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CASE AND PROBLEMS-BASED LEARNING – [CBL]Using specific cases to teach and learn how to deal with clinical problems

AN INTRODUCTION

By;Col Abrar Hussain Zaidi

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SEQUENCE

1. NOMENCLATURE2. INTRODUCTION3. THE SPECTRUM OF STUDIES4. CASE SELECTION5. THE LEARNING OBJECTIVES

[SLO’S]6. METHODOLOGY/FORMATS7. THE PROCESS/STEPS OF LEARNING8. CBL IN AMC

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NOMENCLATURE

• PROBLEM BASED LEARNING--PBL

• CASE BASED LEARNING -- CBL• SUBJECT BASED LEARNING--

SBL• TARGET BASED LEARNING-- TBL

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NOMENCLATURE

PBL - A scientific problem could be of any type -Term used in broader perspective CBL - In clinical studies the problems are the individual cases /the patients

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INTRODUCTION

CBL – The learning that stems out from;

studying a given; individual case/problem/subject and involves clinical process of Understanding the problem [investigations and diagnosis] and Rationalizing the resolution of a problem [treatment].

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CBL vs conventional learning

The problem is encountered first

in the learning process

[opposite to conventional]

INTRODUCTION

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INTRODUCTION

The method of problem-based learning

(PBL) has been used in different fields of sciences for decades.

In medical education it began at McMaster University in the mid-1970s. [Barrows and Tamblyn (1980):]

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Problem-based learning (PBL) has been widely adopted in U.S. medical schools and is believed to be highly effective for knowledge acquisition and clinical performance.

1-Colliver JA. Effectiveness of problem-based learning curricula: research and theory. Acad Med2000;75(3):259-266.

2-Galey WR. What is the future of problem-based learning in medical education? Adv Physiol Educ 275:12-15, 1998.

INTRODUCTION

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PBL/CBL learning strategy that builds on linkages between basic science

and clinical knowledge.

INTRODUCTION

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THE SPECTRUM OF STUDIES

A broad range of topics in a clinically relevant

context.

Define your learning objectives

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CASE SELECTION

Usual Practice Clinical cases are generally organized around organ systems.

Major, typical, model cases common clinical problems of all body systems

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THE LEARNING OBJECTIVES [SLO’S]

DOMAINS1. COAGNITIVE2. PSYCHOMOTOR3. AFFECTIVE

SU-CATEGORY [LEVEL]1. C-1 BASIC KNOWLEDGE2. C-2 INTERPRETATION3. C-3 SOLVING THE PROBLEM

IMPORTANCE OF DEFINING THE SLO’S--?

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METHODOLOGY/FORMATS

PBL/CBL method of teaching /learning can be used in many formats

• Problem-based lectures • Small-group tutorials • large-group case discussion, • Problem-based laboratories (Kaufman, 1995).

most common -- small groups with a facilitator

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05/%

Assessed after 02 wks

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[AFTER HAVING DEFINED OUR SLOS AND HAVING SELECTED THE CASES ]

Most practical for student teaching

Small-group tutorials

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It is a student-centered approach • Small groups of students • Facilitator• Steps wise discussion• Information gathering• Problem identification • The judicious application of diagnostic tests• Evaluation and interpretation of data• Management decisions or therapy and

intervention • Outcomes monitoring

THE PROCESS/STEPS OF LEARNING

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PBL/CBL method involves the three steps :

• Confronting the problem • Engaging in independent study • Returning to the problem- Discussion (Wilkerson & Feletti, 1989).

THE PROCESS/STEPS OF LEARNING

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CBL discussion utilizes

A deductive process that

parallels the steps used routinely in the evaluation and

care of patients in actual clinical practice

(Figure next).

THE PROCESS/STEPS OF LEARNING

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CASE SCENARIO- HISTORY AND PHYSICAL EXAM

SUMMARY PROBLEMS

D/D

INVESTIGATIONLAB/X-RAYS

INTERPRET/EVALUATE THE DATA

DIAGNOSIS AND TREATMENT PLAN

THE PATIENT

THE ON GOING

DISCUSSION

QUESTIONING

MODERATION

LEARNING

THE PROCESS/STEPS OF LEARNING

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CBL IN AMC

•-In AMC the CBL started last year[2008]

•-We are trying to address it critically and are in the process of assessing its effectiveness in our set-up

•-Total 36 topics were covered during previous session /same no to be covered in new class

•-The process of improvement is continuous

•-Students and teachers feed back is important for improvement

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PBL/CBL method involves the three steps :

• Confronting the problem • Engaging in independent study • Returning to the problem-

Discussion (Wilkerson & Feletti, 1989).

CBL IN AMC

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Case scenario are given to students Have a full week for own study Students develop their approach of dealing with the problem; Study different aspects of history [pain /mass

etc] Study D/D Study main aspects of pathology Rationalize investigations Re-assess and give one diagnosis Give a plan of treatment • Small Group discussion -weekly• Moderated and guided by a teacher• Every student has to participate • Individual student grading will be done by teacher

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Limitations/flaws/loopholes

1. Students may not take the task seriously No active participation Remain passive learners with low retention2. Every student may not have enough participation3. Time may be too less to cover all aspects of topic4. Some teachers may convert the discussion into a kind of lecture5. Students grading is not always accurate6. Interest and efforts expressed by teachers7. Others ?

CBL IN AMC

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Limitations/flaws/loopholes

How to overcome--?

Reward: CME credits for the teachers

Grading for students

CBL IN AMC

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Is the system effective in our set up -?

How to objectively assess

Needs an observational study

CBL IN AMC

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CBL - ?

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