Transcript PBL: students' roles - University of Leeds

Problem
Based
Learning
Dr Reg Dennick
Assistant Director of Medical Education
The University of Nottingham
The University of Nottingham
What do you already know/not
know about PBL?
• Discuss with a partner.
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Learning Objectives
• Explain the educational rationale for PBL
• Describe the ‘seven-step’ PBL process
• Participate/Observe in a partial PBL
session
• Critically evaluate the evidence for the
effectiveness of PBL
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Traditional
The University of Nottingham
?
PBL
LATIN
&
GREEK
ANCIENT MEDICAL
‘THEORY’
HIPPOCRATES
ARISTOTLE
GALEN
The University of Nottingham
GRAMMAR, PUBLIC SCHOOLS & UNIVERSITIES
Dominated by
Latin & Greek
Ancient history and philosophy
Theology
MEDICINE
Entry needed Latin (Greek)
All anatomical nomenclature in Latin/Greek
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Entry into medicine had a language and
theory barrier going back to an ancient
view of education. (Higher education
was for an elite class using a ‘secret’
language?)
Even with rise of ‘scientific medicine’
in 19th C the traditional medical
curriculum had a Theory/Practice split
and the requirement for Latin was not
dropped till 1950s in UK
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Theory & Practice
• In education there has been a historical
split between theory and practice
• Theory has to be learned first before
dealing with practice.
• PBL turns this split on its head.
• Problems deriving from practice are
used as triggers to acquire theoretical
knowledge
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PBL: definition
The learning which results from the
process of working towards the
understanding of, or resolution of, a
problem
(Barrow & Tamblyn 1980)
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“The most powerful
Cognitive
Problemsoccurs when
learning
dissonanc
Dis-equilibration
the student
is
dealing
e
(Piaget)
with uncertainty.”
(Festinger)
Paradigm
John Dewey
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shifts
(Kuhn)
Problem Based Learning
A strategy for learning where small
groups of six to eight students
work in a series of tutorials
discussing problems provided by the
Faculty related to their course.
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PBL is a type of Small Group Teaching
activity
Content
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The Scenario
The Problem
The Context
The Knowledge
The Skills
The Attitudes
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Process
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Talking
Dialogue
Questioning
Hypothesising
Collaboration
Activity
Communication skills
Interpersonal skills
PBL
students engage in a collaborative activity that:
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makes them think
makes them ask questions
activates prior knowledge
tests their understanding
elaborates new knowledge
reinforces their understanding by speaking
provides motivation for learning
makes them practise a logical, analytical approach to
unfamiliar situations
– Involves
learning in context
integrated learning
collaboration
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PBL fulfils the conditions
for effective adult learning
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Relevant context
Adults are self-motivated
Adults learn best in groups
Adults prefer ‘doing’ to being told
Active learning through posing own questions and
finding own answers: therefore student centred
• Integrated learning: learning in a variety of disciplines
simultaneously
• Deep learning for understanding; metacognition;
reflection; appropriate feedback; opportunities for
practice
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Where does it come from?
• Celstin Freinet (1896-1966)
• McMaster Medical School (Hamilton,
Ontario) 1969
• University of Maastricht (1974)
• Manchester (1995)
• Liverpool etc (1997)
• Nottingham (Derby) 2003
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How does it work?
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Scenario
Small group
Generate questions
Research questions
Answer questions
Communicate answers
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The Maastricht ‘Seven
Step’ PBL process
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Step
Step
Step
Step
1:
2:
3:
4:
Clarify terms and concepts
Define the problem(s)
Analyse the problem(s) - ”Brainstorm”
List of the analysis and possible
solutions
• Step 5: Formulate Learning Objectives
• Step 6: Collect additional information focussed
on Learning Objectives
• Step 7: Synthesise and present new
information
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A PBL scenario
Ranjit Singh, 46, has just returned from the Indian
sub-continent where he visited his brother and
family for a period of one month. He lives with his
wife, their four children and his parents in a three
bedroom terraced house in the Peartree district of
Derby. He works as a waiter in a local Indian
restaurant. Recently he has started coughing a lot,
has little energy, is losing weight and has developed
a fever. He visited his GP after he coughed up some
blood and developed chest pains. His GP suspects
TB and has sent a sputum sample for analysis and
Mr Singh for a chest X-ray.
The University of Nottingham
Learning Objectives for the PBL scenario
Basic and clinical sciences
•Describe mechanisms and common causes of cough.
•Describe types of clinical investigations available for
patients with cough. Interpretation of CXR.
•Outline the microbiology of mycobacterium tuberculosis.
•Describe the immune response to TB, its use in diagnosis
and the tuberculin test.
•Describe clinical and pathological manifestations of TB.
•Outline the drug regimes for treating TB, their mode of
action, side effects and the problem of drug resistance.
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Learning Objectives for the PBL scenario
Community and population
•Describe the epidemiology of TB, the impact of socioeconomic factors and its relation to HIV.
•Discuss the social and family issues associated with TB
in the community.
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Learning Objectives for the PBL scenario
Patient and Doctor
•Describe how communication problems can be dealt with
in ethnic minorities.
•Awareness of perception of TB in Asian communities
and problems of stigmatisation.
•Dealing with issues of confidentiality versus compulsory
notification: patient autonomy.
•Describe how to ensure compliance with complex and
long-term drug regimes.
•Persuade family members to be immunised.
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Learning Objectives for the PBL scenario
Personal and Professional Development
Doctor as patient: awareness of personal immune
status.
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PBL: students’ roles
• 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
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PBL: role of the facilitator
• The facilitator must let the students be
responsible for their learning.
• The facilitator must let the students do the
work.
• The facilitator has the role of monitoring and
evaluating the discussion. Guidance is given in
the form of suggestions.
• The facilitator has background information
concerning the case under discussion.
• The facilitator may intervene if the students
are not working or if the activity is starting to
go in the wrong direction.
• The students may ask the facilitator for advice
which can be given according to his or her
judgement.
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Small group Facilitator styles
Kurt Lewin:
Autocratic:
facilitator basically controls all the objectives and
activities of the group and keeps intervening to
ensure they are carried out.
Laissez-faire:
allows the group to decide what its objectives are,
what activities it is engaged in and has minimal input
into the session.
Democratic:
collaborates with the group, helping them to agree on
a set of objectives and activities and only intervening
to keep the group dynamic orientated in a positive
direction.
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Facilitator Styles
John Heron: ‘Six dimensions of facilitation’
Facilitators need to be aware of basic issues which can
influence the learning process:
Planning
Meaning
Confronting
Feeling
Structuring
Valuing.
These are independent processes that weave through
each SGT session.
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Heron’s 18 facilitation styles
Planning
Meaning
Confronting Feeling
Structuring Valuing
Hierarchy
Cooperation
Autonomy
Facilitators can move between all these
styles during a small group teaching
session.
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Heron: the most effective
facilitator……
……should value autonomy, co-operation
and hierarchy in that order as this
recognizes the personal autonomy of
group members to self-actualize
collaboratively, with the facilitator
taking responsibility to achieve group
goals.
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The University of Nottingham
Students engage in a wide variety of
learning experiences of which PBL
tutorials are of central importance.
lecture/plenary
topic
tutorials
library
skills
PBL
tutorial
clinical work
practicals
personal study
demonstrations
computer assisted
learning
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A PBL week
AM
PM
Monday
Tuesday
PBL Tutorial (finish
of previous week’s
scenario)
Lectures
Seminars
Workshops
Demonstrations
Early clinical
experience: GP,
community &
hospital visits
PBL Tutorial
Additional
information
Clinical and
communication
skills
Free time
Independent
learning
(including
CAL/NLE,
histopathology
museum,
Anatomy
resources)
PBL Tutorial (New
scenario)
P
Independent
learning (including
CAL/NLE,
histopathology
museum, anatomy
resources)
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Wednesday
Thursday
Friday
PPD
Ethics
EBM
Longitudinal
themes
Lectures
Seminars
Workshops
Demonstrations
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A taste of PBL
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Problem Based Learning Scenario
(Environmental Studies)
Rolls Royce have revealed that they have a small
nuclear reprocessing plant on their premises in
a heavily populated area of Derby. It is
similar to a plant in Japan where there was a
recent accident.
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Step
Step
Step
Step
1:
2:
3:
4:
Clarify terms and concepts
Define the problem(s)
Analyse the problem(s) - ”Brainstorm”
List of the analysis and possible
solutions
• Step 5: Formulate Learning Objectives
• Step 6: Collect additional information focussed
on Learning Objectives
• Step 7: Synthesise and present new
information
Rolls Royce have revealed that they have a nuclear
reprocessing plant on their premises in a heavily populated
area of Derby. It is similar to a plant in Japan where
there was a recent accident.
The University of Nottingham
Evidence for effectiveness
• We need to know what it is.
• What do we mean by effectiveness?
• What outcome measures should we use?
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The Evidence
Can you define/describe it?
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What sort of an educational process is it?
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How does it relate to mainstream educational
theories?
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What is the educational rationale?
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Is it Constructivist, Student Centred, Rogerian,
Kolbian, Dewian, Post-modern, Confucian?
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Is there a common underlying process?
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Is it really Question Based Learning? Problem
solving? Situation based Learning?
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How many variants of PBL are there? How are they
related?
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Evidence
How effective is it?
• What do we mean by effective in this
context?
• Can we measure its effectiveness?
• How do we measure its effectiveness?
Quantitative or Qualitative or both?
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Can you control all the variables?
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Evidence
What outcomes can be used to ‘measure’ effectiveness?
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Exam results?
Personal satisfaction? Academic achievement? Clinical
competence? Patient satisfaction?
Knowledge, Skills, Attitudes?
Communication and interpersonal skills?
Life-long learning skills?
Participation in CPD?
Must there be a control or comparative group?
Randomization?
Is the RCT the ‘gold standard’ for educational research?
Is process more important than outcomes?
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Summary of evidence
• Academic achievement:
– little significant difference
• Clinical achievement:
– PBL students have superior clinical skills
and communication skills
• Approaches to learning:
– PBL students more likely to use deep rather
than surface and more likely to engage in
self-directed learning
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Summary of Evidence
• Graduates of PBL
– More likely to engage in CPD
• Teacher & Student satisfaction
– Greater for PBL
• Costs
– More expensive with >100 students
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Problems with PBL
•Perceptions
•Training
•Dual tracking
•Coverage & ‘holes’ in knowledge
•Expert v. non-expert tutors
•Resource-intensive
•Significant start-up and maintenance costs
•Demanding of staff time
•Can be stressful for students and staff
•Need strong commitment of faculty
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My views
• It needs to be well defined, organized and integrated
into the curriculum.
• Students need to understand what it is; they need to
learn about learning.
• For most students it’s a great way to learn and they love
its collaborative and interactive nature.
• Students talk to each other for three hours a week
about the subject.
• For students and facilitators its very stimulating and
enjoyable: it’s fun!
• Graduate PBL students achieve the same knowledge
scores in clinical exams and communicate well in the
clinical environment
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A student view
“My overall experience of PBL has been a positive
one and I would argue that PBL has a lot to offer
medical students. PBL not only provided me with a
knowledge of the fundamental areas of medicine
but also made me aware of my responsibility for
my own learning, a crucial element in
itself….Working in a group allowed me to develop
my interpersonal skills as well as providing a
stimulating work environment, which is not always
achieved if spent in lectures all day.”
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References
• Foundations of Problem-based Learning (2004).
Maggi Savin-Baden & Claire Howell Major. Open
University Press.
• The challenge of Problem Based Learning (1997).
Eds: David Boud and Grahame Feletti. Kogan
Page.
• A pilot systematic review and meta-analysis on
the effectiveness of Problem Based Learning.
(2003) Mark Newman. LTSN-01 report.
(http://www.medev.ac.uk/docs/pbl_report.pdf)
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Any final questions?
The University of Nottingham
Learning Objectives
• Explain the educational rationale for PBL
• Describe the ‘seven-step’ PBL process
• Participate/Observe in a partial PBL
session
• Critically evaluate the evidence for the
effectiveness of PBL
The University of Nottingham