Problemistics in-medical-education

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Problem based learning (PBL) as a teaching-learning method is a Spectrum. Barrow's classification enables educators to design a wide variety of PBL modules for effective learning of problem solving. Problemistics is an innovative and holistic way to approach the "science of dealing with problems". I have presented different versions of this talk since 1994. This is 2014 "copy-left" version.

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Problemistics in-medical-education

  1. 1. Problemistics and Problem-Centred Health Professional Education Prof KR Sethuraman. MD, PGDHE Email: krs@sbvu.ac.in
  2. 2. Overview • • • • • What is Problem Centred Learning (PCL) Why PCL? Types of PCL: PBL versus PSE Challenges of implementing PBL Problem-Knowledge coupling (PKC) for finding holistic solutions to patient problems • Problemistics – the science of Problem dealing • Spectrum of PBL / PSE
  3. 3. Memorize and Recite! T: “Tell me 10 causes of Anemia” S: “I know 50 Sir! Shall I tell all of them?” POME 3
  4. 4. Bowled by a simple Problem! T: How will you treat a pregnant woman with anemia for Rs.30 per month? S: Hmm…Errr… POME 4
  5. 5. COGNITIV E “Tomorrow’s Doctors” 1993 & 2009 http://www.gmc-uk.org/education/undergraduate/tomorrows_doctors_2009.asp 5
  6. 6. Hybrid Curricula The S P I C E S model || Student-centred ..……………...…….Teacher-centred Problem-based ……………...……Passive acquisition || Integrated ………...…………...……Discipline-based | | Community……..……………...……..Hospital-based | | Electives ……………...………...…….Standardized | | Systematic...……………….....……….Opportunistic | | | | = Where We Are Harden
  7. 7. What is Problem-Centred Learning? • – – – Essential principles of PCL  The problem, activates prior learning resembles real life cases facilitates transfer of learning to other problems • Solving the problem involves – elaboration of knowledge via group-discussion and – reflection to consolidate learning experiences. • Includes problem-solving exercise (PSE) and problem-based learning (PBL)
  8. 8. Why Problem-Centred Learning? • Solving authentic problems matches 21st Century skills • What are 21st C Skills?
  9. 9. 21st Century Education • Learning ‘to be’ – not ‘learn about’ • Learn by doing – not just listening • Learning how to learn – Generation Y (web-2.0 gen) is – participatory – cooperative & adapted for – constructivist learning
  10. 10. Goals for Problem-Centred Learning • Structure knowledge for practice • Develop clinical reasoning • Develop self-directed learning • Increase motivation • Problem-centred learning predates 21st century skills but is more relevant now
  11. 11. PCL Types: PSE & PBL - Different but Related - Problem-solving - arriving at solutions based on prior knowledge and reasoning Problem-based learning - the process of acquiring new knowledge based on recognition of a need to learn
  12. 12. T: How will you treat a pregnant woman with anemia for Rs.30 per month? Teach & Solve = PSE Learn by Solving = PBL POME 12
  13. 13. PBL & PCL begin with a problem – Group analysis of what needs to be known – Individual research – Developing a solution – Reflection on process & learning
  14. 14. Characteristics of PBL 1. Starting point is a problem 2. Authentic for professionals 3. Knowledge organised around problems 4. Students have responsibility for learning 5. Most learning in small groups, not lectures 6. Andragogy (adult learning) - Not pedagogy
  15. 15. The Relative Proportion of PSE to PBL Changes with Curriculum Progress Problem solving Mostly New ! Problem-based learning  Time in the curriculum  Mostly Known !
  16. 16. How “pure” must PBL be? PBL – Barrows proposed a taxonomy – Spectrum of methods Achieving objectives by degrees PCL
  17. 17. Six methods in the spectrum
  18. 18. Barrows’ taxonomy of PBL methods SCC CRP SDL MOT Lecture-based cases 1 1 0 1 Case-based lectures 2 2 0 2 Case method 3 3 3 4 Modified case-based 4 3 3 5 Problem-based 4 4 4 5 Closed-loop problem-based 5 5 5 5 Complete case or case vignette Abbreviations: CRP - Clinical Reasoning Process SCC - Student Centered Curriculum SDL – Self Directed Learning MOT – Motivation to Learn Partial problem simulation Full problem simulation (free inquiry) Teacher-directed learning Student-directed learning Partially student & teacher directed
  19. 19. Fidelity in PBL - i • Presentation format: – simulated patient (high fidelity) to – "case write up"(low fidelity). • Manifestation: – ill structured with a range of possibilities (high fidelity) to – a "text-book case" (low fidelity & 'bookish').
  20. 20. Fidelity in PBL - ii • Signal-Noise Ratio – “noise” (associated problems) overlaying the “signal” (main problem) = high fidelity – pure filtered one-dimensional problem = low fidelity • Context: – permit real-life situations, eg., talk with family members of the patient (high fidelity) – more contrived (low fidelity).
  21. 21. Fidelity in PBL - iii • Objectives: – patient-centred and integrated across disciplines (high fidelity) – only disease-focussed, discrete and piece-meal (low fidelity and artificial) • Low-fidelity problems borrowed from textbooks are counterproductive in terms of the Goals of PBL. – Jayawickramarajah. Problems for Problem-Based Learning: a comparative study of documents. Medical Education, 1996;30:272-282
  22. 22. Effectiveness of PBL Curricula: Research and Theory • “No convincing evidence that PBL improves knowledge base and clinical performance, – at least not of the magnitude that would be expected given the resources required for a PBL curriculum.” • Jerry A. Colliver, Acad. Med. 2000;75:259–266.
  23. 23. Individualising Solutions "Give me ‘standard patients’ and I'll practice standard medicine." --James S. Todd, MD. AMA Executive Vice President, 1990-1996 POME 23
  24. 24. Problem Knowledge Coupling POME 24
  25. 25. What is Problemistics ? • It is the science of dealing with problems • It is an activity aimed at – the resolution of a Problem & – the development of Well-Being POME 25
  26. 26. Problemistics – contd… • It is concerned with  Problem Framing – Context  Problem Finding – Holistic approach  Problem Solving – Appropriate resolution  Problem Acting - Systematic action * POME 26
  27. 27. Spheres of Problem Experience • Bio-sphere environment infections) nature and (e.g., • Socio-sphere - individuals & groups (e.g., phobic neurosis) • Techno-sphere - tools and artifacts (e.g., implant malfunction iatrogenesis etc) 27 POME
  28. 28. Problem Dealer (Professional in Making) • Cultivate following characteristics – – Dimensions - cognition, emotion & volition – Qualities - thrill, skill, will • Thrill - emotive ( enthusiastic ) • Skill - cognitive ( mindful & critical *) • Will - volitional ( proactive ) POME 28
  29. 29. Range of Problem-Centred Education
  30. 30. DURATION = SEMESTER(S) Example - FULL TIME P B L or HYBRID CURRICULUM
  31. 31. DURATION = Hours to Days Example - Integrated Modules Orientation Workshops
  32. 32. DURATION = 1 – 3 hours Example - Problem Solving Exercises Simulation Games
  33. 33. DURATION = 3 to 10 minutes Example - Buzz Session Simulated Initial Management
  34. 34. We must make our Graduates • Think critically and be able to solve complex, realworld problems • Find, evaluate, and use appropriate learning resources • Work cooperatively in teams and small groups • Demonstrate versatile and effective communication skills, both verbal and written • Become life-long learners to update their knowledge and skills acquired at the university Can We Do it ?
  35. 35. We can ! If we have the self belief and motivation like this modeler, who shapes “mere Clay” in to “Desirable objects”
  36. 36. THANK YOU All ! The Handout has more details on PKC & Problemistics (visit www.problemistics.org and www.pkc.org for more information) POME 36

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