open questions and ask each other to explain topics in their own words or by the use of drawings and diagrams
PBL in curriculum design bull PBL may be used either as the mainstay of an entire
curriculum or for the delivery of individual courses In practice PBL is usually part of an integrated curriculum using a systems based approach with non-clinical material delivered in the context of clinical practice A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge skills and attitudes A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios Sufficient time should be allowed each week for students to do the self directed learning required for PBL
bull
Copyright copy2003 BMJ Publishing Group Ltd
Wood D F BMJ 2003326328-330
No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found
Writing PBL scenarios
bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives
bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after
studying the scenario should be consistent with the faculty learning objectives
bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding
bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice
bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge
bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented
bull The problem should be sufficiently open so that discussion is not curtailed too early in the process
bull Scenarios should promote participation by the students in seeking information from various learning resources
bull Adapted from Dolmans et al Med Teacher 199719185-9
Staff development
bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)
A dysfunctional group a dominant character may
make it difficult for other students to be heard
A dysfunctional group a dominant character may make it difficult for other students to be heard
bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties
Advantages of PBL bull Student centred PBLIt fostersactive learning improved
understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks
Disadvantagesbull Tutors who cant teachTutorsenjoy passing on
their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful
Assessment of PBL
bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods
bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL
Conclusion
bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning
bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL
PBL 5 Easy Steps
bull Read the problem
Mrs Paula Embledon
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
2 Brain storm
bull Brainstorm
bull ndash hypotheses
bull - what do we know in support of the hypothesis
bull - what do we need to know to test the hypothesis
ndash learning issues
Brainstorm
bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)
ndash specific issues (for individuals to look up)
ndash overlapping issues
bull 4 Individual Reading - Research - Preparation
bull 5 Return
bull ndash review case so far ndash report and discuss
ndash assess progress - continue pagenext pagecomplete
ndash self-evaluation - How did things go Any suggestions for next time
ndash next problem
bull 5 Return
THE FIRST GROUP SESSION
bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day
bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session
bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr
bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine
bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise
bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator
bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues
bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know
bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)
bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)
bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)
PBL in curriculum design bull PBL may be used either as the mainstay of an entire
curriculum or for the delivery of individual courses In practice PBL is usually part of an integrated curriculum using a systems based approach with non-clinical material delivered in the context of clinical practice A module or short course can be designed to include mixed teaching methods (including PBL) to achieve the learning outcomes in knowledge skills and attitudes A small number of lectures may be desirable to introduce topics or provide an overview of difficult subject material in conjunction with the PBL scenarios Sufficient time should be allowed each week for students to do the self directed learning required for PBL
bull
Copyright copy2003 BMJ Publishing Group Ltd
Wood D F BMJ 2003326328-330
No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found
Writing PBL scenarios
bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives
bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after
studying the scenario should be consistent with the faculty learning objectives
bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding
bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice
bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge
bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented
bull The problem should be sufficiently open so that discussion is not curtailed too early in the process
bull Scenarios should promote participation by the students in seeking information from various learning resources
bull Adapted from Dolmans et al Med Teacher 199719185-9
Staff development
bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)
A dysfunctional group a dominant character may
make it difficult for other students to be heard
A dysfunctional group a dominant character may make it difficult for other students to be heard
bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties
Advantages of PBL bull Student centred PBLIt fostersactive learning improved
understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks
Disadvantagesbull Tutors who cant teachTutorsenjoy passing on
their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful
Assessment of PBL
bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods
bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL
Conclusion
bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning
bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL
PBL 5 Easy Steps
bull Read the problem
Mrs Paula Embledon
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
2 Brain storm
bull Brainstorm
bull ndash hypotheses
bull - what do we know in support of the hypothesis
bull - what do we need to know to test the hypothesis
ndash learning issues
Brainstorm
bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)
ndash specific issues (for individuals to look up)
ndash overlapping issues
bull 4 Individual Reading - Research - Preparation
bull 5 Return
bull ndash review case so far ndash report and discuss
ndash assess progress - continue pagenext pagecomplete
ndash self-evaluation - How did things go Any suggestions for next time
ndash next problem
bull 5 Return
THE FIRST GROUP SESSION
bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day
bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session
bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr
bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine
bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise
bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator
bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues
bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know
bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)
bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)
bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)
Copyright copy2003 BMJ Publishing Group Ltd
Wood D F BMJ 2003326328-330
No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found
Writing PBL scenarios
bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives
bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after
studying the scenario should be consistent with the faculty learning objectives
bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding
bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice
bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge
bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented
bull The problem should be sufficiently open so that discussion is not curtailed too early in the process
bull Scenarios should promote participation by the students in seeking information from various learning resources
bull Adapted from Dolmans et al Med Teacher 199719185-9
Staff development
bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)
A dysfunctional group a dominant character may
make it difficult for other students to be heard
A dysfunctional group a dominant character may make it difficult for other students to be heard
bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties
Advantages of PBL bull Student centred PBLIt fostersactive learning improved
understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks
Disadvantagesbull Tutors who cant teachTutorsenjoy passing on
their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful
Assessment of PBL
bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods
bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL
Conclusion
bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning
bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL
PBL 5 Easy Steps
bull Read the problem
Mrs Paula Embledon
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
2 Brain storm
bull Brainstorm
bull ndash hypotheses
bull - what do we know in support of the hypothesis
bull - what do we need to know to test the hypothesis
ndash learning issues
Brainstorm
bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)
ndash specific issues (for individuals to look up)
ndash overlapping issues
bull 4 Individual Reading - Research - Preparation
bull 5 Return
bull ndash review case so far ndash report and discuss
ndash assess progress - continue pagenext pagecomplete
ndash self-evaluation - How did things go Any suggestions for next time
ndash next problem
bull 5 Return
THE FIRST GROUP SESSION
bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day
bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session
bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr
bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine
bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise
bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator
bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues
bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know
bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)
bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)
bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)
Writing PBL scenarios
bull PBL is successful only if the scenarios are of high quality In most undergraduate PBL curriculums the faculty identifies learning objectives in advance The scenario should lead students to a particular area of study to achieve those learning objectives
bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after
studying the scenario should be consistent with the faculty learning objectives
bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding
bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice
bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge
bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented
bull The problem should be sufficiently open so that discussion is not curtailed too early in the process
bull Scenarios should promote participation by the students in seeking information from various learning resources
bull Adapted from Dolmans et al Med Teacher 199719185-9
Staff development
bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)
A dysfunctional group a dominant character may
make it difficult for other students to be heard
A dysfunctional group a dominant character may make it difficult for other students to be heard
bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties
Advantages of PBL bull Student centred PBLIt fostersactive learning improved
understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks
Disadvantagesbull Tutors who cant teachTutorsenjoy passing on
their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful
Assessment of PBL
bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods
bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL
Conclusion
bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning
bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL
PBL 5 Easy Steps
bull Read the problem
Mrs Paula Embledon
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
2 Brain storm
bull Brainstorm
bull ndash hypotheses
bull - what do we know in support of the hypothesis
bull - what do we need to know to test the hypothesis
ndash learning issues
Brainstorm
bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)
ndash specific issues (for individuals to look up)
ndash overlapping issues
bull 4 Individual Reading - Research - Preparation
bull 5 Return
bull ndash review case so far ndash report and discuss
ndash assess progress - continue pagenext pagecomplete
ndash self-evaluation - How did things go Any suggestions for next time
ndash next problem
bull 5 Return
THE FIRST GROUP SESSION
bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day
bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session
bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr
bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine
bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise
bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator
bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues
bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know
bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)
bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)
bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)
bull How to create effective PBL scenarios bull Learning objectives likely to be defined by the students after
studying the scenario should be consistent with the faculty learning objectives
bull Problems should be appropriate to the stage of the curriculum and the level of the students understanding
bull Scenarios should have sufficient intrinsic interest for the students or relevance to future practice
bull Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge
bull Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented
bull The problem should be sufficiently open so that discussion is not curtailed too early in the process
bull Scenarios should promote participation by the students in seeking information from various learning resources
bull Adapted from Dolmans et al Med Teacher 199719185-9
Staff development
bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)
A dysfunctional group a dominant character may
make it difficult for other students to be heard
A dysfunctional group a dominant character may make it difficult for other students to be heard
bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties
Advantages of PBL bull Student centred PBLIt fostersactive learning improved
understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks
Disadvantagesbull Tutors who cant teachTutorsenjoy passing on
their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful
Assessment of PBL
bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods
bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL
Conclusion
bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning
bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL
PBL 5 Easy Steps
bull Read the problem
Mrs Paula Embledon
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
2 Brain storm
bull Brainstorm
bull ndash hypotheses
bull - what do we know in support of the hypothesis
bull - what do we need to know to test the hypothesis
ndash learning issues
Brainstorm
bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)
ndash specific issues (for individuals to look up)
ndash overlapping issues
bull 4 Individual Reading - Research - Preparation
bull 5 Return
bull ndash review case so far ndash report and discuss
ndash assess progress - continue pagenext pagecomplete
ndash self-evaluation - How did things go Any suggestions for next time
ndash next problem
bull 5 Return
THE FIRST GROUP SESSION
bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day
bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session
bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr
bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine
bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise
bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator
bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues
bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know
bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)
bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)
bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)
Staff development
bull Introducing PBL into a course makes new demands on tutors requiring them to function as facilitators for small group learning rather than acting as providers of information Staff development is essential and should focus on enabling the PBL tutors to acquire skills in facilitation and in management of group dynamics (including dysfunctional groups)
A dysfunctional group a dominant character may
make it difficult for other students to be heard
A dysfunctional group a dominant character may make it difficult for other students to be heard
bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties
Advantages of PBL bull Student centred PBLIt fostersactive learning improved
understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks
Disadvantagesbull Tutors who cant teachTutorsenjoy passing on
their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful
Assessment of PBL
bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods
bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL
Conclusion
bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning
bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL
PBL 5 Easy Steps
bull Read the problem
Mrs Paula Embledon
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
2 Brain storm
bull Brainstorm
bull ndash hypotheses
bull - what do we know in support of the hypothesis
bull - what do we need to know to test the hypothesis
ndash learning issues
Brainstorm
bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)
ndash specific issues (for individuals to look up)
ndash overlapping issues
bull 4 Individual Reading - Research - Preparation
bull 5 Return
bull ndash review case so far ndash report and discuss
ndash assess progress - continue pagenext pagecomplete
ndash self-evaluation - How did things go Any suggestions for next time
ndash next problem
bull 5 Return
THE FIRST GROUP SESSION
bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day
bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session
bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr
bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine
bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise
bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator
bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues
bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know
bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)
bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)
bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)
A dysfunctional group a dominant character may
make it difficult for other students to be heard
A dysfunctional group a dominant character may make it difficult for other students to be heard
bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties
Advantages of PBL bull Student centred PBLIt fostersactive learning improved
understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks
Disadvantagesbull Tutors who cant teachTutorsenjoy passing on
their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful
Assessment of PBL
bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods
bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL
Conclusion
bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning
bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL
PBL 5 Easy Steps
bull Read the problem
Mrs Paula Embledon
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
2 Brain storm
bull Brainstorm
bull ndash hypotheses
bull - what do we know in support of the hypothesis
bull - what do we need to know to test the hypothesis
ndash learning issues
Brainstorm
bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)
ndash specific issues (for individuals to look up)
ndash overlapping issues
bull 4 Individual Reading - Research - Preparation
bull 5 Return
bull ndash review case so far ndash report and discuss
ndash assess progress - continue pagenext pagecomplete
ndash self-evaluation - How did things go Any suggestions for next time
ndash next problem
bull 5 Return
THE FIRST GROUP SESSION
bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day
bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session
bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr
bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine
bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise
bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator
bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues
bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know
bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)
bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)
bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)
A dysfunctional group a dominant character may make it difficult for other students to be heard
bull Tutors should be also given information about the institutions educational strategy and curriculum programme so that they can help students to understand the learning objectives of individual modules in the context of the curriculum as a whole Methods of assessment and evaluation should be described and time should be available to discuss anxieties
Advantages of PBL bull Student centred PBLIt fostersactive learning improved
understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks
Disadvantagesbull Tutors who cant teachTutorsenjoy passing on
their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful
Assessment of PBL
bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods
bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL
Conclusion
bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning
bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL
PBL 5 Easy Steps
bull Read the problem
Mrs Paula Embledon
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
2 Brain storm
bull Brainstorm
bull ndash hypotheses
bull - what do we know in support of the hypothesis
bull - what do we need to know to test the hypothesis
ndash learning issues
Brainstorm
bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)
ndash specific issues (for individuals to look up)
ndash overlapping issues
bull 4 Individual Reading - Research - Preparation
bull 5 Return
bull ndash review case so far ndash report and discuss
ndash assess progress - continue pagenext pagecomplete
ndash self-evaluation - How did things go Any suggestions for next time
ndash next problem
bull 5 Return
THE FIRST GROUP SESSION
bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day
bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session
bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr
bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine
bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise
bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator
bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues
bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know
bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)
bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)
bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)
Advantages of PBL bull Student centred PBLIt fostersactive learning improved
understanding and retention and development of lifelong learning skillsGeneric competenciesPBL allowsstudents to develop generic skills and attitudes desirable in their future practiceIntegrationPBL facilitates anintegrated core curriculumMotivationPBL is fun for studentsand tutors and the process requires all students to be engaged in the learning processDeep learningPBL fosters deeplearning (students interact with learning materials relate concepts to everyday activities and improve their understanding)Constructivist approachStudentsactivate prior knowledge and build on existing conceptual knowledge frameworks
Disadvantagesbull Tutors who cant teachTutorsenjoy passing on
their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful
Assessment of PBL
bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods
bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL
Conclusion
bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning
bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL
PBL 5 Easy Steps
bull Read the problem
Mrs Paula Embledon
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
2 Brain storm
bull Brainstorm
bull ndash hypotheses
bull - what do we know in support of the hypothesis
bull - what do we need to know to test the hypothesis
ndash learning issues
Brainstorm
bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)
ndash specific issues (for individuals to look up)
ndash overlapping issues
bull 4 Individual Reading - Research - Preparation
bull 5 Return
bull ndash review case so far ndash report and discuss
ndash assess progress - continue pagenext pagecomplete
ndash self-evaluation - How did things go Any suggestions for next time
ndash next problem
bull 5 Return
THE FIRST GROUP SESSION
bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day
bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session
bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr
bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine
bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise
bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator
bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues
bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know
bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)
bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)
bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)
Disadvantagesbull Tutors who cant teachTutorsenjoy passing on
their own knowledge and understanding so may find PBL facilitation difficult and frustratingHuman resourcesMore staffhave to take part in the tutoring processOther resourcesLarge numbersof students need access to the same library and computer resources simultaneouslyRole modelsStudents may bedeprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large groupInformation overloadStudentsmay be unsure how much self directed study to do and what information is relevant and useful
Assessment of PBL
bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods
bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL
Conclusion
bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning
bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL
PBL 5 Easy Steps
bull Read the problem
Mrs Paula Embledon
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
2 Brain storm
bull Brainstorm
bull ndash hypotheses
bull - what do we know in support of the hypothesis
bull - what do we need to know to test the hypothesis
ndash learning issues
Brainstorm
bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)
ndash specific issues (for individuals to look up)
ndash overlapping issues
bull 4 Individual Reading - Research - Preparation
bull 5 Return
bull ndash review case so far ndash report and discuss
ndash assess progress - continue pagenext pagecomplete
ndash self-evaluation - How did things go Any suggestions for next time
ndash next problem
bull 5 Return
THE FIRST GROUP SESSION
bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day
bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session
bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr
bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine
bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise
bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator
bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues
bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know
bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)
bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)
bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)
Assessment of PBL
bull Student learning is influenced greatly by the assessment methods used If assessment methods rely solely on factual recall then PBL is unlikely to succeed in the curriculum All assessment schedules should follow the basic principles of testing the student in relation to the curriculum outcomes and should use an appropriate range of assessment methods
bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL
Conclusion
bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning
bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL
PBL 5 Easy Steps
bull Read the problem
Mrs Paula Embledon
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
2 Brain storm
bull Brainstorm
bull ndash hypotheses
bull - what do we know in support of the hypothesis
bull - what do we need to know to test the hypothesis
ndash learning issues
Brainstorm
bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)
ndash specific issues (for individuals to look up)
ndash overlapping issues
bull 4 Individual Reading - Research - Preparation
bull 5 Return
bull ndash review case so far ndash report and discuss
ndash assess progress - continue pagenext pagecomplete
ndash self-evaluation - How did things go Any suggestions for next time
ndash next problem
bull 5 Return
THE FIRST GROUP SESSION
bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day
bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session
bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr
bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine
bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise
bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator
bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues
bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know
bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)
bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)
bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)
bull Assessment of students activities in their PBL groups is advisable Tutors should give feedback or use formative or summative assessment procedures as dictated by the faculty assessment schedule It is also helpful to consider assessment of the group as a whole The group should be encouraged to reflect on its PBL performance including its adherence to the process communication skills respect for others and individual contributions Peer pressure in the group reduces the likelihood of students failing to keep up with workload and the award of a group mark added to each individuals assessment schedule encourages students to achieve the generic goals associated with PBL
Conclusion
bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning
bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL
PBL 5 Easy Steps
bull Read the problem
Mrs Paula Embledon
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
2 Brain storm
bull Brainstorm
bull ndash hypotheses
bull - what do we know in support of the hypothesis
bull - what do we need to know to test the hypothesis
ndash learning issues
Brainstorm
bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)
ndash specific issues (for individuals to look up)
ndash overlapping issues
bull 4 Individual Reading - Research - Preparation
bull 5 Return
bull ndash review case so far ndash report and discuss
ndash assess progress - continue pagenext pagecomplete
ndash self-evaluation - How did things go Any suggestions for next time
ndash next problem
bull 5 Return
THE FIRST GROUP SESSION
bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day
bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session
bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr
bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine
bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise
bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator
bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues
bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know
bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)
bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)
bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)
Conclusion
bull PBL is an effective way of delivering medical education in a coherent integrated programme and offers several advantages over traditional teaching methods It is based on principles of adult learning theory including motivating the students encouraging them to set their own learning goals and giving them a role in decisions that affect their own learning
bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL
PBL 5 Easy Steps
bull Read the problem
Mrs Paula Embledon
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
2 Brain storm
bull Brainstorm
bull ndash hypotheses
bull - what do we know in support of the hypothesis
bull - what do we need to know to test the hypothesis
ndash learning issues
Brainstorm
bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)
ndash specific issues (for individuals to look up)
ndash overlapping issues
bull 4 Individual Reading - Research - Preparation
bull 5 Return
bull ndash review case so far ndash report and discuss
ndash assess progress - continue pagenext pagecomplete
ndash self-evaluation - How did things go Any suggestions for next time
ndash next problem
bull 5 Return
THE FIRST GROUP SESSION
bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day
bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session
bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr
bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine
bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise
bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator
bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues
bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know
bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)
bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)
bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)
bull PBL does not offer a universal panacea for teaching and learning in medicine and it has several well recognised disadvantages Traditional knowledge based assessments of curriculum outcomes have shown little or no difference in students graduating from PBL or traditional curriculums Importantly though students from PBL curriculums seem to have better knowledge retention PBL also generates a more stimulating and challenging educational environment and the beneficial effects from the generic attributes acquired through PBL
PBL 5 Easy Steps
bull Read the problem
Mrs Paula Embledon
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
2 Brain storm
bull Brainstorm
bull ndash hypotheses
bull - what do we know in support of the hypothesis
bull - what do we need to know to test the hypothesis
ndash learning issues
Brainstorm
bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)
ndash specific issues (for individuals to look up)
ndash overlapping issues
bull 4 Individual Reading - Research - Preparation
bull 5 Return
bull ndash review case so far ndash report and discuss
ndash assess progress - continue pagenext pagecomplete
ndash self-evaluation - How did things go Any suggestions for next time
ndash next problem
bull 5 Return
THE FIRST GROUP SESSION
bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day
bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session
bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr
bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine
bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise
bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator
bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues
bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know
bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)
bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)
bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)
PBL 5 Easy Steps
bull Read the problem
Mrs Paula Embledon
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
2 Brain storm
bull Brainstorm
bull ndash hypotheses
bull - what do we know in support of the hypothesis
bull - what do we need to know to test the hypothesis
ndash learning issues
Brainstorm
bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)
ndash specific issues (for individuals to look up)
ndash overlapping issues
bull 4 Individual Reading - Research - Preparation
bull 5 Return
bull ndash review case so far ndash report and discuss
ndash assess progress - continue pagenext pagecomplete
ndash self-evaluation - How did things go Any suggestions for next time
ndash next problem
bull 5 Return
THE FIRST GROUP SESSION
bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day
bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session
bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr
bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine
bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise
bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator
bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues
bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know
bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)
bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)
bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)
2 Brain storm
bull Brainstorm
bull ndash hypotheses
bull - what do we know in support of the hypothesis
bull - what do we need to know to test the hypothesis
ndash learning issues
Brainstorm
bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)
ndash specific issues (for individuals to look up)
ndash overlapping issues
bull 4 Individual Reading - Research - Preparation
bull 5 Return
bull ndash review case so far ndash report and discuss
ndash assess progress - continue pagenext pagecomplete
ndash self-evaluation - How did things go Any suggestions for next time
ndash next problem
bull 5 Return
THE FIRST GROUP SESSION
bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day
bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session
bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr
bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine
bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise
bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator
bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues
bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know
bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)
bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)
bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)
Brainstorm
bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)
ndash specific issues (for individuals to look up)
ndash overlapping issues
bull 4 Individual Reading - Research - Preparation
bull 5 Return
bull ndash review case so far ndash report and discuss
ndash assess progress - continue pagenext pagecomplete
ndash self-evaluation - How did things go Any suggestions for next time
ndash next problem
bull 5 Return
THE FIRST GROUP SESSION
bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day
bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session
bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr
bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine
bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise
bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator
bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues
bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know
bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)
bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)
bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)
bull 3 IdentifyDiscussAssignndash essential issues (for everyone to look up)
ndash specific issues (for individuals to look up)
ndash overlapping issues
bull 4 Individual Reading - Research - Preparation
bull 5 Return
bull ndash review case so far ndash report and discuss
ndash assess progress - continue pagenext pagecomplete
ndash self-evaluation - How did things go Any suggestions for next time
ndash next problem
bull 5 Return
THE FIRST GROUP SESSION
bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day
bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session
bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr
bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine
bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise
bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator
bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues
bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know
bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)
bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)
bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)
bull 4 Individual Reading - Research - Preparation
bull 5 Return
bull ndash review case so far ndash report and discuss
ndash assess progress - continue pagenext pagecomplete
ndash self-evaluation - How did things go Any suggestions for next time
ndash next problem
bull 5 Return
THE FIRST GROUP SESSION
bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day
bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session
bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr
bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine
bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise
bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator
bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues
bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know
bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)
bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)
bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)
bull 5 Return
bull ndash review case so far ndash report and discuss
ndash assess progress - continue pagenext pagecomplete
ndash self-evaluation - How did things go Any suggestions for next time
ndash next problem
bull 5 Return
THE FIRST GROUP SESSION
bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day
bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session
bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr
bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine
bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise
bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator
bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues
bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know
bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)
bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)
bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)
bull 5 Return
THE FIRST GROUP SESSION
bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day
bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session
bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr
bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine
bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise
bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator
bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues
bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know
bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)
bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)
bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)
THE FIRST GROUP SESSION
bull ltgtBe sure you have the necessary information Bring your handbook to the session especially at first The tutors will ensure that you have the information relevant to the case to be discussed that day
bull Seating arrangements Be sure that conversation can flow easily and be sure that everyone can establish eye contact with everyone else in the group If this is not the case suggest seating changes during this first session
bull Tutor introductions Tutors will introduce themselves by telling the group something about their field and personal interests Tutors may want to identify how they wish to be addressed (eg Please call me Barry in these group sessions and Dr Smith in the clinical setting) Some students will be more comfortable addressing the tutor as Dr
bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine
bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise
bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator
bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues
bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know
bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)
bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)
bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)
bull ltgtStudent introductions Students will be asked to introduce themselves to the group Let the tutor and the others know about you your interests your background etc Tell the group something about yourself that they do not already know Include areas of special interest or experience outside of medicine
bull Review the objectives of PBL and the evaluation process Briefly go over the process and the objectives of PBL and review the evaluation process It may help to discuss your understanding of the objectives It is especially useful if the members of the group discuss their own experience in previous PBL groups - what worked what didnt This should lead to a consensus as to how to proceed in the current sessions It also serves to prevent some problems before they arise
bull Choose a secretary The secretary is the email link between the group and the PBL coordinator He or she is also responsible for i) ensuring tutor evaluation is carried out and the results transmitted to the tutor and the PBL coordinator and ii) giving feedback on the process and problems to the PBL coordinator
bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues
bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know
bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)
bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)
bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)
bull ltgt Starting the case After the introductions and discussions are completed the tutor distributes the first page (only) to each student and the process begins with one of the students reading it Based on their current level of knowledge the students then discuss the key information presented formulate hypotheses as to the nature of the problem discuss what information may be needed to test their hypotheses and finally generate a list of learning issues
bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know
bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)
bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)
bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)
bull ltgtBy the end of the session Before the end of each session the students in the group need to clarify their plans for their own learning between sessions by
bull FIRST identifying all of the significant issues arising from the hypothesis - what is known in support of the hypothesis what do they need to know
bull SECOND settling on a do-able list of learning tasks for the next sessiondeciding which issues everyone will tackle and which will be divided up (some issues are so fundamental to the whole area that all students should read about them themselves)
bull THIRD deciding what SPECIFIC questions individuals will try to answer (even minor issues should be looked up by at least two individuals to promote discussion)
bull FOURTH deciding on the enquiry strategy - how they will address these learning issues (eg by looking up notes from a course reading a section of a textbook doing a literature search searching the internet consulting an expert accessing community resources and so on)