[Problem-based learning for surgery. Increased motivation with less teaching personnel?]

The effectiveness of problem-based learning compared with lecture-based learning in surgical education: a systematic review and meta-analysis

BACKGROUND

This meta-analysis was conducted to systematically evaluate the impact of problem-based learning (PBL) and lecture-based learning (LBL) teaching models on students' learning in surgical education.

METHODS

We systematically searched the publications related to the application of PBL and LBL in surgical courses in PubMed, Embase, Web of Science and Cochrane Library databases, the last retrieval time is September 20, 2022. After screening the literature according to the inclusion and exclusion criteria, extracting data and evaluating the methodological treatment of the included studies, Stata 17.0 software was used to perform meta-analysis.

RESULTS

Nine studies were included totally. The results showed that compared with LBL, PBL was superior in clinical competence (SMD = 0.81, 95% CI: 0.12 ~ 1.49, P = 0.020) and student satisfaction (SMD = 2.13, 95% CI: 1.11 ~ 3.15, P < 0.0001) with significant differences. But the comprehensive scores (SMD = 0.26, 95% CI: -0.37 ~ 0.89, P = 0.421) and theoretical knowledge (SMD=-0.19, 95% CI: -0.71 ~ 0.33, P = 0.482) to PBL and LBL had no significant difference.

CONCLUSION

This study showed that the PBL teaching model is more effective than the LBL teaching model in surgical education on the aspects of enhancing clinical competence and student satisfaction. However, further well-designed studies are needed to confirm our findings.

Cross-sectional study of the quality of randomized control trials on problem-based learning in medical education

Problem-based learning (PBL) is increasingly being used in medical education globally, but its effectiveness in teaching remains controversial. A randomized controlled trial (RCT) is the method of choice for evaluating its effectiveness. The quality of an RCT has a significant effect on this evaluation, but to date we have not seen an assessment of the quality of RCTs for PBL. Two researchers searched MEDLINE and EMBASE for RCTs addressing PBL in medical education. The overall quality of each report was measured on a 28-point overall quality score (OQS) based on the 2010 revised Comprehensive Standards for Reporting and Testing (CONSORT) Statement. Furthermore, to study the key factors affecting OQS more effectively, a linear regression model of those factors was established using SPSS. After literature screening, 30 RCTs were eventually included and analyzed. The median OQS was 15 (range, 7-20), which meant that half of the items in the revised 2010 CONSORT statement were poorly reported in at least 40% of the RCTs analyzed. The regression model showed that the year of publication of RCTs and the impact factors of the journals in which they were published were the main factors affecting OQS. The overall quality of reporting of RCTs on PBL teaching in medical education was not satisfactory. Some RCTs were subjectively selective in reporting certain items, leading to heterogeneity in quality. It is expected that statisticians will develop new standards more suitable for evaluating RCTs related to teaching research and that editors and peer reviewers will be required to review the relevant RCTs more strictly.

[Specifics of teaching in vascular surgery in an interdisciplinary surgical setting]

Ziel

Es sollen die komplexen Veränderungen in der gefäßchirurgischen Lehre, Gemeinsamkeiten/Unterschiede zur Allgemeinchirurgie, Spezifika der Lehre/Lehrinhalte sowie deren universitäre Voraussetzungen umrissen werden.

Methode

Kompakte narrative Kurzübersicht.

Ergebnisse

Der gefäßchirurgische Anteil an den chirurgischen Vorlesungen im Universitätsklinikum Magdeburg A.ö.R. umfasst 10 akademische Lehrstunden und beinhaltet die Themen: pAVK, Embolie/Thrombose, Gefäßverletzung, Kompartmentsyndrom, Mesenterialischämie, Aorten‑/Aneurysma- und venöse Chirurgie. Damit liegt die hiesige gefäßchirurgische Lehre deutlich über dem Durchschnitt von 6,1 akademischen Lehrstunden in Deutschland. Die Stärke der (gefäß‑)chirurgischen Ausbildung liegt insbesondere darin, dass der Erkenntnisgewinn am Krankenbett anschließend im Operationssaal insbesondere an visuelle Eindrücke mit simultaner Erklärung gekoppelt werden kann. Eine enge Einbindung der/s Studierenden ins Team ist die hohe Kunst, um die Akzeptanz der (Gefäß‑)Chirurgie als Beruf und Berufung zu fördern. Voraussetzung für eine erfolgreiche Lehre ist ein didaktisch kompetenter Lehrender mit fachlicher Expertise, proaktiver Lehreinstellung, Kenntnissen der speziellen Lernziele, des Curriculums, modernen Lehrmethoden und Bewusstsein für die besondere Vorbildfunktion für Studierende. Die berechtigte und zu stärkende klassische Lehre mittels Vorlesung, Seminar, Praktikum und Lehrbuch wird zunehmend durch Nutzung von internetbasierten Lernplattformen, Bibliotheken und Videoportalen ergänzt.

Zusammenfassung

Die gefäßchirurgische Lehre wird sich in den nächsten Jahren multimodal/-medial mit mehr praxisorientierten Anteilen und intensiver Integration der Studierenden in den Klinikalltag verlagern (müssen).

The Berlin reformed curriculum in undergraduate medical education: a retrospective of the development history, principles, and termination

The Reformed Medical Curriculum (RMC) at Charité-Universitätsmedizin Berlin was launched in autumn 1999, while medical schools in Canada, the United States, Scotland, the Netherlands, and Scandinavia already had adapted educational reforms in medical education many years before [1], [2]. For eleven years, 63 medical students per year trained at the Faculty in accordance with international standards governing the RMC. It was the first and perhaps most revolutionary reformed medical curriculum at a German university after the commencement of "Modellklausel", a new section in the Licensing Regulations for Doctors (Approbationsordnung für Ärztinnen und Ärzte) in 1999 that paved the way for fundamental reforms within undergraduate medical education in Germany. The idea was to establish and test a "pilot project of a fundamental reform of medical education in Germany" [3], thus aligning Germany with international developments and establishing a model for other reform initiatives. The first part of the article will provide an overview of how the RMC were able to emerge. It reports who initiated the project and why, who kept it running and encountered opposition and what were the social and political conditions. The second part of the article describes the principles that were fundamental for the development of the RMC. The third part illustrates the quality assurance measures, and the final section covers the termination of the RMC.

[Patient Motivation to Participate in Medical Education]

BACKGROUND

Student education focuses increasingly on case-related teaching. Often the consent of the patient to participate in student education is supposed to be provided. In most instances this is taken for granted - which it is not. Here, we investigated the motivation of the patients to participate in student education and influence factors using an anonymised survey.

MATERIAL AND METHODS

The survey was performed from 2017/01/01 until 2017/04/30 and recruited inpatients of a university department of trauma surgery. The questionnaire contained 10 multiple choice questions targeting socio-demographic factors and the motivation of the patients to participate in different aspects of medical education. This was captured using a 5-point Likert scale. The electronic analysis of the questionnaire was performed with the program KLAUS (Blubbsoft GmbH, Berlin, Germany) after digitalizing the data.

RESULTS

In total 162 questionnaires were analysed. The patients were generally highly motivated to participate in bedside teaching and a student examination as well as consenting to the collection of pictures, videos and X-ray images or subsequent contact. Patient satisfaction was a principle factor. There was a positive correlation between the satisfaction with the motivation to participate in bedside teaching and a student examination as well as giving consent to the collection of pictures, videos and X-ray images or subsequent contact. There was significantly decreased motivation for participation in a lecture. In comparison, male patients had greater motivation to participate in a lecture. Moreover 40- to 49-year-old patients were significantly less motivated to participate in a lecture than 20- to 29-year-old and 50- to 59-year-old patients. Patient satisfaction had no influence on motivation to participate in a lecture.

CONCLUSION

The motivation of the patients to participate in bedside teaching and a student examination as well as giving consent to the collection of pictures, videos and X-ray images or subsequent contact correlated with patient satisfaction. Socio-demographic factors are less important. Patient motivation to participate in a lecture is lower regardless of patient satisfaction.

Student evaluation of problem-based learning in a dental orthodontic curriculum--a pilot study

OBJECTIVE

The present questionnaire survey investigated student reception of problem-based learning (PBL) in the orthodontic curriculum with regard to acceptance, sense of purpose and motivation, knowledge and understanding, as well as tutorial support.

METHODS

Over a period of two terms, we compared two different didactic methods (PBL and short presentations) by randomizing the participants of a course on orthodontic diagnostics into two different groups, who inversed methods after the first term.

RESULTS

The two student groups did not show any significant differences with regard to assessments or examination performance. Therefore, acceptance of the PBL concept seems to be mainly associated with the motivation of individuals to use this method. The higher the motivation, the more positive is the attitude towards the PBL concept. Students seem to work more constructively and efficiently with PBL if they can judge the concept meaningful for themselves.

CONCLUSION

In consideration of the relevant literature and the present results, PBL can be principally integrated into the dental curriculum as a method of learning. However, student motivation is vital to learning success.

A Model for Persistent Improvement of Medical Education as Illustrated by the Surgical Reform Curriculum HeiCuMed

BACKGROUND

Heidelberg Medical School underwent a major curricular change with the implementation of the reform curriculum HeiCuMed (Heidelberg Curriculum Medicinale) in October 2001. It is based on rotational modules with daily cycles of interactive, case-based small-group seminars, PBL tutorials and training of sensomotor and communication skills. For surgical undergraduate training an organisational structure was developed that ensures continuity of medical teachers for student groups and enables their unimpaired engagement for defined periods of time while accounting for the daily clinical routine in a large surgery department of a university hospital. It includes obligatory didactic training, standardising teaching material on the basis of learning objectives and releasing teaching doctors from clinical duties for the duration of a module.

OBJECTIVE

To compare the effectiveness of the undergraduate surgical reform curriculum with that of the preceding traditional one as reflected by students' evaluations.

METHOD

The present work analyses student evaluations of the undergraduate surgical training between 1999 and 2008 including three cohorts (~360 students each) in the traditional curriculum and 13 cohorts (~150 students each) in the reform curriculum.

RESULTS

The evaluation of the courses, their organisation, the teaching quality, and the subjective learning was significantly better in HeiCuMed than in the preceding traditional curriculum over the whole study period.

CONCLUSION

A medical curriculum based on the implementation of interactive didactical methods is more important to successful teaching and the subjective gain of knowledge than knowledge transfer by traditional classroom teaching. The organisational strategy adopted in the surgical training of HeiCuMed has been successful in enabling the maintenance of a complex modern curriculum on a continuously high level within the framework of a busy surgical environment.