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Problem based learning


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Problem based learning

  1. 1. Dr. Soumya Swaroop Sahoo Junior Resident Dept. of Community Medicine
  2. 2. Introduction Differences between traditional learning and Problem Based Learning (PBL) PBL Characteristics Steps of PBL Advantages and disadvantages of PBL Examples Indian scenario Conclusion
  3. 3. “ You can not teach a man anything, you can only help him find it within himself ” - Galileo ‘Spoon feeding in the long run teaches us nothing but the shape of the spoon’ - E M Forster
  4. 4. 1913 Sir William Osler (concerning the education of medical students) “ too great a reliance on lectures and on students’ capability of memorising a growing number of items of knowledge.” 1960’s PBL introduced in Canadian medical school 1970’s most of US and worldwide medical schools adopted PBL 1990’s PBL introduced into medical schools in UK by Manchester, Glasgow and Liverpool universities.
  5. 5. PBL was pioneered in the medical school program at McMaster University in Hamilton, Ontario, Canada in the late 1960s by Howard Barrows and his colleagues.
  6. 6. McMaster architect of PBL who pioneered the concept of using simulated patients to train medical students. Professor of medicine at McMaster from 1971 to 1980, Barrows created educational tools and learning methods that have defined modern medical training. His research encompassed the problem solving skills of physicians and PBL as a structured teaching/learning method. HOWARD BARROWS 1928-2011
  7. 7. The intent is to challenge the learner with problems found in practice both as a stimulus for learning and focus for organizing what has been learned for later recall and application to future work. Howard Barrows “…a process of acquiring understanding, knowledge, skills and attitudes in the context of an unfamiliar situation, and applying such learning to that situation.” C. E. Engel, University of Newcastle
  8. 8. Grades did not predict success Many students could not apply knowledge Diagnosis Problem solving Education is a continuous process and requires life-long learners PBL adopted to better prepare people for handling real life situations
  9. 9. Institutions Medical Schools Pharmacy Schools Veterinary Schools Business Schools Community Colleges Disciplines Health Care and Nursing Engineering Geography Cell Biology Law
  10. 10. (118 courses at 103 institutions across 35 countries) Linkoping University Roskilde University
  11. 11. Problem-based learning (PBL) is a student-centered pedagogy in which students learn about a subject through the experience of problem solving.
  12. 12. Problem-Based Learning really is just what its name implies…allowing students to learn through solving real-world problems.
  13. 13. We are preparing our students for jobs that don't exist, using technologies that have not been invented, to solve problems that we haven't even considered yet. Moreover PBL meets the demand of modern job requirements Richard Riley (1999) Communication skills Teamwork Analysis
  14. 14. From focus on teaching To focus on learning Investigation of real world problems Engages students as stakeholders Utilizes cooperative learning Instructor becomes coach
  15. 15. Told what we need to know Memorize it Problem assigned to illustrate how to use it Problem assigned Identify what we need to know Learn and apply it to solve the problem Traditional Learning Problem based learning
  16. 16. New- Innovative Curricula Traditional Medical Curricula  Continuum  Student-centered Teacher-centered Problem-based Information gathering Integrated Discipline-based Community-based Hospital based Elective Standard Systematic Apprenticeship-based S P I C E S SPICES
  17. 17. >> learning is driven by challenging & open-ended problems. >> students work in collaborative groups. >> teachers take on the role as "facilitators" of learning.
  18. 18. >> learning is driven by challenging & open-ended problems. >> students work in collaborative groups. >> teachers take on the role as "facilitators" of learning.
  19. 19. >> learning is driven by challenging & open-ended problems. >> students work in collaborative groups. >> teachers take on the role as "facilitators" of learning.
  20. 20. Existing Content Lecturer Student Problem Facilitator Problem Solver PBL Learn new knowledge
  22. 22. Barrows identified six core features of PBL: Learning is student-centred. Learning occurs in small student groups. Teachers are facilitators or guides. Problems are the organizing focus and stimulus for learning. Problems are the vehicle for the development of clinical problem-solving skills. New information is acquired through self-directed learning.
  23. 23. PBL Characteristics 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. 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.
  24. 24. Exciting alternative to traditional classroom learning. The teacher presents a problem, not lectures or assignments or exercises. Since students are not handed "content", the learning becomes active in the sense that they discover and work with content that they determine to be necessary to solve the problem. In PBL, teacher acts as facilitator and mentor, rather than a source of "solutions.”
  25. 25. PBL Characteristics FACTS IDEAS LEARNING ISSUES ACTION PLAN Information extracted from the problem scenario. Grouped according to themes, where possible. Possible causes/effects/ ideas/solution. Based on facts identified. Accepted without judgment. Evolves over time. Phrased as questions When answered should contribute towards solving the problem Activities to be carried out to answer gaps in order to help solve the problem e.g. conduct research, interview
  26. 26. Steps in Problem Based Learning 1. Identify the problem 2. Explore pre-existing knowledge 3. Generate hypotheses and possible mechanisms 4. Identify learning issues 5. Self study 6. Re-evaluation and application of new knowledge to the problem 7. Assessment and reflection on learning
  27. 27. Step 1: Define the Problem Your task today is to solve………………… Facilitator present problem to student.
  28. 28. Step 2: Propose solution to solve the problem Lets discuss about…. • Clarify the facts and • Define what the problem is. • Brainstorm ideas based on the prior knowledge. • Identify what they need to learn to work on the problem • What they do not know learning issues Student discuss problem in a small group
  29. 29. Step 3: Gather and Evaluate Information Students will gather information from all sorts of resorces like from books and websites Then students will need to evaluate the findings. Student engage on independent study
  30. 30. Step 4: Synthesize and Form Solutions Student come back to group and share
  31. 31. Review How to improve this? What are the problems? Students review what they have learnt and compile final report
  32. 32. P - Problems R - Resources O - Objectives B - Behaviour L - Learning E - Examples M - Motivation S -Self directed learning and asessment
  33. 33. Analyse a Problem: 1. Clarifying terms 2. Defining the problem 3. Brainstorming 4. Structuring & hypothesis 5. Learning objectives 6. Searching for information 7. Synthesis Pre-discussion Post-discussion
  34. 34. needs more information before it becomes clear act as triggers are interdisciplinary only given guidelines to approach problem several alternative solutions are often possible
  35. 35. Work in a group of six to eight Meet for about an hour and a half two or three times a week Analyse, discuss and generate questions and learning tasks from the scenario Engage in self-directed learning Communicate results back to group
  36. 36. Monitors and evaluates learning/discussion Guidance is given in the form of suggestions Keeps students involved Manages group dynamics Keeps process moving May intervene if the students are not working or if the activity is starting to go in the wrong direction. Provides authentic assessment
  37. 37. all participants have a role to play Tutor 1.Putting the problem in context and help prioritizing issues 2. Encourage all group members to participate 3.Prevent sidetracking 4.Check understanding 5.Access performance Chair 1.Lead the group through the process 2.Keep group dynamics 3.Time keeping 4.Ensure group keeps to task in hand 5. Ensure scribe can keep up and make an accurate record. Scribe 1.Record points agreed upon by group members 2. Help group order their thoughts 3. Participate in discussion 4. Record resources to be used by groups Group members 1.Follow the steps of the process of PBL as it has been agreed upon 2. Participate effectively in the discussion 3. Listen to and respect contributions of others 4. Ask open questions to stimulate the discussion; 5. Share information within the group.
  38. 38. ‘Conventional’ PBL Expected effects Teacher-centred Student-centred Motivation  Rote learning Active learning Retention  Discipline-based Integrated Applicability  Competitive Collaborative Interpersonal  Information gathering Problem-solving Relevance  Assigned resources Information management Professional  Examinations Progressive learning Life-long learning 
  39. 39. 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
  40. 40. Method Learning through problem solving Project based learning PBL Emphasis Application Integration and application Acquisition Integration Application
  41. 41. PROBLEM: Julia , a 19-year-old woman who presents to a local adolescent clinic for the first time with concerns about a vaginal discharge and irregular menses. She has been sexually active for about two years with several partners. She frequently, though not always, has her partner use a condom. She is not using any other form of birth control and has not previously seen a physician for routine gynecologic care or contraceptive advice. Her family does not have health insurance. She is concerned about the possibility of a sexually transmitted disease and possible pregnancy. Results of the initial evaluation reveal that Julia has Chlamydia trachomatis, a lower genital tract infection. Treatment of her infection is initiated. The clinic reports her infection to the public health authorities.
  42. 42. Set up learning objectives: Causes of STD and risk factors for it Probable predisposing risk factors in the patient Describe the regulations and procedures pertaining to reportable infectious diseases, including the: Role of local public health authorities in tracking the epidemiology of reportable diseases Role of the local public health authorities in undertaking contact tracing procedures Primary functions of the Centers for Disease Control and Prevention and its role in monitoring reportable diseases in the United States Describe the different types of health insurance available to citizens
  43. 43. Session 1: the students are given the script of Julia's first office visit to the adolescent clinic. The group should begin the process of reviewing the learning objectives and related questions. Session 2 Given the describing the results of her initial physical examination and summary of the laboratory testing and formulate a plan for her subsequent treatment and follow up care.
  44. 44. Active learning : learn by doing Increases student motivation Relevant issues and learning (real life problems) Greater use of library and other resource material Less use of memorization/short-term recall Increased faculty-student interaction
  45. 45. Students engage in a wide variety of learning experiences of which PBL tutorials lecture/plenary PBL tutorial topic tutorials practicals personal study computer assisted learning library skills clinical work demonstrations are of central importance.
  46. 46. Demanding on staff time Teacher’s not acquainted with PBL Human resources Other resources Information overload Different type of students- quiet student and dominant student Dysfunctional group Difficult with large classes Needs flexibility and adaptability
  47. 47. Although, world is weighing up for PBL and its positive outcomes, it could not extend much in Indian higher education. In India, after 4 decades, PBL is still in its infancy, and its use is limited to particular subject or topics of a few premier institutions. In India it is practised only in some private schools, engineering colleges, medical colleges and private hospitals. Keeping in mind the dearth of resources it would be difficult to implement PBL in all streams across various institutions as of now.
  48. 48. A hybrid system incorporates elements of conventional curricula, such as lectures and tutorials, in a problem based curriculum. overcome some of the shortcomings of a purely PBL curriculum some schools such as University of Otago Medical School, New Zealand, use a hybrid system in their preclinical curriculum. In India, used in CMC Vellore.
  49. 49. Objective: to learn the GI system using case based scenario topics used for the PBL cases were: 1. Upper gastrointestinal tract: A case of peptic ulcer 2. Lower gastrointestinal tract: A case of malabsorption 3. Hepatobiliary system: A case of obstructive jaundice Problem Based learning Session 1: evolve a consensus on the learning objectives to be pursued. each student in the group takes responsibility for one or more specific learning objectives.
  50. 50. Session 2: Given the 2nd part of the case and shared the information they had gathered during the study time. Session 3: students were given the third part of the case At the end of session 3, the facilitator assessed each student’s participation in the sessions. The group did a self-assessment of their performance and that of the facilitator, using a similar scale.
  51. 51. Integrated lectures: Lectures related to Physiology and Biochemistry consisted of Case-based lectures (for example, a case of pancreatitis was used to discuss the physiology of pancreatic secretions), Overview lectures (such as an overview on secretions in the gastrointestinal tract), and Enrichment lectures (such as one on the historical evolution of knowledge concerning peptic ulcers). Clinical visits: Group visited clinical wards to see patients in medicine and surgery also visited the departments of radiology and gastroenterology.
  52. 52. General medicine. Patients with diseases of the gastrointestinal tract such as gastrointestinal bleeding, malignancy and cirrhosis of the liver. General surgery. Preoperative and postoperative patients with cholecystitis, appendicitis and colonic malignancies. Gastroenterology. Students watched gastroscopies being performed by gastroenterologists. Radiology. Students were shown images of barium meals ultrasonograms and computerized tomography (CT) images of the GI tract by radiologists, who emphasized the anatomical correlations in health and disease.
  53. 53. Small group laboratory work These sessions consisted of anatomy dissection and practical exercises in histology and biochemistry. The practical exercises in biochemistry related to investigations for assessment of liver function. Assessment Assessment of performance and skills acquired Assessment of self-directed learning skills (the content and the process) Assessment of knowledge (the content).
  54. 54. PBL in and for the future needs to be as an approach to learning that is not just about employability… or the “happening” new genre in higher education learning. It needs to be seen as an approach to learning that really does help learners to engage with and live in a complex world. Savin-Baden, M. & Major, C.H. (2004)
  55. 55. Nevelle AJ, Norman GR: PBL in the Undergraduate MD Program at McMaster University: Three Iterations in Three decades. Acad. Med.2007, 82:370-374. Albanese, Mark A. Problem based Learning. [ed.] Tim Swanwick. Understanding Medical Education:Evidence, Theory and Practice. London : WileyBlackwell,2010, pp. 3752. Barrows H. 1994. Practice-Based Learning: Problem-Based Learning Applied to Medical Education. Springfield, IL: Southern Illinois University School of Medicine. Kahn, P. & O’ Rourke, K. (2005). Understanding Enquiry Based Learning in T. Barrett, I. Mac Labhrainn & H. Fallon (eds). Handbook of Enquiry and Problem based Learning. Galway: Celt Bhattacharya N, Shankar N, Khaliq F, Rajesh CS, Tandon OP. Introducing problem-based learning in physiology in the conventional Indian medical curriculum. Natl Med J India 2005;18:92–5.