Problem based learning

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Problem based learning

  1. 1. PROBLEM BASED LEARNING Professor S. A. Tabish FRCP (London), FRCP (Edin), FAMS, MD
  2. 2. New Horizons in Medical Education What were the challenges? • Changes in patient’s expectations • Changes in HC delivery (style of practice of doctors) • Changes in medical knowledge - traditionally the course was structured as a progression from basic sciences to the clinical sciences, with little integration • Failing to prepare students adequately for the diversity of problems which they will encounter as professionals. Student’s expectations of quality of teaching are higher
  3. 3. • The exponential growth of med knowledge & 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
  4. 4. Domains of essential Global Requirements of ME
  5. 5. What was the response to these challenges? • The development of new curricula incorporating new curriculum themes & different educational strategies • The introduction of new learning situations & the use of new tools & aids to learning • New methods of assessment [OSCE: objective structured clinical exam. Which can test performance & competence in a wide diversity of settings; Formative Assessment; Portfolio assessment; Workbased assess]
  6. 6. New Educational Strategies • New strategies appropriate for adult learning (instead of spoon-feeding): • Self-directed learning • Problem Based Learning • Integrated system based approach • Task Based learning • Core & Student-selected Components • A spiral curriculum
  7. 7. New Tools & Aids • Use of Study Guides • Use of Computer Assisted Programs & Internet • Use of Videos to teach Clinical Skills/consultation techniques • Role of Simulators & Simulations in aspects of physical exam & practical procedures
  8. 8. PBL • Problem-based learning (PBL) is a method of learning in which learners first encounter a problem followed by a systematic, learnercentered inquiry and reflection process. • 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. • 􀂄 The problem comes first without advance readings, lectures, or preparation. • 􀂄 The problem serves as a stimulus for the need to know.
  9. 9. PBL • Helps learners build a bridge between what they already know and what they need to know to reach the next level • Emphasizing active learning, which has been shown to be more satisfying than passive teacher-to-student learning and to enhance retention and recall • Emphasizing student-centered learning in which students are actively involved in setting their own learning goals
  10. 10. Advantages Encourages: • effective & self-directed learning • Critical thinking • Team work • understanding rather than memorization • Facility with professional language • Both students & staff enjoy the process
  11. 11. Advantages In preparing students for professional practice, PBL: • Encourages independence as students identify & meet individual learning needs • Stimulates reflection & self-direction for lifelong learning • Supports ongoing self-assessment • Introduces clinical reasoning • Enhances critical thinking & evidence-based decision making • Ensures that knowledge is transferred, applied & retained by providing a relevant, integrated context
  12. 12. • A problem initiates the activity • The Group is stimulated to explore basic scientific & clinical mechanisms together with social, psychological, ethical or professional issues • Problem stimulates students to reason, think critically & weigh evidence; they seek out & share relevant info
  13. 13. PBL • Groups do not need prior knowledge to generate lively ideas as they identify areas for further collective & personal learning • Each student brings individual experience & makes a distinctive contribution • the Tutor’s role is to manage interactions rather than supply info
  14. 14. • An effective Group provides a safe environment for sharing & testing new knowledge • Students practice the language of science & medicine, evaluate ideas and receive feedback from peers & teacher • When clinical exposure is introduced concurrently, intellectual & practical skills develop in parallel
  15. 15. Framework for PBL • A trigger initiates the problem (paper/computer/video) • Groups brainstorm to identify key issues for discussion • Broad thinking produces a rich array of mechanisms & ideas • Hypothesis are critically explored through reasoning • The need for additional info is identified • A Conclusion is reached • Group reviews the process
  16. 16. Framework for PBL - II • In Breaks between Tutorials, students identfy Learning Issues to be pursued • They are encouraged to adot an evidence-based approach • When they reconvene, they share and review the learning
  17. 17. Characteristics of an effective PBL Group An Effective Group is: Cohesive, motivated, mutually supportive & actively engaged in learning • The Group understands the process & energetically pursues its task • Members respect each other’s contribution but examine them critically • Discussions flow as students cooperate rather than compete • The atmosphere is friendly & good humoured • Roles are shared; all take turns in scribing, leading discussion, taking responsibility for acquiring information
  18. 18. Staff Development • Basic training is mandatory • Further development may be a requirement • Initial training may involve observation & practice with a group from the program • Effective training ensures that necessary background, goals & local strategies are considered, together with info on assessment & evaluation • In addition to materials supplied to students, tutors are usually issued with handbooks, highlighting issues for each problem
  19. 19. Tutor’s Role in Assessment • Individual Students/Groups may be assessed Summatively (determining progression) or formatively (for feedback). The GROUP • At the end of each problem, groups review their processes, to encourage self-reflection &enhance their collective performance
  20. 20. Tutor’s Role in Assessment Individual students: • Tutors should provide formative feedback to each member • Ask students to complete a simple selfassessment questionnaire reviewing appropriate behaviors; the tutor returns them with comments • Students will be a written/oral/clinical tests that will determine their progression & ultimate graduation
  21. 21. Evaluating PBL Tutorials-II • At the end of each problem time is allocated for evaluation • Both the process & learning in PBL can be evaluated against explicit goals • The tutor’s review of effectiveness of group processes offers insight for the members • Students normally evaluate their tutor: helpfulness, support for clinical reasoning, encouragement for independent learning, appropriate intervention, provision for effective feedback
  22. 22. PBL • • • • • 􀂄 Enabling students to learn in the context in which the information will be used, which increases the ability to retrieve and apply information 􀂄 Focusing on important concepts which helps learners organize and store new information in a way that facilitates retrieval and application 􀂄 Exploring prior knowledge, formulating inquiries derived from and defined by the learners’ need to know, and actively constructing meaning through dialogue and reflection 􀂄 Utilizing problems designed to simulate students’ perception of their future profession, which serves as a powerful stimulus for students’ intrinsic motivation to learn 􀂄 Actively involving students in monitoring their own progress and reflecting on what works and what needs improvement; frequently assessing student performance and providing feedback
  23. 23. PBL: Starting the case • 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. • Reading the case aloud keeps the group focused • 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.
  24. 24. PBL Case (contd.) • 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: – FIRST, identifying all of the significant issues and settle on a "do-able" list of learning tasks for the next session.
  25. 25. PBL Case contd. • 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). • THIRD, deciding what SPECIFIC questions individuals will try to answer. • FOURTH, deciding how they will address these learning issues (e.g., by looking up notes from a course, reading a section of a textbook, doing a literature search, searching the internet or consulting an expert)
  26. 26. The Process of PBL • What are the issues? Identify the important issues in the problem • How well do you understand the issues? • Are there any words or terms about which you are unclear?
  27. 27. The Process of PBL contd. • Consider the basic mechanisms that might explain each important aspect of each problem. • Assess your current understanding of the basic structural and/or functional mechanisms that may contribute to the presentation of the problem • Use the collective skills and experiences of group members to explore or explain these phenomena. Identify current gaps in knowledge or understanding.
  28. 28. Learn from each other • Share your own knowledge, expertise, or ability to reason and synthesize information. Be receptive and appreciative of the contribution of your small group members.
  29. 29. Determine priorities for learning • Consider time, resources and objectives and set priorities regarding the relative importance of each learning issue. • 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.
  30. 30. • The problem is a stimulus for discussion, asking questions, and a framework for organizing your knowledge. • It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career.
  31. 31. PBL • The problem comes first without advance readings, lectures, or preparation. • The problem serves as a stimulus for the need to know.
  32. 32. Learning Issues • Learning issues are questions that cannot be answered with students’ current knowledge and that can be explored and answered through systematic, self-directed inquiry. • The use of learning issues in tutorials prepares students to handle similar challenges in clinical practice and life-long learning.
  33. 33. Learning Issues in PBL: First Session 1. Getting Started (Introductions, Ground Rules, Expectations) 2. Identifying Problem 3. Exploring Pre-Existing Knowledge 4. Generating Hypotheses and Explaining Mechanisms 5. Unfolding the Case Incrementally 6. Re-Evaluating/Reprioritizing Hypotheses Based on New Information 7. Assessment/Reflection
  34. 34. PBL: Second Session 8. Independent SelfDirected Study of Learning Issues
  35. 35. PBL: Third Session • 9. Discussion of Learning Issues and Application of New Knowledge to the Case • 10. Continued Unfolding of the Case Incrementally • 11. Assessment/Reflection
  36. 36. During Tutorial Session students will 􀂄 Come prepared to discuss the case and learning issues researched since the last tutorial. 􀂄 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. 􀂄 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. 􀂄 Consider biological, population, behavior/mental health issues/explanations and questions of professional attitudes, values, and ethics related to the patient’s problem(s) described in the case.
  37. 37. Tutorial Session contd. 􀂄 Go to the board to diagram, outline, draw, etc. in explanation of mechanisms related to hypotheses. 􀂄 Debate evidence related to the case and avoid personal attacks on others. 􀂄 Comply with ground rules with regard to how the group will function and how its members treat one another. 􀂄 Participate in end-of-session reflection and assessment by giving and receiving constructive criticism regarding self, tutor, student, and group performance.
  38. 38. Between Tutorial Session 􀂄 Research key learning issues using a variety of resources 􀂄 Critically evaluate the credibility of sources and the validity of the information they have obtained in their research. 􀂄 Integrate what they have learned through research, lectures, labs, clinical skills, Perspectives in Medicine (PIM), etc. into what is discussed in tutorials 􀂄 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.
  39. 39. Determine priorities for learning • Consider time, resources and objectives and set priorities regarding the relative importance of each learning issue • 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. • The problem is a stimulus for discussion, asking questions, and a framework for organizing your knowledge. • It will encourage the development of sound concepts and lead to the establishment of principles which will apply throughout your medical career
  40. 40. PBL: Starting the case • 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. • Reading the case aloud keeps the group focused • 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.
  41. 41. Problem-based learning is designed to develop 􀂄 Integrated, context-specific knowledge base 􀂄 Decision-making/critical thinking process and skills 􀂄 Self-directed, life-long learning skills 􀂄 Interpersonal, collaboration, and communication skills 􀂄 Constructive self and peer assessment skills 􀂄 Professional ethics and behavior
  42. 42. PBL Case (contd.) • 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: – FIRST, identifying all of the significant issues and settle on a "do-able" list of learning tasks for the next session.
  43. 43. What is problem based learning? • In PBL students use "triggers" from the problem case or scenario to define their own learning objectives. • Subsequently they do independent, self directed study before returning to the group to discuss and refine their acquired knowledge. • Thus, PBL is not about problem solving per se, but rather it uses appropriate problems to increase knowledge and understanding. • The process is clearly defined
  44. 44. PBL • PBL uses clinical cases as the context for students to study basic and clinical sciences. • 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 selfdirected life-long learning. • Possible disadvantages include higher costs, both in resources and staff time.
  45. 45. PBL • 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 • Students usually meet in small groups two or three times a week for PBL tutorials • 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. • A tutor usually acts as a facilitator, guiding students in this group-learning process.
  46. 46. • 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.
  47. 47. Rationale for using PBL • • • • • The PBL approach is based on principles of adult education20 and cognitive psychology.21 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 reasons:4,22,23 It creates an artificial divide between the basic and clinical sciences; Time is wasted in acquiring knowledge that is subsequently forgotten or found to be irrelevant; Application of the acquired knowledge can be difficult; The acquisition and retention of information that has no apparent relevance can be boring and even demoralising for students.
  48. 48. The group learning process: acquiring desirable learning skills
  49. 49. Generic Skills & attitudes • • • • Teamwork Critical evaluation of literature Chairing a group Self directed learning and use of resources • Listening Presentation skills Recording • Cooperation • Respect for colleagues' views
  50. 50. • 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.
  51. 51. • 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
  52. 52. No CRoles of participants in a PBL tutorial aption Found Wood, D. F BMJ 2003;326:328-330 Copyright ©2003 BMJ Publishing Group Ltd.
  53. 53. What happens in a PBL tutorial? • 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. • 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.
  54. 54. • 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.
  55. 55. Examples of trigger material for PBL scenarios • • • • • • • • Paper based clinical scenarios Experimental or clinical laboratory data Photographs Video clips Newspaper articles All or part of an article from a scientific journal A real or simulated patient A family tree showing an inherited disorder
  56. 56. PBL tutorial process – Step 1 Identify and clarify unfamiliar terms presented in the scenario; scribe lists those that remain unexplained after discussion – 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 – Step 3 "Brainstorming" session to discuss the problem(s), suggesting possible explanations on basis of prior knowledge; students draw on each other's knowledge and identify areas of incomplete knowledge; scribe records all discussion – Step 4 Review steps 2 and 3 and arrange explanations into tentative solutions; scribe organises the explanations and restructures if necessary – Step 5 Formulate learning objectives; group reaches consensus on the learning objectives; tutor ensures learning objectives are focused, achievable, comprehensive, and appropriate – Step 6 Private study (all students gather information related to each learning objective) – Step 7 Group shares results of private study (students identify their learning resources and share their results); tutor checks learning and may assess the group
  57. 57. • 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.
  58. 58. PBL in curriculum design • • 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.
  59. 59. No C Designing and implementing a curriculum module using PBL supported by other teaching methods aption Found Wood, D. F BMJ 2003;326:328-330 Copyright ©2003 BMJ Publishing Group Ltd.
  60. 60. Writing PBL scenarios • 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
  61. 61. • • • • • • • • • How to create effective PBL scenarios* Learning objectives likely to be defined by the students after studying the scenario should be consistent with the faculty learning objectives Problems should be appropriate to the stage of the curriculum and the level of the students' understanding Scenarios should have sufficient intrinsic interest for the students or relevance to future practice Basic science should be presented in the context of a clinical scenario to encourage integration of knowledge Scenarios should contain cues to stimulate discussion and encourage students to seek explanations for the issues presented The problem should be sufficiently open, so that discussion is not curtailed too early in the process Scenarios should promote participation by the students in seeking information from various learning resources *Adapted from Dolmans et al. Med Teacher 1997;19:185-9
  62. 62. Staff development • 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).
  63. 63. A dysfunctional group: a dominant character may make it difficult for other students to be heard
  64. 64. A dysfunctional group: a dominant character may make it difficult for other students to be heard • Tutors should be also given information about the institution's 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
  65. 65. Advantages of PBL • 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 process"Deep" 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
  66. 66. Disadvantages • Tutors who can't "teach"Tutorsenjoy 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
  67. 67. Assessment of PBL • 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.
  68. 68. • 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 individual's assessment schedule encourages students to achieve the generic goals associated with PBL.
  69. 69. Conclusion • 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.
  70. 70. • 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
  71. 71. PBL: 5 Easy Steps • 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.....
  72. 72. 2. Brain storm • Brainstorm • – hypotheses • - what do we know in support of the hypothesis? • - what do we need to know to test the hypothesis? – learning issues
  73. 73. Brainstorm
  74. 74. • 3. Identify/Discuss/Assign – essential issues (for everyone to look up) – specific issues (for individuals to look up) – overlapping issues
  75. 75. • 4. Individual Reading - Research Preparation
  76. 76. • 5. Return • – review case so far – report and discuss – assess progress - continue page/next page/complete – self-evaluation - How did things go? Any suggestions for next time? – next problem
  77. 77. • 5. Return
  78. 78. THE FIRST GROUP SESSION • • • <>Be 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. 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. 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 (e.g., "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.
  79. 79. • • • <>Student 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. 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 didn't. 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. 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.
  80. 80. • <> 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.
  81. 81. • • <>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: 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? • SECOND, settling on a "do-able" list of learning tasks for the next session.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). • 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). • FOURTH, deciding on the "enquiry strategy" - how they will address these learning issues (e.g. 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).

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