4.PBL.pdf

Tutorial (4) LS120 — Fall 2023 Dr. Halima Daw Buni Assistance Professor in Community Medicine  By the end of this tutorial, students will be able to: 1) Define the problem based learning (PBL) 2) Highlight the importance of PBL in clinical practice 3) Understand the dynamics and process of PBL tuto...

Tutorial (4) LS120 — Fall 2023 Dr. Halima Daw Buni Assistance Professor in Community Medicine  By the end of this tutorial, students will be able to: 1) Define the problem based learning (PBL) 2) Highlight the importance of PBL in clinical practice 3) Understand the dynamics and process of PBL tutorials 4) Describe the advantages and disadvantages of PBL 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. What is problem based learning?  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, and the several variations that exist all follow a similar series of steps The importance of PBL: 1. 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. The importance of PBL: cont’d… 2. PBL combines the acquisition of knowledge with the development of generic skills and attitudes. 3. Presentation of clinical material as the stimulus for learning enables students to understand the relevance of underlying scientific knowledge in clinical practice. What happens in a PBL tutorial?  A typical PBL tutorial consists of a group of students (usually 8 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 behavior emerges. What happens in a PBL tutorial? cont’d…  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. What happens in a PBL tutorial? cont’d…  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. What happens in a PBL tutorial? cont’d…  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 in the curriculum.  The tutor should encourage students to check their understanding of the material. Examples of trigger material for PBL scenarios  Paper based clinical scenarios  Experimental or clinical laboratory data  Photographs  Videos  All or part of an article from a scientific journal  A real or simulated patient  A family tree showing an inherited disorder 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; 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 PBL tutorial process: cont’d…  Step 4— Review steps 2 and 3 and arrange explanations; scribe organizes the explanations 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 A dysfunctional group: a dominant character may make it difficult for other students to be heard Advantages of PBL: 1) Student-centred PBL— It fosters active learning, improved understanding, and retention and development of lifelong learning skills 2) Generic competencies— PBL allows students to develop generic skills and attitudes desirable in their future practice 3) Integration— PBL facilitates an integrated core curriculum Advantages of PBL: cont’d… 4) Motivation—PBL is fun for students and tutors, and the process requires all students to be engaged in the learning process 5) “Deep” learning— PBL fosters deep learning (students interact with learning materials, relate concepts to everyday activities, and improve their understanding) 6) Constructive approach— Students activate prior knowledge and build on existing conceptual knowledge frameworks Disadvantages of PBL: 1) Tutors who can’t “teach”— Tutors enjoy passing on their own knowledge and understanding so may find PBL facilitation difficult 2) Human resources— More staff have to take part in the tutoring process 3) Other resources— Large numbers of students need access to the same library and computer resources simultaneously Disadvantages of PBL: cont’d… 4) Role models— Students may be deprived access to a particular inspirational teacher who in a traditional curriculum would deliver lectures to a large group 5) Information overload— Students may be unsure how much self directed study to do and what information is relevant and useful PBL scenario example (1):  Mr. Salem , a 58 year old car mechanic with a history of chronic obstructive pulmonary disease, was at work when he complained of pain in his chest. The pain steadily got worse and he described an aching in his jaw and left arm. One hour after the pain started, he collapsed and his colleagues called an ambulance. When he arrived at the emergency department, Mr. Salem was pale, sweaty, and in severe pain.  Examination showed:  Blood pressure 80/60 mm Hg  Heart rate 64 beats/min  Electrocardiography showed anterolateral myocardial infarction  He was treated with diamorphine, metoclopramide, and aspirin.  As the accident and emergency staff were preparing to give him streptokinase, he had a cardiac arrest.  Electrocardiography showed a systolic cardiac arrest. Despite all efforts, resuscitation failed. PBL scenario example (1): cont’d…  Faculty learning objectives: 1) List the risk factors for myocardial infarction 2) Describe a rehabilitation program for patients who have had a myocardial infarction  Notes:  This scenario is complex for students with limited clinical experience.  The faculty learning objectives related to the epidemiological aspects of ischemic heart disease. PBL scenario example (2):  A 35 year old part time nurse, presented to her general practitioner, Dr. Suleiman, with a six month history of weight loss (12.7 kg). When questioned, she said she was eating well but had diarrhoea. She also felt exhausted and had developed insomnia.  On further questioning, she admitted to feeling increasingly hot and shaky and to having muscle weakness in her legs, particularly when climbing stairs. She was normally well and had not seen the doctor since her last pregnancy eight years ago.  A blood test showed the following results:  Free thyroxine 49.7 pmol/l (normal range 11 to 24.5)  Total thyroxine 225 nmol/l (normal range 60 to 150)  Thyroid stimulating hormone < 0.01 mU/l (0.4 to 4.0)  Dr. Suleiman referred her to an endocrinologist at the hospital where initial investigations confirmed a diagnosis of Graves’ disease. She was treated with carbimazole and propranolol for the first month of treatment followed by carbimazole alone. PBL scenario example (2): cont’d…  Faculty learning objectives: 1) Describe the clinical features of thyrotoxicosis and diagnostic signs of Graves' disease 2) Interpret basic thyroid function tests in the light of the pituitary thyroid axis and feedback mechanisms 3) List the types of treatment for thyrotoxicosis including their indications, mode of action, and potential side effects  Notes:  The faculty learning objectives relate to the scenario; the problem is relevant to the level of study and integrates basic science with clinical medicine.  The combination of basic science, clinical medicine, and therapeutics should lead to extensive discussion and broadly based self directed learning  PBL is an effective way of delivering medical education in a coherent, integrated program and offers several advantages over traditional teaching methods: 1) PBL generates a more stimulating and challenging educational environment 2) PBL 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. Bibliography: 1. ABC of learning and teaching in medicine. Peter Cantillon, Linda Hutchinson, and Diana Wood. 2003, bmj publishing group 2. Problem based learning in medicine, Tim David, Leena Patel, Leith Burdett, Patangi Rangachari. 1st edition. 3. Accelerated learning skills for students, Joe Mccullough. 4. Make it stick, Peter C. Brown, Henry L. Roediger III, Mark A. McDaniel. 5. How we learn, Benedict Carey. 6. ‫ سالم علي الغرابية‬,‫مهارات التفكير وأساليب التعلم‬ 7. ‫ هشام سعيد الحالق‬,‫ مهارات تستحق التعلم‬,‫التفكير اإلبداعي‬ 8. ‫ محمد أحمد غزالة‬,‫ أحمد حسن القواسمة‬,‫تنمية مهارات التعلم والتفكير والبحث العلمي‬  Q1: Mention the 4 components of the Fleming’s VARK model of learning? (1 mark)  Q2: What is the definition of student-centered learning? (1 mark) Dr. Halima Buni  Q1: Mention 2 learning strategies used by visual learners? (1 mark)  Q2: What is the definition of education? (1 mark) Dr. Halima Buni  Q1: Mention 2 learning concerns of the 1st year students related to their transition from school into college? (1 mark)  Q2: What is the definition of distance formal education? (1 mark) Dr. Halima Buni