Recruiting problem-based learning (PBL) tutors for a PBL-based curriculum: the Flinders University experience

Attractions and barriers to Australian physician-researcher careers

BACKGROUND

There is a global concern that physician-researchers are 'a dying breed'. Recent studies of clinical career choices of Australian medical students and doctors have signalled the rising age of medical graduates, generational shifts in work-life attitudes and increased proportion of female graduates. There are scant data regarding Australian physician-researchers.

AIMS

To develop and utilise a questionnaire determining respondent characteristics and 'push' and 'pull' factors for medical graduates to incorporate research into their careers.

METHODS

We developed and administered an 88-item online survey, including quantitative and qualitative questions, to medical students, faculty and alumni of Sydney Medical School, The University of Sydney, asking about their medical career, research experience and interest and reasons for doing or not doing medical research. Responses to all 74 quantitative questions are reported here.

RESULTS

Data from 427 respondents (44% female; mean ± standard deviation age 38 ± 13 years; 56% completed or undertaking a PhD) were analysed. Attractions of research included a desire to improve human health, intellectual stimulation and career diversity. Barriers included low funding rates, job insecurity and low salaries. Although few were prepared to undertake or recommend full-time research, 71% would recommend part-time research. Respondents perceived a smaller-than-actual gap between clinical and research salaries, and if comparable (75-100% of a clinician's) salaries were available, 89% would like to spend 21-60% of their work time undertaking research.

CONCLUSION

Many Australian medical students and doctors are interested in research, especially part time. Perceived obstacles include job insecurity, low funding rates and salary. Respondents underestimated clinical and research salary differences.

What can we learn from problem-based learning tutors at a graduate entry medical school? A mixed method approach

Problem-based learning (PBL) has been adopted by many medical schools as an innovative method to deliver an integrated medical curriculum since its inception at McMaster University (Dornan et al., Med Educ 39(2):163-170, 2005; Finucane et al., Med Educ 35(1):56-61, 2001; Barrows, Tutorials in problem-based learning: A new direction in teaching the health professions, 1984). The student experience in PBL has been explored in detail (Merriam, New Directions for Adult and Continuing Education 89: 3-13, 2001; Azer, Kaohsiung J Med Sci 25(5): 240-249, 2009; Boelens et al., BMC Med Ed 15(1): 84, 2015; Dolmans et al., Med Teach 24(2):173-180, 2002; Lee et al., Med Teach 35(2): e935-e942, 2013) but the tutors who facilitate PBL have valuable insight into how PBL functions and this aspect has not been extensively researched. The integrated curriculum for years 1 and 2 at the Graduate Entry Medical School at the University of Limerick is delivered though problem-based learning (PBL). This programme requires collaborative teamwork between students and the tutors who facilitate small-group tutorial sessions. All PBL tutors at GEMS are medically qualified, with the majority (68%) currently working in clinical practice.

METHODS

A mixed-methods approach was adopted, utilising two surveys and follow-up focus groups to fully understand the tutor experience. Thirty-three tutors took part in two online surveys with a response rate of 89%. Thirteen tutors participated in two focus groups. Descriptive analysis was completed on survey data and thematic analysis on focus group discussions which highlighted five main themes.

RESULTS

Tutors reported challenges with managing group dynamics, development of confidence in tutoring with experience and a willingness to learn from peers to improve practice. Findings are in keeping with previously published work. Results also identified several less commonly discussed issues impacting student engagement in PBL including the use of mobile device technology, unauthorised access to learning objectives and PBL cases, and the importance and need for professional development amongst tutors, including the impact of tutoring on clinical practice. This study revealed that experienced tutors spend considerable time preparing for PBL tutorials in the basic sciences and that this input is rewarded by the benefits it brings to their clinical practice.

CONCLUSIONS

Understanding PBL from the tutor's perspective reveals valuable insights which can inform ongoing tutor development and support. Limited research exists in the area of PBL tutor's experiences which may be of interest to medical educators, clinicians and the wider medical community. Findings highlight the value of shared tutor experiences as a resource that can be capitalised on to benefit both novice and experienced tutors.

Update on research and application of problem-based learning in medical science education

Problem-based learning (PBL) is a unique form of pedagogy dedicated to developing students' self-learning and clinical practice skills. After several decades of development, although applications vary, PBL has been recognized all over the world and implemented by many medical schools. This review summarizes and updates the application and study of PBL in medical education through the literature published between 1993 and early 2017. It focuses on understanding real medical PBL courses and ways to improve PBL to achieve better learning outcomes. PBL aims to develop lifelong skills to solve practical problems rather than limiting learning to theoretical knowledge. To achieve this goal, strict and reasonable procedures need to be designed and implemented. Rigorous monitoring and timely feedback and evaluation are indispensable to constant improvements and perfecting of the process. © 2017 by The International Union of Biochemistry and Molecular Biology, 46(2):186-194, 2018.

Cracks in problem-based learning: what is your action plan?

BACKGROUND

Problem-based learning (PBL) as an educational approach has been adopted by medical and health sciences faculties worldwide. Successful implementation of these curricula may, however, end a few years later with several problems reflecting cracks in curriculum maintenance.

AIMS

The aim of this article is to discuss these problems, their possible causes and what action can be taken to maintain effective curriculum delivery.

METHODS

We reviewed the current literature, recent Association for Medical Education in Europe conferences' sessions on PBL, explored curriculum design approaches and problems (cracks) identified in PBL programs that may occur a few years after successful implementation. We have also reflected on our collective experience in a number of universities to develop these tips.

RESULTS

Incorporating the methods described, we have developed the following 12 tips: (1) Pay attention to training new staff for PBL, (2) Maintain the briefing/debriefing sessions, (3) Review the PBL material and program in light of the previous year's feedback, (4) Monitor the delivery of the program, (5) Review management of the PBL program, (6) Encourage research and publications in PBL, (7) Ensure that assessment reflects PBL principles, (8) Refrain from adding new lectures to the timetable, (9) Reward contributions to on-going curriculum maintenance, (10) Provide on-going and advanced professional development tutor training, (11) Make explicit (and develop) students' skills required for PBL and (12) Attend to conflict and group dysfunction.

CONCLUSIONS

Being vigilant of possible cracks (erosion) in the PBL curriculum that may occur a few years after successful implementation is mandatory. Erosion of PBL can be minimized or avoided if these tips can be applied.

Perceptions of job satisfaction relating to affective organisation commitment

OBJECTIVES

Affective organisation commitment, which refers to a psychological attachment to, and involvement with, an employing institution, is regarded as important because of its effects on employee identification with the employer and its causal effects on work effort and staff retention. This paper explores the experiences of casual tutors facilitating problem-based learning (PBL) tutorials and aims to identify aspects of their role that strengthen and detract from employee job satisfaction and affective commitment.

METHODS

Qualitative data were gathered from first- and second-year tutors (N = 13) through 2 focus groups. Both clinicians and non-clinicians were recruited, including highly experienced staff and those with < 12 months of tutoring experience.

RESULTS

Four main themes arose from inductive analysis of data: job-related factors; job-involvement characteristics; professional challenges and responsibilities, and mentoring for learning and support. The first 2 themes are congruent with previous literature on organisation commitment; novel findings include the supportive and compensatory nature of the collegial relationships formed between casual tutors. Role attenuation, a job-related factor, was a predominant perception as it related to dysfunctional groups and increasing student disengagement with PBL.

CONCLUSIONS

Within the unique learning environment of PBL, positive factors relating to job satisfaction may have an important role to play in improving tutors' commitment to their employing organisation. Aspects of the role which are viewed most negatively and relate most significantly to affective commitment need to be addressed promptly. Attention should be directed to supporting tutors to maximise the perceived benefits and providing professional development and improved communication to better address issues associated with difficult or disengaged students as well as isolation from decision-makers.

The first attempt at initiating problem-based learning as a method of teaching-learning at the University of Medical Sciences in Poznan, Poland

The main objective of problem-based learning (PBL) is to provoke students to solve a new problem by themselves. The aim of this study was to investigate whether PBL was a better method of teaching basic and advanced life support to medical students compared with the classical method. The research was undertaken in 2002 in accordance with the European Guidelines 2000 and involved 36 medical students in year 4. The students were divided into two groups: experimental PBL group (17 students) and the control-classical method group (19 students). After the advanced life support course, the students wrote two tests to assess their knowledge on how to open the airway and how to perform basic and advanced resuscitation. The questions contained true or false answers. The students' skills of basic and advanced methods of opening the airway and advanced resuscitation were checked by practical tests. The Mann-Whitney test was used for statistical analysis. The experimental PBL group received significantly better results: 30-45 points (mean, 38.29 points) and 30-47 points (mean, 40.94 points) for the written and practical tests, respectively, compared with the control-classical group (22-34 points [mean, 29.36 points] and 22-35 points [mean, 28.63 points], respectively). Therefore, PBL offers a better method for teaching basic and advanced life support to medical students compared with the classical method.

The financial costs of delivering problem-based learning in a new, graduate-entry medical programme

CONTEXT

In discussions of the merits and limitations of problem-based learning (PBL) as an educational methodology, the cost of its delivery is often cited as a significant issue. Although there appears to be no shortage of opinion as to the perceived cost of PBL, we know of no institution that has accurately measured its cost, even in financial terms. Where factual information is lacking, opinion and misconception tend to proliferate. In setting up a new, graduate-entry medical programme on a greenfield site at the University of Limerick, we took the opportunity to calculate both the initial and recurring costs of our particular approach to the delivery of PBL.

METHODS

We calculated the initial cost of providing purpose-built facilities to deliver PBL to 240 students in the first 2 years of our 4-year programme. We also calculated the annual recurring costs of delivering PBL, based on having a student : tutor ratio of 8 : 1 and on having tutors who are all medically qualified, who are reasonably well remunerated for their work and who each deliver 5 hours of PBL tutoring per week.

RESULTS

The initial cost of delivering PBL was calculated as euro 1,526,952 (equivalent to pound sterling 1,369,138 or US$2,050,375). The annual recurring cost of PBL approximates euro 664,000/year (at time of writing equivalent to pound sterling 527,000 and US$988,000). This recurring cost equates to euro 2767/student/year, 89% of which relates to tutor salaries.

CONCLUSIONS

Although the cost of delivering PBL will be greatly influenced by the approach taken at different institutions, we hope that a breakdown of costs at our institution will contribute to the ongoing debate on the strengths and weaknesses of PBL.

Challenges facing PBL tutors: 12 tips for successful group facilitation

One of the main tasks of a problem-based learning (PBL) tutor is to facilitate group discussion. Group facilitation is about process rather than content. In this process, a tutor helps the group increase their skills and progress in their discussion. Several studies have highlighted strategies and training used in preparing PBL tutors. However, PBL tutors usually feel that it is not that easy to change their teaching style to the PBL format. They are sometimes unsure about their role or what strategy they might use to facilitate their students' discussion. This article in the '12 Tips' series is a detailed description of, and provides answers to, common challenges faced by PBL tutors. The tips provided in this manuscript should help tutors with practical answers. The article may be useful to PBL tutors, medical and health educators and those responsible for PBL training workshops.

Cohort study of examination performance of undergraduate medical students learning in community settings

OBJECTIVES

To determine whether moving clinical medical education out of the tertiary hospital into a community setting compromises academic standards.

DESIGN

Cohort study.

SETTING

Flinders University four year graduate entry medical course. In their third year, students are able to choose to study at the tertiary teaching hospital in Adelaide, in rural general practices, or at Royal Darwin Hospital, a regional secondary referral hospital.

PARTICIPANTS

All 371 medical students who did their year 3 study from 1998-2002.

MAIN OUTCOME MEASURES

Mean student examination score (%) at the end of year 3.

RESULTS

The unadjusted mean year 3 scores at each location differed significantly (P < 0.001); the mean score was 65.2 (SE = 0.43) for Adelaide students, 68.2 (0.83) for Darwin students, and 69.3 (0.97) for students on the rural programme. Mean year 2 scores were similar for each location. Post hoc tests of means adjusted for sex, age, year 2 score, and cohort year showed that the rural and Darwin groups had a significantly improved score in year 3 compared with the Adelaide group (adjusted mean difference = 3.08, 95% confidence interval 1.25 to 4.90, P < 0.001 for rural group; 1.91, 0.47 to 3.36, P = 0.001 for Darwin group).

CONCLUSIONS

These findings show that the concern that student academic performance in the tertiary hospital would be better than that of students in the regional hospital and community settings is not justified. This challenges the orthodoxy of a tertiary hospital education being the gold standard for undergraduate medical students.

Radiologists as clinical tutors in a problem-based medical school curriculum

RATIONALE AND OBJECTIVES

The authors sought to evaluate the experience of radiologists teaching in a problem-based pre-clinical medical school curriculum.

MATERIALS AND METHODS

The undergraduate medical school curriculum at Wake Forest University includes 2 problem-based preclinical years that integrate basic and clinical sciences. Sixteen radiology fellows served as general clinical tutors for 5-9 weeks, each guiding the work of six 2nd-year students, often in tandem with a basic science tutor. On completion of the tutoring. the radiologists and the students were surveyed by means of a questionnaire. A follow-up group interview was conducted with the radiologists.

RESULTS

The response rate to the questionnaire was 81% for the radiologists and 47% for the students. On average, radiologists spent 6.1 hours weekly on preparation and tutoring and 3.5 hours in total on administration and grading. All radiologists thought tutoring was rewarding, but seven of the 13 respondents (54%) disliked assigning grades. Radiologists spent less time teaching radiology residents and performing research, but few thought their clinical work was adversely affected. Nearly half of the radiologist-tutors thought that the preliminary orientation and training provided to them by the medical school was not adequate, and nearly all of them thought that they could have been better prepared. All of the medical students improved their perceptions of radiologists after having had a radiologist as a tutor, and most thought that the radiologist-tutors performed as well as or better than tutors from other disciplines.

CONCLUSION

Radiologists can be successful as general tutors in a problem-based medical school curriculum. benefiting both radiologists and students. Better orientation and training by the medical school would improve the program.