PROBLEM-BASED LEARNING：以问题为基础的学习

PROBLEM-BASEDLEARNINGPresentedby:Dr.SohaRashedArefMostafaProf.ofCommunityMedicineMemberofMedicalEducationDepartmentFacultyofMedicineAlexandriaUniversityEgyptTeacher-centeredStudent-centeredNew-InnovativeCurricula

TraditionalMedicalCurriculaInformationgatheringProblem-basedDiscipline-basedIntegratedHospitalbasedCommunity-basedStandardElectiveApprenticeship-basedSystematic

Continuum

SPICESSPICESwhatisit?DefinitionofPBLAninstructionalstudent-centeredapproachwhichusescarefullyconstructedclinicalproblemsasacontextforstudentsto:definetheirlearningneeds,conductself-directedenquiry,integratetheoryandpractice,andapplyknowledgeandskillstodevelopasolutiontoadefinedproblem.Thecaseservesasastimulusforlearning

WHATISPROBLEM-BASEDLEARNING,ANDHOWDOESITDIFFERFROMPROBLEMSOLVING?Problem-solvingvs.problem-basedlearning

-differentbutinter-related-Problem-solving:arrivingatdecisionsbasedonpriorknowledgeandreasoningProblem-basedlearning:theprocessofacquiringnewknowledgebasedonrecognitionofaneedtolearn(ProblemSolving)PROBLEMSOLVINGPROBLEM-BASEDLEARNINGEducationalstrategyTraditionaldiscipline-basedIntegratedsystems-basedMaincharacteristics-Thefocusisonpreparatorylearningpriortoexposuretotheproblem.-Thestaffsettheproblems(casehistoryproblemsinaprimarilylecture-basedformat),andstudentsattempttoresolvethemusingpreviouslytaughtcurricularcontent.-Theproblemcomesfirstwithoutadvancereadings,lectures,orpreparation.-Theproblemservesasastimulusfortheneedtoknow.-Basedontheirownpriorknowledgeandtheidentifiedgapsinthatknowledge,studentsdeterminethelearningissueswithintheirowngroup.Theythenidentifyanduseavarietyoflearningresourcestostudytheseissuesandreturntothegrouptodiscussandsharewhattheyhavelearned.PROBLEMSOLVINGPROBLEM-BASEDLEARNINGRoleoftheteacherContentexpertTutor/FacilitatorLearningenvironmentPassive,teacher-centeredLearningbecomesdependentupontheself-directedeffortsofthesmallgroup.Thismethodcreatesamoreactive,student-centeredlearningenvironmentWhoisresponsiblefordirectingthelearningactivitiesTeacherThestudentdecideswhathe/sheneedstolearnRationaleforintroducingPBLintotheundergraduatecurriculaTherationaleforPBLliesinitscomparabilitywithmoderneducationalprinciples.Itsapproachisbasedonprinciplesofadulteducationandself-directedlearning.PrinciplesofadultlearningAdultsaremotivatedbylearningthat:IsperceivedasrelevantIsbasedon,andbuildson,theirpreviousexperiencesIsparticipatoryandactivelyinvolvesthemIsfocusedonproblemsIsdesignedsothattheycantakeresponsibilityfortheirownlearningCanbeimmediatelyappliedinpracticeInvolvescyclesofactionandreflectionIsbasedonmutualtrustandrespectItdiffersfundamentallyfromourtraditionalcurricula,inwhichstudents:

Preclinicalphase(years1-3)acquire"background"knowledgeofthebasicsciencesClinicalphase(years4-6)applythisknowledgetothediagnosisandmanagementofclinicalproblemsThistraditionalapproachhasbeencriticisedforanumberofreasons:

ManyexistingcurriculafailtomeettheneedsofcurrentandfuturedoctorsItcreatesanartificialdividebetweenthebasicandclinicalsciencesTimeiswastedinacquiringknowledgethatissubsequentlyforgottenorfoundtobeirrelevant(Theacquisitionandretentionofinformationthathasnoapparentrelevancecanbeboringandevendemoralisingforstudents)ApplicationoftheacquiredknowledgecanbedifficultTheeducationalobjectivesofPBLaddressmanyoftheperceivedproblemsintraditionalmedicalcurriculaItspossibleadvantagesovertraditionalapproachesinclude:itsgreaterrelevancetothepracticeofmedicine,itsabilitytopromoteretentionandapplicationofknowledge,anditsencouragementofself-directedlife-longlearningCoursematerialisusuallysystems-based

IntegrationofbasicandclinicalsciencesIntegratedSystems-basedCurriculumMapExample

WhenstudyingPBLcasesrelatingtoCVS,studentslearnabout:NormalbodilystructureandfunctionTheclinicalfeatures,diagnosisandmanagementofcommonCVDsFurthermore,theylearntotakearelevantclinicalhistoryandtophysicallyexaminetheCVSKnowledgeisacquiredincontextandbuildsonwhatisalreadyknownThesefacetsaidknowledgeretention,addinterestandincreasemotivationtolearnStudentscontinuallyexploretheirknowledge,identifyboththeirpersonallearningneedsandstrategiesrequiredtoaddressthem.Thisprocesshelpstodevelopskillsforlife-longlearningEfficacyandadvantagesofPBLPBL:theclaimsandtheevidenceToomuchdebates!!

AlthoughefficacyofPBLisdifficulttoevaluate,thecurrententhusiasmforPBLseemsjustifiedanditsuseislikelytoincreasefurther.

TheplaceofPBLinthecurriculumTeacher-centeredStudent-centeredNew-InnovativeCurricula

TraditionalMedicalCurriculaInformationgatheringProblem-basedDiscipline-basedIntegratedHospitalbasedCommunity-basedStandardElectiveApprenticeship-basedSystematic

Continuum

SPICESSPICESEmphasisonPBLrangesDominanceofthecurriculumMinorsupportingroleProblem-basedlearningClinicalApprenticeshipModelTimeinthecurriculumPreclinicalphaseClinicalphaseAPBL-basedcurriculumistypicallyorganizedintoanumberofunitsbasedonbodysystems.EachunitisbasedonanumberofPBLCases(case=hypotheticalpatientwhoseproblemrequiresanalysisandresolution).HybridcurriculaInpreclinicalphase,PBLcanbedesignedandtimetabledsoastocomplementotherteachingmethodssuchas:LecturesPracticals,otherlaboratoryworkComputer-assistedlearningExampleWhilelearningaboutCVSinPBLtutorials,studentsdissecttheheartinanatomypracticals,andhavelecturesontheradiologicalfeaturesofheartdisease.THEPBLTUTORIALPROCESSThePBLprocessistightlystructuredandcontainsanumberofkeystepsThePBLtutorial:Typicallyconsistsofasmallnumberofstudents(ideallybetween6-10)IsfacilitatedbyoneormorefacultytutorswhoguidetheprocesswithoutcontributingdirectlytothesolutionoftheproblemorbeingtheprimarysourceofinformationMeetingtwotimesaweekfortwoorthreehourspersessionCompletingacaseintwoorthreesessionsKeystepsinthePBLtutorialprocessCasepresentationIdentifyingkeyinformationGeneratingandrankinghypothesesGeneratinganenquirystrategyDefininglearningobjectivesReportingbackIntegratingnewknowledgeHowdoesproblem-basedlearningwork?

Whatinstructorsdo:-Developreal-world,complexandopen-endedproblemssuchasmightbefacedintheworkplaceordailylife.-Actasfacilitators,makingsurestudentsarestayingontrackandfindingtheresourcestheyneed.-Raisequestionstostudentgroupsthatdeepentheconnectionstheymakeamongconcepts.-Strikeabalancebetweenprovidingdirectguidanceandencouragingself-directedlearning.Whatstudentsdo:-Addresstheproblem,identifyingwhattheyneedtolearninordertodevelopasolutionandwheretolookforappropriatelearningresources.-Collaboratetogatherresources,shareandsynthesizetheirfindings,andposequestionstoguidefurtherlearningtasksforthegroup.e.g.,6-weekCardiovascularUnitStudentsmightdealwith6casesin18PBLtutorialsEachcaseisdesignedandwrittenbyexpertswithspecificlearningobjectivesinminde.g.,oneoftheLOofacasedealingwithasthmamightbetostimulatestudentstolearnaboutthestructureandfunctionoftherespiratorysystem.Casesarewrittensoastoencouragestudentsthemselvestoidentifytheirownspecificlearningobjectives.Learningprocessisstudent-directed,andthetutorfunctionsmoreasafacilitator,notadidacticteacher.CasepresentationHowdoesacaseserveasastimulusforlearning?Example:

PBLtutorialprocess

1.Casepresentation:Thetutorprovidesthegroupwithsomeintroductoryclinicalinformationaboutahypotheticalpatient.

MarySmith,a28-year-oldofficeworkerandpart-timeswimminginstructor,comestoseeherGPbecauseofpaininherchestandshortnessofbreath.Thishasbeenarecurringprobleminrecentmonthsandseemstobegraduallyworse.Onthepreviousevening,whileparticipatinginaswimminggala,shebecamesoshortofbreaththatshefounditdifficulttowalk.

IdentifyingkeyinformationGeneratingandrankinghypotheses:

e.g.,Infection,cardiacproblem,allergy,asthma,brokenrib.Allergy˃cardiacproblemGenerateanenquirystrategy:

Whatadditionalinformationisrequired?

e.g.,Previousmedicalproblemsandrelevantdrug,family&psychosocialhistories,physicalexam,lab.tests.discuss,extract,identify,summarizebrainstormdecideAdditionalinformation

FurtherdiscussionwithherGPrevealsthatMsSmith’schestpainandshortnessofbreathcomeonfollowingexercise,particularlyinacoldenvironment.Whenshebecomesparticularlyshortofbreath,shestartstowheeze.Shesometimeshasadrycoughandhasneverhadhaemoptysis.Thereisnorecenthistoryofphysicaltraumaandnopersonalorfamilyhistoryofheartdisease.Shehadeczemainchildhoodbuthasneverhadasthma.Shehassmokedforthepast5yearsandincreasedhersmokingto40cigarettesadaysinceshebrokeupwithherintimatefriend3monthsago.Shetakesanoralcontraceptivepillbutnoothermedication.NewinformationRevisingtheirhypothesesDiscard/Re-rank/OtherhypothesesAnxietyattackswithhyperventilationPossiblethromboembolicdiseaseduetooralcontraceptiveuseAsthmaCardiacproblemBrokenrib5.DefininglearningobjectivesOncethestudentshavedecidedonapreferredhypothesis(e.g.,allergy),theymustexplainthebiomedicalsciencemechanismsthatlinktheirhypothesistothepresentingproblems.Whatstudentsknow?Whattheydonotknow?Whattheyneedtoknow?tofurthertheirunderstandingoftheunderlyingmechanisms,andtheirabilitytosolvetheclinicalproblem.e.g.,Studentsmayidentifygapsintheirknowledgeofthemechanicsofbreathing,anatomyofairways,mechanismsofoxygendeliverytotissues,ormechanismsofpainperception.5.Defining

learningobjectives(cont.)Theidentificationofgapsinknowledgehelpsstudentstodefinetheirlearningobjectivesandthesebecomethefocusofself-directedstudyintheintervalbetweentutorials.Learningobjectivesshouldbeclearandspecificandofappropriatescopetobeaddressedinthetimeavailablebetweentutorials(typically2-3days).Ateachtutorial,thegroupmightidentifythreetofivemajorlearningobjectivesandperhapsanequalnumberoflesserobjectives.5.Defining

learningobjectives(cont.)AlthoughthePBLtutorialisstudent-centered,majorlearningobjectivesareidentifiedinadvancebythecasewritersaspartoftheoverallcurriculumdesign.Tutorsmayneedtoprovidepromptstoensurethatmajorobjectivesareidentifiedandpursued.InPBL,asknowledgeisacquiredinthecontextofaspecificclinicalproblem(theproblemisencounteredbeforethestudenthastheknowledgetounderstandit),itislikelytobebetterfocusedandretained.6.ReportingbackInthefollow-uptutorial,studentsreconvenetoreportontheirself-directedstudyandshareandintegratenewknowledge.Allstudentsshouldcontributetothereport-backandtheiruniqueperspectivesareincorporatedintotheprocessofknowledgebuilding.Theexchangeanddebateofideaspromotestheconsolidationandelaborationofnewknowledgeandunderstanding7.Integratingnewknowledge

Basedontheprinciplethatknowledgeisconsolidatedmorereadilyincontext,students,guidedbythetutor/facilitator,shouldrelatenewbiomedicalknowledgetothepatient'sproblem.

Studentsarerequiredalsotoextendtheirdiscussionbeyondthebiomedicalandclinicalsciencesandconsiderthepublichealth,socioeconomic,ethicalandlegalaspectsofthecase.

HowdoIgetstartedwithPBL?

Developproblemsthat:-Capturestudents’interestbyrelatingtoreal-worldissues.-Drawonstudents’previouslearningandexperience.-Integratecontentobjectiveswithproblem-solvingskills.-Requireacooperative,multi-stagedmethodtosolve.-Necessitatethatstudentsdosomeindependentresearchtogatherallinformationrelevanttotheproblem.Designassessmenttoolsthat:-Accountforprocess(e.g.research,collaboration)aswellascontentskills.-Arecloselytiedtocourselearningobjectives.-Balanceindividualandgroupperformance.HowtocreateeffectivePBLscenarios

LearningobjectiveslikelytobedefinedbythestudentsafterstudyingthescenarioshouldbeconsistentwiththefacultylearningobjectivesProblemsshouldbeappropriatetothestageofthecurriculumandthelevelofthestudents'understandingScenariosshouldhavesufficientintrinsicinterestforthestudentsorrelevancetofuturepracticeBasicscienceshouldbepresentedinthecontextofaclinicalscenariotoencourageintegrationofknowledgeScenariosshouldcontaincuestostim