Outcome Based EducationProblem Based Learning

What is it ?

How would it run at Medanta ?

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Yesterdays Students

Based on facts

Stress on what does the student know ?

Subject based curriculum

Educational research:

Lecturers from experts doesnot influence practice

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Tomorrows students

What can the student do ?

Competencies

Outcome based curriculum

(competency based)

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Outcome based curriculum

Outcome: What should the student be able to do ?

Outcome based curriculum: decisions about curriculum are driven by exit learning outcomes

Product defines content & process

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Outcome based curriculum

Clearly define exit outcomes

Curriculum driven by exit outcomes

Learning strategies & opportunities to match learning outcomes

Assessment process matches outcomes

Regular feedback on progress

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Types of outcomes

Exit outcome:

to diagnose & manage pt with asthma

Intermediate outcome:

take respiratory history of a pt . Perform general examination of respiratory system.

Introductory outcomes:

Describe airway physiology

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Levels of Educational Outcomes

Level 1. An awareness of procedure

Level 2. A full theoretical understanding of the procedure

Level 3. Observation of the procedure

Level 4. Carrying out some part of the procedure

Level 5. Undertaking the procedure under supervision

Level 6. Undertaking the procedure unsupervised.

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Levels of competencies & PerformancesDryfus & Dryfus model

1. Student

2. Novice

3. Advanced learner

4. Competent

5. Proficient

6. Expert

7. Master

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Target Zero

Problem Based Learning (PBL)

• begun in 1950’s as a movement to restructure medical school education

• unlike traditional instruction that culminates in a problem after basic instruction on facts and skills, PBL begins with a problem, teaching facts and skills in a relevant context

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Principles of adult learningAdults are motivated by learning that:

• Is perceived as relevant

• Is based on, and builds on, their previous experiences

• Is participatory and actively involves them

• Is focused on problems

• Is designed so that they can take responsibility for their own learning

• Can be immediately applied in practice

• Involves cycles of action and reflection

• Is based on mutual trust and respect

11NJCATE 4 June 2000

Problem-Based Learning

“PBL is any learning environment in which the problem drives the learning.

12NJCATE 4 June 2000

Problem-Based Learning

“PBL is any learning environment in which the problem drives the learning. That is, before students learn some knowledge they are given a problem.

13NJCATE 4 June 2000

Problem-Based Learning

“PBL is any learning environment in which the problem drives the learning. That is, before students learn some knowledge they are given a problem. The problem is posed so that the students discover that they need to learn some new knowledge

14NJCATE 4 June 2000

Problem-Based Learning

“PBL is any learning environment in which the problem drives the learning. That is, before students learn some knowledge they are given a problem. The problem is posed so that the students discover that they need to learn some new knowledge before they can solve the problem.”

- Don Woods

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Problem-solving vs. problem-based learning

- different but inter-related -

Problem-solving: arriving at decisions based on prior knowledge and reasoning

Problem-based learning: the process of acquiring new knowledge based on recognition of a need to learn

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Tenets of PBL

• requires students to solve authentic, open-ended problems with many correct answers possible

• authentic problems faced by scientists, doctors, engineers, lawyers, educators, administrators, counselors, etc.

• Problems given to students are ill defined with many potential solutions. Problems should be authentic

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Tenets of PBL

• emphasizes students’ pre-existing knowledge; “start with what you know”

• students actively participate by helping plan, organize, and evaluate the problem solving process

• interdisciplinary connections stressed

• students undertake authentic roles

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Basic steps of PBL

• students divided into groups

• real problem is presented and discussed

• students identify what is known, what information is needed, and what strategies or next steps to take (identify gaps)

• individuals research different issues, gather resources

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Basic Steps of PBL

• resources evaluated in group

• cycle repeats until students feel the problem has been framed adequately and all issues have been addressed

• possible actions, recommendations, solutions, or hypotheses are generated

• tutor groups conduct peer/self assessments

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Teachers as facilitators

• a facilitator is key to these learning environments

• models higher-order process skills

• probes for student understanding

• never identifies issues or states an opinion while students frame problems

• Asks open ended questions: where can you ..? What do you think ….? What are the next steps ?

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Advantages of PBL

• greater recall of knowledge, retention

• interdisciplinary, can require accessing and using information from a variety of subject domains; better integration of knowledge

• development of life-long learning skills:how to research, how to communicate in groups, how to handle problems

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Advantages of PBL

• increased motivation, interest in subject areas

• increased student-student interaction, and student-instructor interaction

• Shifts paradigm from teacher centered to student centered

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Traditional system : Teacher centered

…the individuals learning the most in the teacher-centered classrooms are the teachers there. They have reserved for themselves the very conditions that promote learning:

actively seeking new information,

integrating it with what is known,

organizing it in a meaningful way, and

explaining it to others.

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Comparison of Paradigms

Teacher-Centered

Knowledge is transmitted from professor to student.

Learner-Centered

Students construct knowledge through gathering and synthesizing information and integrating it with the general skills of inquiry, communication, critical thinking, and problem solving.

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Comparison of Paradigms

Teacher-Centered

Students passively receive information

Learner-Centered

Students are actively involved.

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Comparison of Paradigms

Teacher-Centered

Emphasis is on acquisition of knowledge outside the context in which it will be used

Learner-Centered

Emphasis is on using and communicating knowledge effectively to address enduring and emerging issues and problems in real-life contexts.

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Comparison of Paradigms

Teacher-Centered

Instructor’s role is to be primary information giver and primary evaluator.

Learner-Centered

Instructor’s role is to coach and facilitate. Instructor and students evaluate learning together.

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Comparison of Paradigms

Teacher-Centered

Teaching and assessing are separate.

Learner-Centered

Teaching and assessing are intertwined.

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Comparison of Paradigms

Teacher-Centered

Assessment is used to monitor learning.

Learner-Centered

Assessment is used to promote and diagnose learning.

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Comparison of Paradigms

Teacher-Centered

Emphasis is on right answers.

Learner-Centered

Emphasis is on generating better questions and learning from errors.

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Comparison of Paradigms

Teacher-Centered

Desired learning is assessed indirectly through the use of objectively scored tests.

Learner-Centered

Desired learning is assessed directly through papers, projects, performances, portfolios, and the like.

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Comparison of Paradigms

Teacher-Centered

Focus is on a single discipline.

Learner-Centered

Approach is compatible with interdisciplinary investigation.

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Comparison of Paradigms

Teacher-Centered

Culture is competitive and individualistic.

Learner-Centered

Culture is cooperative, collaborative, and supportive.

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Comparison of Paradigms

Teacher-Centered

Only students are viewed as learners.

Learner-Centered

Professor and students learn together.

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Outcome

Moving away from:

Are students getting the right answer?

Moving to:

Can students demonstrate the qualities that we value in educated persons, the qualities we expect of college graduates?

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Outcome

Can students gather and evaluate new information, think critically, reason effectively, and solve problems?

Can [students] communicate clearly, drawing upon evidence to provide a basis for argumentation?

Do [students’] decisions and judgments reflect understanding of universal truths[/concepts] in the humanities and arts [etc.]?

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Outcome

Can [students] work respectfully and productively with others?

Do [students] have self-regulating qualities like persistence and time management that will help them reach long-term goals?

Evidence based, Independent Life Long Learner

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How does a case serve as a stimulus for learning?

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Example: PBL tutorial process

1. Case presentation: The tutor provides the group with some introductory clinical information about a hypothetical patient.

Mary Smith, a 28-year-old office worker and part-time swimming instructor, comes to see her GP because of pain in her chest and shortness of breath. This has been a recurring problem in recent months and seems to be gradually worse. On the previous evening, while participating in a swimming gala, she became so short of breath that she found it difficult to walk.

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2. Identifying key information

3. Generating and ranking hypotheses:

e.g., Infection, cardiac problem, allergy, asthma, broken rib.

Allergy ˃ cardiac problem

4. Generate an enquiry strategy:

What additional information is required?

e.g., Previous medical problems and relevant drug, family & psychosocial histories, physical exam, lab. tests.

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Additional information

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

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New information

Revising their hypotheses

Discard / Re-rank / Other hypotheses

• Anxiety attacks with hyperventilation

• Possible thromboembolic disease due to oral contraceptive use

• Asthma • Cardiac problem

• Broken rib

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5. Defining learning objectives

Once the students have decided on a preferred hypothesis (e.g., allergy), they must explain the biomedical science mechanisms that link their hypothesis to the presenting problems.

What students know?

What they do not know?

What they need to know?

to further their understanding of the underlying mechanisms, and their ability to solve the clinical problem.

e.g., Students may identify gaps in their knowledge of the mechanics of breathing, anatomy of airways, mechanisms of oxygen delivery to tissues, or mechanisms of pain perception.

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5. Defining learning objectives (cont.)The identification of gaps in knowledge helps students to define their

learning objectives and these become the focus of self-directed study in the interval between tutorials.

Learning objectives should be clear and specific and of appropriate scope to be addressed in the time available between tutorials (typically 2-3 days).

At each tutorial, the group might identify three to five major learning objectives and perhaps an equal number of lesser objectives.

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5. Defining learning objectives (cont.)

Although the PBL tutorial is student-centered, major learning objectives are identified in advance by the case writers as part of the overall curriculum design. Tutors may need to provide prompts to ensure that major objectives are identified and pursue d.

In PBL, as knowledge is acquired in the context of a specific clinical problem (the problem is encountered before the student has the knowledge to understand it), it is likely to be better focused and retained.

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6. Reporting back

In the follow-up tutorial, students reconvene to report on their self-directed study and share and integrate new knowledge.

All students should contribute to the report-back and their unique perspectives are incorporated into the process of knowledge building. The exchange and debate of ideas promotes the consolidation and elaboration of new knowledge and understanding

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7. Integrating new knowledge

• Based on the principle that knowledge is consolidated more readily in context, students, guided by the tutor/facilitator, should relate new biomedical knowledge to the patient's problem.

• Students are required also to extend their discussion beyond the biomedical and clinical sciences and consider the public health, socioeconomic, ethical and legal aspects of the case.

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How does PBL work ?

College of Medicine, Sharjah University , UAEin collaboration with Monash University, Australia

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Learning Strategies

1. PBL tutorial session

2. Resource sessions

3. Laboratory sessions

4. Review sessions : Team based Learning

5. Clinical skills sessions

6. Hospital visits

7. Community Health visits

8. Self directed learning

9. Student Portfolio

10. Academic Advising

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End of Unit Assessment

Written paper: MCQ & SAQ

Objective Structured Practical Exam: OSPE

Objective Structured Clinical Exam: OSCE

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