Marion Webb January 2015 By the end of the session, participants will have Critically considered what problem based learning is and how it can be used in the classroom Considered how PBL activities relate to assessment Designed a PBL activity for use in their own teaching context PBL is a student-centred approach to learning that encourages students to be self-directed, interdependent and independent as they attempt to solve the set problem. Both a teaching method and an approach to the curriculum To encourage students to develop skills in accessing, interpreting and evaluating information To allow students to make connections between their academic work and their own lives A problem-based learning environment emulates the workplace and develops selfdirected learners. This is preferable to a mimetic learning environment in which students only watch, memorize, and repeat what they have been told. OMMUNDSEN Medical education at McMaster University Learning through problem solving more effective for crating a body of knowledge usable in the future Problem solving skills more important than memory skills The learning which results from the process of working towards the understanding of, or resolution of, a problem Barrowsand Tamblyn 1980 Problem based learning: an approach to Medical Education students engage in a collaborative activity that: 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 The problem is raised at the start of the topic before the students have been taught some of the relevant information Facilitator introduces an “ill structured problem” List what is known Includes content and knowledge of others’ strengths and capabilities Writing out the problem statement Listing possible solutions List actions to be taken: what do we need to be know? What do we need to do The Maastricht ‘Seven Step’ PBL process • • • • 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 List actions to be taken Research Possible resources Assign tasks "How to make a DENT in a problem: Define, Explore, Narrow, Test." A 28-year-old man appears to have osteoporosis Groups brainstorm possible causes: osteoblasts, diet, vitamin D, parathyroid hormone, growth hormone, calcitonin, kidney function, Each group ranks its hypotheses in order of priority and prepares requests for more data. (E.g., for calcium deficiency hypothesis -"What did he usually eat?") Student suggestions may include Low calcium diet Immobility Low density of vitamin D receptors Calcitonin deficiency Excessive PTH Chronic acidosis buffered by salts mobilized from bone The students could now be told that the man's lumbar spine density is 3.1 standard deviations below the average age-matched healthy female (osteoporosis = 2.5+ SD), his height is 204 cm, his left middle finger is 10 cm, and knee films show open epiphyses. (The students should now be able to figure out that the man may still be growing at age 28). A Case of a Confused Person A 58-year-old woman experienced attacks of confusion: she would repeat the same question 30 times even though it was answered for her each time. [New England Journal of Medicine 315:1209-19.] This is a good introductory case, as the students are able to generate a wide range of ideas: Alzheimer's Disease, trauma, alcohol abuse, atherosclerosis, arrhythmia, hypotension, cancer, epilepsy, diabetes, hypocalcemia, emphysema, dehydration, hypoglcemia, stroke, etc. Students will ask the circumstances of the woman's attacks (e.g., "Following alcohol consumption?") When the students learn that the attacks occurred in the late afternoon, they will likely focus on diet and blood sugar. The student groups can now brainstorm and investigate possible causes of the low blood glucose: glucagon deficiency, insulin poisoning, anorexia nervosa, extreme exercise, etc. They may ask for an x-ray image of her abdomen. The students can be assisted in identifying the anatomy, including an abnormal mass in the pancreas (an insulin-secreting tumour) 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 Xray. 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. Learning Objectives for the PBL scenario Community and population •Describe the epidemiology of TB, the impact of socio-economic factors and its relation to HIV. •Discuss the social and family issues associated with TB in the community. 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. 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 • • • • • • • • • • Loss of teacher control-teacher becomes the facilitator Resources Loss of content Learning on-line Perceptions Training 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 Group/individual presentation Case based individual essay Case based clinical care plan Portfolio Self-assessment Peer assessment Viva Reflective journal (online) Facilitator assessment Report Patchwork text Mind map 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. 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. Design a PBL scenario that you could use in your own teaching Graduates of PBL ◦ More likely to engage in CPD Teacher & Student satisfaction ◦ Greater for PBL Costs ◦ More expensive with >100 students Savery, J. ‘Overview of Problem-based Learning: definitions and Distinctions’ The Interdisciplinary Journal of Problem- based Learning • volume 1, no. 1 (Spring 2006); 9-20 Maggi Savin-Baden & Claire Howell Major(2004). Foundations of Problem-based Learning Open University Press. David Boud and Grahame Feletti Eds 1997. The challenge of Problem Based Learning Kogan Page Open University Press.