Problem-based learning

Dr. Kieran Walsh, Editor, BMJ Learning.

Problem-based learning
Still a hot topic

Much debate
Become widespread

Problem-based learning what is it

Learning in context of a problem Student-driven Student generates issues, finds answers, shares answers Active learning Group process Facilitated > taught

Problem-based learning why?

Help the student Acquire necessary knowledge and skills Learn how to apply this Become a life long learner

Problem-based learning what is it

The curriculum Worked example

Problem-based learning Session 1

40 year old man with jaundice. Took 40 paracetamol tablets 72 hours ago. History of asthma. Says he wants to die. Doesnt want any treatment. How will you deal with the issues that he presents?

Problem-based learning Session 1

Talk through scenario, understand it, decide on the problems Define/analyse the problems Brainstorming Prioritise the problems, restructure Decide on learning objectives Every member has a task private study

Problem-based learning Session 2

Feedback on what they have discovered Everyone contributes Reflection

Problem-based learning what is a good problem?

Realistic, common, important Sufficiently open Complexity a number of components Maybe a problem that actually happened and that was poorly managed

Problem-based learning what is a good trigger?

Clinical scenarios on paper Laboratory data Photograph Video Real/simulated patient

Problem-based learning - benefits

Natural Motivational Learn applied knowledge Encourages preparation and homework Team based Searching skills Critical thinking and clinical reasoning Close, more equal student-faculty relationship Enjoyable Presentational skills

PBL the problems with PBL

Cost Time Workload Tutor quality Unscheduled time Students with no supervision .. The tutor takes over

One faculty member for each group of students!

PBL the problems with PBL

One of the hardest things about running a problem-based learning curriculum is making sure that what is happening is actually PBL. David Taylor

Problem based learning is successful only if the scenarios are of high quality. Diana Wood

PBL the problem with tutors

Need a facilitator > tutor Problem first > subject first Encouragement, guidance Dont solve the problem, dont even hint at the solution, dont even even tell them the problem Not necessarily a subject expert It wasnt like this in my day Hospital super-specialists can feel uncomfortable These are all difficult concepts for traditional medical teachers

PBL the problem with students

Products of didactic secondary schools Lost Not consulted in curriculum change Teach yourself medicine Gaps in knowledge

Whilst medical educators wish to develop critical thinkers and lifelong learners, the early years of PBL cause much anxiety amongst young learners, many who enter directly from school. Michelle McLean

PBL the problem with cost

Cost depends on

Group size (6-8) Number of groups Number of hours of facilitation per week

PBL the problem with studies of its effectiveness

What does effective mean? Is what is being studied actually PBL? Confounding What outcomes are we looking at?

Good evidence for enjoyment and enthusiasm Apart from that PBL graduates are indistinguishable from their traditional counterparts

PBL the problem with studies of its effectiveness

Most attempts at longitudinal, controlled intervention studies in PBL have been overtaken by events. Brian Jolly Deciding whether problem based learning produces better doctors requires, at least, clear consensus on what constitutes a better doctor. Lambert Schuwirth and Peter Cantillon

Problem-based learning - assessment

Assessment drives learning Miller

If just factual recall, little motivation for PBL Assessment should be blueprinted to the learning outcomes

PBL strategies to introduce

Preclinical clinical OR not Established school/new school Introduce PBL year by year or all at once Introduce PBL dept by dept or all at once

Change management

Problem-based learning mixing it with other methods

Simulation/simulated patients

Interprofessional education should the group include nurses/AHPs?

E-learning

Problem-based learning
Doesnt suit everything

E.g. learning resuscitation skills

Problem-based learning last word?

PBL should be regarded as a tool, a means, and not as an end. Shimon Glick

Problem-based learning - references

Donner RS, Bickley H. Problem-based learning in American medical education: an overview. Bull Med Libr Assoc. 1993 Jul;81(3):294-8. Wood DF. Problem based learning. BMJ. 2003 Feb 8;326(7384):328-30. Kilroy DA. Problem based learning. Emerg Med J. 2004 Jul;21(4):411-3. Walton HJ, Matthews MB. Essentials of problem-based learning. Med Educ. 1989 Nov;23(6):542-58. Mellon AF, Mellon J. Logical debate on problem based learning. BMJ. 2006 Mar 4;332(7540):550-1. Wood DF. Problem based learning. BMJ. 2008 May 3;336(7651):971.