PHASE 1PHILOSOPHY AND DESIRED OUTCOMES

Problem Based Learning

What is Problem based learning?

PBL

Defining features?

Encourages students to develop clinical reasoning

Student centred style of learning that uses problems / case scenarios as the impetus for discussion and learning

PBL

Encourages students to support their hypotheses with a basic science explanation

Focuses the student on relevant anatomy, physiology, pathophysiology as well as patient factors

Requires the student to justify their hypotheses based on the interpretation of the clinical information presented in the case

PBL Goals

Goals of PBL (Barrows 1986)1. Structuring knowledge for use in working

contexts2. Developing effective reasoning processes3. Developing self directed learning skills4. Increased motivation for learning5. Developing group skills, working with

colleagues

PBL process

Small group (8 students)Identify the problems in each case scenarioGenerate hypotheses (possible causes etc)Look for more information(construct an

enquiry plan)Refine the hypothesesFind learning goals and identify knowledge

gapsResearch information to achieve the goals

Why use PBL?

Cognitive / clinical reasoning skills (the thinking and decision making process which is integral to clinical practice)

Self directed learningApplication of knowledge Interpersonal and communication skillsteamwork

Why use PBL in the medical curriculum?

Collective wisdomClinical reasoning is a central component to

physician competence (and objectives related to the mastery of clinical reasoning skills appear in the documentation of most medical schools) Norman G: 2005

Why use PBL in the medical curriculum?

One of the core tasks assigned to clinical teachers is to enable students to sort through a cluster of features presented by a patient and accurately assign a diagnostic label Eva K: 2004

Why use PBL in the medical curriculum?

Clinical reasoning is the foundation of professional clinical practice; in the absence of sound clinical reasoning, clinical practice becomes a technical operation requiring direction from a decision maker. Higgs J and Jones M: 2000

Student PBL skills

Develop ability to deal with uncertaintyGenerate hypothesesDevelop an enquiry planIntegrate knowledge from basic and clinical

sciencesIdentify learning goalsUse resource to construct new informationInterpret the results of investigations and

apply new knowledge

PBL tutor/ facilitator

Facilitation is not about detailed content, answering questions or providing a lecture

It is about : helping the group deal with big conceptsIdentifying open ended questions to encourage

discussionUnderstanding the learning needs of the groupKeeping the group task focussed Guiding achievement of goals

Shortcomings of PBL

Resource intensiveMay not suit all learning stylesMay inhibit talents and skills of expert teachersSome teachers may not be able to facilitate the PBL

process effectivelyTime intensive for students

Effective Teaching

3 models of thinking about teaching:(First 2 are “blame” models)1. Blame the learner (Focus on what students

are)2. Blame the teacher (Focus on what teachers

do)

3. Third model integrates learning and teaching. (Focus on what the student does)

Effective Teaching

This defines 3 levels of thinking about teaching

1. Level 1- teachers role is to display information, students to absorb it. If the student is unable to do this then this is the students problem

2. Level 2- the teachers role is to explain concepts and principles and present information. They need various skills, techniques and competencies to do this and so the focus is on what the teacher does rather than on the student

3. Level 3- focus is on what the student does- are they engaging? If not, what sort of context would best help them? How can I know they have achieved intended outcomes?

Focus on what the Student DOES

Level 3 ! Student centred model of teaching2 main theories behind this concept

(phenomenography and constructivism)Both agree that effective learning changes the way we see the world. The acquisition of information in itself does not bring about a change but rather the way we structure that information and think with it.

Effective Teaching and Learning

1. Is it clear to both student and teacher what the intended outcomes of learning are?

2. Does the student experience the need to “get there”? If not initially motivated, the art of good teaching will communicate the need to the student

3. Does the student feel free to focus on the task?

4. Can the students work collaboratively and in dialogue with others?

Effective Teaching and Learning

Surface

Versus

Deep

Surface approach to learning

Student side:Student intention to achieve minimal passNon academic > Academic prioritiesInsufficient time / Misunderstand requirementsTeacher side:Teaching piecemeal by bullet listsAssessing for independent factsTeaching in a way that encourages cynicism ( I hate

teaching this session but we have to cover it)Providing insufficient time to cover tasksCreating undue anxiety or low expectations of success

(“anyone who can’t understand this shouldn't be here”)

Deep approach to learning

Student sideIntention to engage the task meaningfully and

appropriatelyAppropriate background knowledgeAbility to focus at high conceptual levelGenuine preference , and ability for working

conceptually rather than with unrelated detail

Teacher side

Deep approach to learning

Teacher sideTeaching in a way to bring out structure of the topicTeaching to elicit an active responseTeaching by building on what students already knowConfronting and eradicating students misconceptionsAssessing for structure rather than independent factsTeaching and assessing to encourage a positive working

atmosphere so students can make mistakes and learn from them

Emphasising depth of learning rather than breadth of cover

Using teaching and assessment methods that support the explicit aims and intended outcomes of the course (constructive alignment)

Effective Teaching and LearningBiggs and Tang Third edition

Effective Learning

Problem Based Learning

How do these teaching and learning characteristics relate to “PBL”?

Effective learning whilst doing PBL

Because students learn a variety of skills, not just knowledge. PBL is designed to develop: Integrated, context-specific knowledge base Decision-making / critical thinking processes and

skills Self-directed, life-long learning skills Interpersonal, collaborative and communication skills Constructive self, peer and group assessment skills Professional ethics and behaviour

PROVIDED THE PRINCIPLES OF PBL ARE BEING ADHERED TO

What does PBL look like?

What are learning issues?

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Learning Issues (LOs)

Are best phrased as ‘how’ (rather than ‘what’) focused questions

Identify what is needed to move students to the next level of understanding

Provide a bridge for linking pre-existing knowledge to new knowledge

Can be identified at any step and at any time as the learning process unfolds

Should be researched between sessions and discussed the following session

Should be researched by all members of the group rather than divided up

Effective Learning

Teaching for Quality Learning at University, Biggs & Tang 3rd Edition p 152“PBL is alignment itself. If the aim is to become a Doctor then the best way of becoming one is being one, under appropriate guidance and safeguards. If the ILO is to make clinical diagnoses then making clinical diagnoses is the obvious teaching/learning activity and how well they are made is the obvious assessment task.”

Effective Learning

Teaching for Quality Learning at university, Biggs & Tang 3rd Edition p 152“In a fully blown PBL program the learner is ready to move directly into the workforce. Less content may well be covered than in a traditional programme but the knowledge so gained is acquired in a working context and is put back to use in that context. Coverage, so dominant in discipline centred teaching is considered less important. Instead , students learn the skill for seeking out the required knowledge as the occasion demands.”

PBL variables

PBL varies according to 2 major variables:i. The degree to which the problem is

structuredii. The extent of the teacher direction

The optimal amount of structure to the problem, and of teacher direction depends at least initially with the educational philosophy of the teachers and tutors participating and what freedom the students can handle.

PBL session structure

PBL cases comprise 3 tutorials

Tutorial 1 (Med 1000- Friday afternoon, Med2000 – Tuesday morning) 2 hours

Tutorial 2 (Med1000- Wednesday morning, Med2000 – student led, no tutor input, Friday afternoon) 2 hours

Tutorial 3 (Med1000 – Friday morning, Med2000 – Tuesday morning) 1 hour

Tutorial 1

Students should:Identify key information in triggers “What do we know?”Generate a list of hypotheses for each

problem identifiedDevelop an enquiry plan “What do we need to know?”Use information from basic sciences to build

mechanisms to explain each hypothesisFormulate Learning Goals

Tutorial 1

Tutors should:Facilitate the students in the PBL process by

asking questions, assist in refining hypotheses and formulating questions to address learning goals

Remember all groups will be different in terms of experiences and background so learning goals will differ from group to group

Review the Key Learning Objective Questions for each trigger to ensure they are covered by students

Tutorial 2

Students should:Discuss learning goals identified in tutorial 1. Use knowledge gained to explain issues raisedIdentify information sources that could help refine

the hypothesesAnalyse, evaluate and interpret the data provided

from any tests and investigationsRefine the hypotheses and identify evidence to

support these viewsDiscuss overall management goals and available

options

Tutorial 2

Tutors should:Monitor how the group is working as a team

and the contribution each member is makingAssist the students in interpreting dataUtilise opportunities to integrate empathy

and reflection into the PBLIncorporate relevant experiences as a

practising clinician into the PBLReview the key learning objective questions

for each trigger

Tutorial 3

Students should:Review the case and determine if there are

any identified learning goals or issues that have not been addressed

Review how they have functioned as a group and if there are any issues that need addressing

Tutorial 3

Tutors should:Monitor how the group is working as a team

and the contribution that each member is making to the process

Review the key learning objective questions for the case

Remember NO NEW INFORMATION should be introduced. This tutorial is for FINALISING learning goals