The process of problem-based learning: what works and why

Exploring Instructor-Led Team Formation and Task Assignment to Enhance Group Dynamics in Pharmacy Problem-Based Learning

OBJECTIVE

This study investigates how different team grouping methods and task assignments affect group dynamics, specifically focusing on the presence of free riders and active learners (students who fully engage and contribute to the group).

METHODS

This study was conducted in 2020 as part of a problem-based learning program in physical chemistry and pharmaceutics. A total of 255 second-year students were randomly assigned to 1 of 3 groups: (1) motivation-based, (2) grade-based, and (3) random. They were then divided into teams based on career prospects, academic performance, radom assignment. Data were collected using postprogram questionnaires which included demographic information, learning behaviors, and peer evaluations. Statistical analyses, including χ2 tests and analysis of variance, were used to compare group dynamics and learner characteristics. Qualitative comments on team performance were analyzed through coding and categorization.

RESULTS

The grade-based group had the highest number of free riders, whereas the motivation-based group had the most active learners. Free riders demonstrated lower grades and self-evaluations, whereas active learners exhibited higher grades and leadership roles. Motivation-based grouping, which aligns team tasks with students' career prospects, was associated with higher engagement and fewer free riders. Grouping students based on career prospects promoted active learning, whereas grouping by academic performance increased free riding.

CONCLUSION

Grouping students from various academic performance levels may not yield positive outcomes, whereas grouping based on career prospects has the potential to enhance student motivation and engagement.

Bridging the gaps in problem-based learning: an evidence-based intervention in bachelor of medicine and surgery (MBBS) program

INTRODUCTION

Problem-based learning (PBL) is one of medical education's most effective student-centered learning modalities. However, a lack of experience has led to several gaps in this useful learning modality, prohibiting it from achieving the desired goals. This study aimed to find gaps in our institution's PBL strategy, take measures to fill these gaps, and then assess the effect of these measures.

METHODS

This interventional study was conducted in a Bachelor of Medicine and Surgery (MBBS) program after receiving ethical approval. The study consisted of three phases: gap identification, intervention, and evaluation. Faculty and student training sessions were conducted to provide insight into PBL processes, followed by a Quality Assessment Questionnaire (QAQ) to assess PBL design and delivery gaps. A PBL revision committee then used the 3C3R model to redesign 136 PBLs, improving alignment with learning outcomes. Pre- and post-intervention scores from the QAQ and formative assessments were analyzed using Wilcoxon signed-rank and paired t-tests.

RESULTS

Pre-intervention QAQ scores averaged 2.7 out of 5, reflecting issues PBL problems and conduction. Post-intervention scores improved to 4.0 (p <.001), indicating a 48.1% enhancement in perceived PBL quality. Post-PBL formative assessments showed significant score improvements across blocks, with an overall effect size (Cohen's d) of -0.54. Student and faculty satisfaction ratings also increased, averaging 4.3 and 4.8, respectively.

CONCLUSION

Due to practical novelty, PBL may have certain gaps and deficiencies that must be removed by targeted interventions to achieve the desired outcomes of this state-of-the-art learning strategy.

TRIAL NUMBER

Not applicable.

Medical student experiences of Case-Based Learning (CBL) at a multicultural medical school

BACKGROUND

Educational research highlights active approaches to learning are more effective in knowledge retention and problem-solving. It has long been acknowledged that adapting to more active ways of learning form part of the challenge for new university students as the pedagogical distance between the didactical approach largely followed by secondary school systems the world over differs quite significantly from the often more student-led, critical approach taken by universities. University students encounter various learning challenges, particularly during the transition from secondary school to university. Poor adaptation and low performance in the first year of tertiary education can lead to higher failure rates and potential withdrawal from study programmes. Adopting active learning strategies early in this transition phase is crucial for supporting students' adaptation and success. Gaining student engagement with active learning can be a significant challenge when there is an expectation to participate in a discussion or voice an opinion. Case-based learning (CBL), with its scaffolded form of learning, is an approach that could provide the support needed to help multicultural learners adapt to their new learning environment in a non-threatening classroom-based setting. The research question in this study was: what features of CBL support active learning?

METHODS

Data was collected using Structured Group Feedback Sessions (SGFS) from 36 students from 12 different countries. Students were placed in eight Structured Group Feedback sessions, a method that facilitates structured discussions and is effect in curriculum evaluation and feedback. The Experience Based Learning model was used as the conceptual framework to guide the analysis, which was completed using the framework analysis method.

RESULTS

Themes were derived from the Experience Based Learning model: affective, pedagogical, and organisational and analysed according to the research question. We found CBL can be used to facilitate active learning with all students at a multicultural medical university. We identified six learning points to highlight features of CBL that support active learning: CBL increased contact with peers and facilitated student bonding; students need to feel psychologically safe to participate; prior learning can enhance confidence to participate; facilitators need to be aware of their role, know about psychological safety, and manage student participation including the dominant voice; some students have a lower tolerance of uncertainty and need additional clarity at the end either via the facilitator or additional notes that provide the key learning points to take away; students became more engaged when a case is aligned to a real patient case giving it authenticity.

CONCLUSIONS

This study explores how CBL can support active learning in a multicultural medical school. We identified that CBL did facilitate active learning and students engaged with it and enjoyed it. We identified six learning points to support others going forward.

Interdisciplinary problem-based learning model for standardized dental residency training: from theory to practice in dental trauma management

Objective

Enhancing clinical skills and quality of dental residents is critical for standardized training. Conventional standardized training falls short in exposing residents to diverse scenarios and fostering interdisciplinary collaboration, essential for dental trauma management. To address these issues, West China Hospital of Stomatology, Sichuan University introduced an interdisciplinary problem-based learning (IPBL) model to improve residents' professional quality and practical abilities.

Methods

Based on the specific needs of dental residents, the hospital established a PBL framework supported by an interdisciplinary collaborative teaching team with a focus on dental trauma diagnosis and treatment. A comprehensive assessment followed the IPBL course, which informed subsequent course modifications. In a preliminary study, 134 students voluntarily chose whether to participate in the program. At the end of the study, the scores of both groups were compared.

Primary results

The IPBL model significantly improved the professional ability of dental residents in the diagnosis and treatment of dental trauma, and obtained positive evaluations from residents and mentors. For the quantitative analysis, the Wilcoxon signed-rank test showed an overall improvement in participants' scores after completing the course.

Conclusion

This teaching model provides a new way for the standardized training of dental residents, and helps to cultivate dental professionals with high professional and practical abilities.

Bridging the educational gaps of health professionals in oncogenomics: results from a pilot e-learning course

BACKGROUND

Genetic and genomic literacy of health professionals is of utmost importance to realize the full potential of personalized medicine. As part of a European Union project, we piloted an e-learning course on oncogenomics, primarily targeted to physicians, and we assessed both its effectiveness and users' satisfaction.

METHODS

The course materials were developed in English according to the Problem-Based Learning method. Learning objectives, covering the basic principles of genetics and the OMICS technologies applied to oncology, were defined based on previously identified core competencies. We used a pre-test vs. post-test study design to assess knowledge improvements. Performance results by demographic and professional characteristics of participants were analyzed using univariate or multivariate statistical methods.

RESULTS

Overall, 346 Italian professionals (61% physicians, 39% biologists) successfully completed the course. Their average post-test score was almost 19% higher than the pre-test (71.6% vs. 52.9%), with no significant differences by sex. Older age (>50 years) and southern area of residence were both correlated with higher gains. The average proportion of correct answers in the final certification test after three attempts was 85% (69% at first attempt), with some differences across professional categories. Methodology, quality of content and usability of the e-learning platform were all highly rated via satisfaction questionnaire (average scores between 4 and 5, scale 1 to 5).

CONCLUSION

The pilot phase confirmed the suitability of the e-learning as a cost-effective method to improve oncogenomic literacy of health professionals. Translation into natural languages and accreditation by European or country-specific Continuing Medical Education systems will be the main incentives for wider dissemination.

Programmatic assessment for learning: A programmatically designed assessment for the purpose of learning: AMEE Guide No. 174

Programmatic assessment for learning (PAL) involves programmatically structured collection of assessment data for the purpose of learning. In this guide, we examine and provide recommendations on several aspects: First, we review the evolution that has led to the development of programmatic assessment, providing clarification of some of its terminology. Second, we outline the learning processes that guide the design of PAL, including distributed learning, interleaving, overlearning, and test-enhanced learning. Third, we review the evolving nature of validity and provide insights into validity from a program perspective. Finally, we examine opportunities, challenges, and future directions of assessment in the context of artificial intelligence.

The effect of simulated problem learning in nursing ethics on moral sensitivity, empathy and critical thinking of nursing students: A quasi-experimental study

AIM

Compare the effects of Simulation with problem-based learning (SPBL) and Problem-based learning (PBL) in nursing ethics education on nursing students' moral sensitivity, empathy, critical thinking, test scores and teaching satisfaction.

BACKGROUND

Promoting nursing students' individual and ethical and abilities through education is an essential way to improve their ethical performance and build trustful relationship with patients. Despite significant efforts in this area, few have evaluated the effectiveness of Simulation with problem-based learning and Problem-based learning as applied to nursing ethics education.

DESIGN

A quasi-experimental design based on a non-equivalent control group pre-test/post-test.

METHODS

A quasi-experimental design was used. Participants were 161 undergraduate nursing students from two levels of a university, 88 subjects in the experimental group were taught using Simulation with problem-based learning and 73 subjects in the control group were taught using Problem-based learning. A pre-test, post-test and questionnaire were used to assess the effectiveness of student nursing ethics education. χ2 test was used to examine group differences in students' characteristics and satisfaction with teaching post-intervention. Student's t-test was used to assess group differences in scale scores and test scores.

RESULTS

Compared to the pre-test, empathy as well as critical thinking were significantly higher in the PBL group (P<0.05), but there was no significant change in moral sensitivity (P>0.05); moral sensitivity, empathy and critical thinking were significantly higher in the SPBL group (P<0.05). Moreover, this study also showed that improvement in moral sensitivity, empathy, critical thinking and grades was more significant in the SPBL group of nursing students compared to the PBL group (P<0.05) and no statistically significant difference was found between the two groups in terms of teaching satisfaction (P>0.05).

CONCLUSION

The use of Simulation with problem-based learning in nursing ethics education has a positive impact on nursing students' competency development and knowledge acquisition. Nurse educators should consider this teaching method and promote change to increase the effectiveness of nursing ethics education.

Expanding the scope of problem-based-learning at Hackensack Meridian School of Medicine; integrating domain-general skills with domain-specific content

The Master Adaptive Learner is a model used to develop students to become self-regulated and adaptable lifelong learners to practice medicine in a complex and ever-changing environment. The Hackensack Meridian School of Medicine (HMSOM) proposes a new course, Patient Presentation Problem-Based Learning Curriculum (PPPC), a dynamic and integrated course that goes beyond the scope of traditional Problem-Based-Learning (PBL). PPPC allows students to build domain-general skills in tandem with domain-specific content learned during a pre-clerkship curriculum. An integrated case provides weekly scaffolding, such that the course takes place throughout the week and is not isolated from the rest of the curriculum. Students receive iterative feedback and structured assignments which allows development of self-directed learning skills along with integration and consolidation of weekly curricular content. A layered analysis approach was used to outline the philosophies, principles and techniques that link to our course objectives. Techniques used could easily be translated to other pre-clerkship curriculum to promote development of self-directed learning and clinical reasoning skills, as well as promote more meaningful learning of basic, clinical, and health system science content.

Surveying Undergraduate Medical Students' Motivational Orientations and Learning Strategies in the First and Last Year of Medical School

Motivation to learn has been linked to learning outcomes, academic performance, learner well-being, and choice of medical specialty. Previous studies showed successful educational interventions to optimize students' levels of motivation and learning strategies. The purposes of this study are (1) to describe undergraduate medical students' motivational orientations and learning strategies in the first and last year at a Canadian university and (2) to analyze possible differences between undergraduate medical students' motivational orientations and learning strategies in those two academic years. An online cross-sectional survey was conducted using the Motivated Strategies for Learning Questionnaire (MSLQ). The survey was sent to a total of 207 first-year and 203 third-year students. We received a total of 58 surveys, 32 of them were complete and analyzed. The overall response rate was 14.1%. The internal consistency for all the scales varied from 0.61 to 0.904. The overall score for the survey was 4.97 on a 7-point scale for all students. Highest scales' scores were obtained for elaboration (mean 5.68) and learning beliefs (mean 5.64), with the lowest scores obtained for rehearsal (3.82) and test anxiety (3.94). The total scores did not differ by students' academic year (p = 0.764), except for the effort regulation scale in which first-year students scored higher (p = 0.01). The largest differences between first- and last-year students were found in effort regulation, where first-years scored higher (difference of 0.99), followed by peer learning (difference of - 0.51), and then test anxiety (- 0.36). Our results showed a sample of students that are highly motivated, mostly driven by intrinsic goals, and are confident that they will master the tasks given to them. They rely more on elaboration strategies building connections between new and prior information, and less in rehearsal strategies used for simple tasks and memorization. The MSLQ showed to be a reliable instrument in our sample, and it could be use as an instrument to identify students' adaptive changes to enhance students' motivation to learn. A portrayal of medical students' attitudes in learning could guide educators to develop instructional programs that would help students to optimize their own learning.

Evaluating the impact of distance learning on gender-affirming healthcare competence: knowledge acquisition and satisfaction among healthcare professionals in Italy

Background

Transgender and gender diverse (TGD) individuals face significant healthcare barriers, with one of the most critical being the inadequate knowledge and skills of healthcare professionals (HCPs) in TGD health. To address this issue, we undertook a project to develop a distance learning course for all healthcare professions, encompassing a comprehensive range of topics related to TGD health issues.

Objectives

This study aimed to evaluate the impact of a course on gender-affirming healthcare competence, with a focus on knowledge acquisition and satisfaction levels. The hypothesis was that participating in the course would enhance the participants' knowledge on the covered topics.

Methods

A distance learning course, designed for all Continuing Medical Education professions, was conducted between March and September 2023. The course was structured according to the Problem-Based Learning methodology. We implemented a pre-test vs. post-test study design to evaluate the enhancement of knowledge, based on a set of Multiple Choice Questions (MCQs), and investigated users' satisfaction through the administration of a semi-structured questionnaire. We examined the pre- and post-course proportions of correct responses to questions, along with the mean score difference, categorized by learners' sex, age, and geographical area. Eventually, a Satisfaction Training Index was created.

Results

The maximum capacity was reached, with 29,998 out of 30,000 available spots filled. Of those enrolled, 18,282 HCPs successfully completed the training. Post-test results revealed an increase in correct answers across all MCQs, with overall mean score rising from 48.8 to 68.0 (p < 0.001). Stratified analysis indicated improvements across all participant categories. A higher average increase among female (19.87) compared to male enrollees (17.06) was detected (p < 0.001). Both "over 55" and "46-55" age groups showed the greatest score increases compared to "35-46" and "under 35" groups, despite no significant differences in pre-test scores. Course satisfaction was high, averaging 4.38 out of 5. Top-rated aspects included "learning new concepts" (4.49), "accessibility" (4.46), and "platform functionality" (4.46).

Conclusion

Our research hypothesis was confirmed by the significant increase in knowledge going from pre-test to post-test and by the high level of user satisfaction. The obtained results serve as a foundation for planning additional professional education in TGD health.

Inquiry in uncertainty-nursing students' learning experience in challenge-based learning: A qualitative study

BACKGROUND

Currently, nursing students face a significant lack of preparedness in efficiently addressing complex issues. The use of challenge-based learning, a student-centred situational learning method that utilizes practice scenarios to solve complex problems, can help alleviate the challenges in nurse education. However, there remains to be more extensive exploration on the application of challenge-based learning in nurse practice education.

OBJECTIVES

This study aims to explore the learning experiences of nursing students in challenge-based learning to gain a deeper understanding of the ways and mechanisms through which challenge-based learning enhances specific learning abilities.

DESIGN/METHODS

This study utilized a hermeneutic phenomenological design, employing semi-structured interviews and thematic analysis.

SETTINGS

A university in Hunan, China, hosted the nursing skills competition based on the principles of challenge-based learning, targeting senior students from nursing schools in Hunan province.

PARTICIPANTS

A total of 24 fourth-year students from six colleges, including one male and twenty-three female students.

RESULTS

Two themes and seven sub-themes emerged from the study. Theme 1 Constructing a knowledge system in complex scenarios with sub-themes: Case-based education centred on comprehensive knowledge promotes knowledge linkage; Reverse reasoning promotes knowledge differentiation; Making mistakes helps finding the correct path of knowledge; Traps inspire identification of potential problems. Theme 2 Inquiry in uncertainty with sub-themes: Unexpected changes promote exploration of general principles; Combining knowledge with diverse case scenarios promotes flexible thinking; The uncertainty of knowledge fosters independent thinking.

CONCLUSIONS

The complexity and variability inherent in challenging learning situations promote the construction of students' knowledge systems and the cultivation of an inquisitive spirit. The identification of these mechanisms contributes to the optimization of instructional environment design, the development of a culture of continuous learning and innovation, and effectively tackling complex issues within an ever-evolving global context.

Gamification in the classroom: Kahoot! As a tool for university teaching innovation

Objectives

The purpose of this study has been to evaluate the use of gamification in the classroom, in terms of its effects on attention, concentration, creativity, and generic capabilities, for university students enrolled in a Bachelor's degree program in Physiotherapy.

Methods

An experimental design was implemented, using three groups differentiated by their time of exposure to the game (0 min, 30 min, or 60 min per week). The sample consisted of 73 s-year students from a Bachelor's degree program in Physiotherapy. The theoretical content for each class was taught during a period of 4 months, reinforced by use of the Kahoot! Online platform. Selective attention and concentration were evaluated using the d2 Test of Attention; creative intelligence using the Creative Intelligence Test (CREA); and generic capabilities using the capabilities subscale of the Student Engagement Questionnaire (SEQ).

Results

The study's participants had a mean age of 19.51 ± 0.9 years, and it has demonstrated that use of Kahoot! For longer periods of time, i.e., more than 60 min per day, can improve essential skills in university students, such as attention, creativity, critical thinking, self-managed learning, adaptability, problem solving, and computer literacy. This study's results show that integrating Kahoot! Into the educational environment, especially with longer sessions that allow for deeper immersion in the game, produces benefits by stimulating various cognitive aspects and enhancing complex skills.

Conclusion

This study has demonstrated that use of Kahoot! Improves key skills such as attention, creativity, and critical thinking, especially when longer sessions are used. It is also suggested that its use should be balanced with other educational activities, in order to achieve comprehensive development for the students.

Implementation of Problem-Based Learning in Undergraduate Medical Education in Ethiopia: An Exploratory Qualitative Study

Background

The poor quality of health professional education in Ethiopia, which was rooted in a traditional curriculum, has posed significant challenges for graduates in effectively addressing real-life health problems. In response, there has been curricular reform by adopting problem-based learning across Ethiopian medical schools. Given the dearth of literature on the topic and the significance of context in the effective implementation of problem-based learning, it is imperative to provide local institutional evidence to pinpoint critical intervention areas and support the effective implementation of problem-based learning.

Methods

A qualitative design based on in-depth, individual, semi-structured interviews was used to explore medical educators, program coordinators, and educational leader's experiences and perspectives on the problem-based learning implementation in health sciences education. A total of 24 participants recruited from five undergraduate health science programs participated in the study. All sessions were audio recorded and transcribed verbatim. Results were analyzed following a qualitative thematic analysis method.

Results

Analysis of the transcripts revealed three main themes, along with their corresponding subthemes. Within the first main theme, participants discussed the importance of integrating Problem-Based Learning into undergraduate medical programs and the educational benefits it brings to medical education. The second main theme explored issues related to challenges in implementing problem-based learning which include inadequate staff training, deficiencies in curricular design and governance, constraints in educational resources, and a lack of preparedness in the educational environment. The third theme deals with the strategic recommendations to address the challenges that contributed to the poor implementation of problem-based learning in undergraduate medical schools.

Conclusion

Our study has addressed several issues related to the implementation of Problem-Based Learning in Ethiopian Health Sciences Colleges. The study's findings have the potential to provide educational stakeholders and policymakers with essential information to strategize successful problem-based learning implementation in undergraduate medical schools.

Infection prevention in medical education - results of a descriptive cross-sectional study in Germany

Objective

The aim of the study was to assess the current curricular status of content on infection prevention in hospitals during medical education prior to the development of a serious game on infection prevention in hospitals. In addition, the data collected was to be contrasted with the training for a specialist nurse in hygiene and infection prevention (FKHI).

Methodology

In an online survey, persons in charge of medical degree programs and continuing education centers for FKHI, SkillsLabs and professional associations in Germany were asked to answer 28 questions on framework conditions, teaching, examinations, and gamification.

Results

Data was collected for 22 medical degree programs and 5 FKHI continuing education centers. Due to the low response rate, the data for the FKHI was only analyzed in summary form. On average, 13.5 teaching units (median) are available in medical studies. Six degree programs have a longitudinal curriculum. In 7 of the 22 degree programs, teaching is based on the National Competency-Based Learning Objectives Catalogue (NKLM). Almost all locations teach this content in lectures (n=18) and/or in internships (n=13). Teaching and examinations are most common in the third year of study (n=12). In addition to practical OSCE examinations (n=5), written (n=12) and computer-based (n=8) examinations are used in particular. Gamification is known as a didactic approach to some extent but is not used for teaching infection prevention.

Conclusions

Infection prevention in hospitals is given relatively low priority in medical education. Teaching and examinations are based on traditional knowledge-oriented formats, although practical teaching and practical examinations are established at some locations. In contrast to the FKHI, learning objectives currently appear to be less standardized. Further interprofessional development of teaching would be desirable in the future.

What Faculty and Students Value When Evaluating Human Digital Anatomy Platforms: A Mixed-Methods Study

OBJECTIVES

There is an increasing availability of digital technologies for teaching and learning of human anatomy. Studies have shown that such applications allow for better spatial awareness than traditional methods. These digital human anatomy platforms offer users myriad features, such as the ability to manipulate 3D models, conduct prosection, investigate anatomical regions through virtual reality, or perform knowledge tests on themselves. This study examined what faculty members' value when using digital human anatomy platforms for teaching and what students value when using these platforms for learning.

METHODS

Six anatomy faculty members and 21 students were selected to participate in this study. After using the three digital anatomy platforms for at least 1 week, a survey was conducted to record their feedback in 4 categories: usability, interactive features, level of detail, and learning support. Respondents' Qualitative feedback within each category was also analyzed to strengthen the study's findings.

RESULTS

The study's findings showed that faculty members and students have different priorities when evaluating digital anatomy platforms. Faculty members valued platforms that provided better accuracy and detailed anatomical structures, while students prioritized usability above the rest of the features.

CONCLUSION

Given that faculty and students have different preferences when selecting digital anatomy platforms, this article proposed that educators maximize the specific affordances offered by the technology by having a clear pedagogy and strategy on how the technology will be incorporated into the curriculum to help students achieve the desired learning outcomes.

Physiology education and teaching in Chinese mainland medical schools: the status quo and the changes over the past two decades

Physiology is a critical subject that bridges basic and clinical medicine. The reform of physiology education is crucial to improving the quality of teaching and supporting student learning; however, there is a lack of comprehensive data documenting the current state of physiology education in medical programs in China. This study conducted an online survey among experienced teachers from the top 100 medical schools in the Chinese mainland in 2022. A total of 89 valid questionnaires were included in this study. In 57.3% of the surveyed medical schools, 70% of the physiology teachers have a Ph.D. degree, while the number of faculty members with a medical background has tended to decrease in 53.9% of the surveyed medical schools. Of the 89 medical schools, 62 have implemented physiology course integration, with 69.4% of the respondents believing that curriculum integration could enhance students' knowledge acquisition and application. The lecture hours per term are 50-70 and 71-90 in 49.4% and 42.7% of the 89 medical schools, respectively. The ratio of course duration of lecture to laboratory was 2:1 in 47.2% of the surveyed medical schools, while the ratio was between 1:1 and 2:1 in 47.2% of the surveyed medical schools, and only 5.6% of medical schools opted for a 1:1 course arrangement. For teaching methods, about 60% of medical schools used problem-based learning, case-based learning, and task-based learning (PBL/CBL/TBL) for clinical medicine students only, and 25.4% of medical schools applied PBL/CBL/TBL to all students. This study is conducive to promoting dialogue and communication among physiology teachers, administrators, and researchers.NEW & NOTEWORTHY This study conducted a nationwide survey of the top 100 medical schools in the Chinese mainland in 2022 to provide first-hand data on the current situation and changes in physiology education and teaching in the Chinese mainland with focuses on the faculty composition, curriculum integration, teaching methods, and assessment modes, which is a microcosm of the reform and development of the medical education in the Chinese mainland, hoping to improve the quality of preclinical medical education.

A Bibliometric Analysis of the 100 Most Cited Articles on Problem-Based Learning in Medical Education

Problem-based learning (PBL) is an instructional approach used in medical education that is characterized by solving problems in small groups with tutor guidance. More than 50 years since PBL's inception, many questions remain to be addressed about its processes and learning outcomes. The purpose of the study was to examine the bibliometric characteristics of the 100 most cited articles on PBL in medical education and to identify landmark papers that have made significant contributions to PBL research. Results were systematically reviewed for citation frequency, publication year, journal, article type, article focus, authors, author collaboration, and country collaboration. The number of citations ranged from 81 to 3531 times cited with 31,041 total citations. The articles were contributed by 211 authors in 23 journals and most articles (68%) were published in Medical Education, Academic Medicine, and Medical Teacher. The majority of the articles (71%) originated from Netherlands, Canada, and the United States and six prolific authors were identified. Almost half of the articles are classified as empirical research. Article foci included theoretical foundations of PBL, curriculum design, learning outcomes and processes, tutors, assessment, guides to PBL implementation, commentaries, and student well-being. The strong author and country collaborations indicate continued global interest in the PBL instructional method, which is likely to remain an active topic of research as the evidence of its effectiveness over traditional instructional methods as well as its most impactful components is inconclusive.

Does prior knowledge affect interaction dynamics and learning achievement in digital problem-based learning? A pilot study

Objective

Previous research on problem-based learning (PBL) describes that videotaped observations develop meaningful insights into cognitive processes in tutorial groups. Analysis regarding the amount of prior knowledge on learning achievement has not been investigated in medical education so far, although both are key factors of PBL success. Thus, we intended to analyse videos of digital problem-based learning (dPBL) sessions, focusing on knowledge acquisition and interaction dynamics among groups with different levels of prior knowledge to reveal any distinctions.

Methods

This study employed a pilot design by dividing 60 dental students into twelve subgroups with less or more prior knowledge, determined by a pre-semester multiple choice test (MCQ). The groups engaged in videotaped dPBL cases, which were examined regarding group interactions and tutor effectiveness. The learning achievement was assessed through a post-semester MCQ, an oral and practical exam.

Results

The video analysis showed that dPBL groups with less prior knowledge achieved significantly higher tutor effectiveness and group interaction utterances, but that the percentage of time in which utterances occurred was similar in both groups. Related to the MCQ results, the students with less prior knowledge learned four times more than those with profound previous abilities, but no significant difference was found in the results of the oral exam and practical exam.

Conclusions

The interaction dynamics in dPBL depend on the group's amount of prior knowledge. Especially groups including participants with less prior knowledge seemed to benefit from dPBL in comparison to groups with more prior knowledge. The dPBL groups acquired knowledge in different ways during the courses but, finally, all students arrived at a similar level of knowledge.

Purpose, Planning, and Individualization of Master of Science in Nursing Capstone Experiences: An Integrative Review

BACKGROUND

Graduate-level education programs use capstone experiences for students to demonstrate achieving essential learning and programmatic outcomes. However, a lack of standardization of these experiences and outcome measurements could result in varying competencies among students with the same degree. Employers seeking specific skills may find this problematic, and graduates may feel unprepared for new roles, which could hinder transition.

METHOD

A systematic search of nine databases was conducted to identify: (1) the essential characteristics of master in nursing capstones and (2) the assessments programs use to demonstrate achievement of program outcomes.

RESULTS

Synthesis and analysis of six sources of evidence revealed uniform agreement in purpose, planning, and individualization of experiences, yet ways of assessing student achievement of program outcomes were less clear and varied widely.

CONCLUSION

Capstone experiences should be relevant to graduate-level education and include mapping to program outcomes to ensure students' competency and readiness to transition into their new role. [J Nurs Educ. 2023;62(9):502-508.].

Problem-based learning versus reflective practice on nursing students' moral sensitivity

BACKGROUND

Moral sensitivity is one of the prerequisites for nurses' professional competency and patient care. It is critical to teach professional ethics in a student-centered manner in order to increase students' moral sensibility. This study evaluated the effects of professional ethics education via problem-based learning and reflective practice on nursing students' moral sensitivity.

METHODS

This experimental study was performed on 74 nursing students who were randomly divided into three groups of problem-based learning, reflective practice and control. Principles of professional ethics were presented for the two intervention groups in four 2-hour sessions using ethical dilemmas scenarios. Participants completed the Moral Sensitivity Questionnaire before, immediately, and three months after the intervention. Data were analyzed using SPSS₁₆.

RESULTS

Demographic characteristics of the three groups were similar (p > 0.05). The total moral sensitivity score significantly differed between the groups immediately and three months after the intervention (p < 0.001). The total mean score for moral sensitivity was significantly different between the two groups of problem-based learning and reflective practice, with the mean scores in the problem-based learning group being higher (p = 0.02). The mean score of moral sensitivity decreased statistically significantly in both experimental groups three months after the intervention as compared to immediately after the intervention (p < 0.001).

CONCLUSION

Nursing students' moral sensitivity can be increased through reflective practice and problem-based learning. While the results indicated that problem-based learning was more successful than reflective practice, additional research is recommended to confirm the influence of these two strategies on moral sensitivity.

e-PBL with multimedia animations: a design-based research

BACKGROUND

This study was conducted to explore the effectiveness of online problem-based learning (e-PBL) with multimedia animation scenarios by comparing the face-to-face (f2f) PBL method with paper-based scenarios. Adapting different f2f teaching methodologies to online environments is a significant problem that urgently needs attention, particularly in health education.

METHODS

This study is part of design-based research and consists of three phases, which comprise design, analysis, and re-design. First, the animation-based problem scenarios were developed, and the learning environment (e-PBL) elements were organized. Then animation-based scenarios and the e-PBL environment were used, and problems related to the use of the environment were determined with an experimental study which was based on a pretest-posttest control group design. Finally, we used the following three measurement tools in the data collection process: a scale to determine the effectiveness of PBL, an attitude scale toward PBL, and the Clinical Objective Reasoning Exams (CORE). The study group in this research comprised 92 medical undergraduates (47 female and 45 male).

RESULTS

There were similar scores between the two groups (e-PBL and f2f) in terms of the effectiveness of the platforms, the attitudes of the medical undergraduates, and the CORE scores. Also, there were positive relationships between the attitude scores, grade point average (GPA), and PBL scores of the undergraduates. Another significant positive relationship was found between the CORE scores and the GPA.

CONCLUSIONS

The animation-supported e-PBL environment positively effects the participants' knowledge, skills, and attitude. Students who have high academic scores attitude positively towards e-PBL. Providing problem scenarios as multimedia animations is the innovative face of the research. They have been produced inexpensively with off-the-shelf web-based animation apps. These technological advances may democratize the production of video-based cases in the future. Although the results of this study were obtained before the pandemic, they showed no differences between e-PBL and f2f-PBL in terms of effectiveness.

Case-based learning interventions for undergraduate nursing students in a theoretical course: A review of design, implementation, and outcomes

BACKGROUND

Case-based learning (CBL) is a contextualized learning and teaching method that can facilitate active and reflective learning to develop critical thinking and problem-solving skills. However, nursing educators have some difficulty in creating a CBL environment that matches the diverse professional nursing curriculum and students' needs, including developing relevant cases and appropriate CBL implementation processes.

OBJECTIVE

To summarize the case design, implementation process, and their relationship with CBL effectiveness.

METHODS

Electronic databases of PubMed, Embase, Web of Science, CINAHL, China National Knowledge Infrastructure (CNKI) and Wanfang Data (a Chinese database) were searched from inception until January 2022. Study quality was assessed using the Mixed Methods Appraisal Tool. A qualitative synthesis was then conducted to summarize the study findings.

RESULTS

The systematic mixed studies review included twenty-one quantitative studies, five qualitative studies and two mixed methods studies. The case design and implementation process were indispensable parts of each study, but the application process of CBL in each study was slightly different, basically including case design, preparation, small-group interaction and exploration, collaborative efforts, teacher summary, assignment and teacher feedback. There were three themes in this review that indicate the effect of CBL on students, namely, knowledge, competence and attitude.

CONCLUSION

The present review analyzes the available literature and suggests that there is no common format for the case design and CBL implementation process, but demonstrates that they are an indispensable part of each study. This review provides conceptual procedures for nurse educators to design and implement CBL in nursing theoretical courses to improve the effectiveness of CBL.

Results and lessons learned from a virtual multi-institutional problem-based interprofessional learning approach: The VIPE program

The importance of interprofessional collaborative practice has come into focus over the past decade as coordination and delivery of health care becomes increasingly complex. The need for students to acquire collaboration-building skills to prepare them to work effectively within diverse healthcare teams to improve patient outcomes is a goal of interprofessional education (IPE). Accrediting bodies across healthcare professions require IPE as part of a robust curriculum to build collaborative skill sets and create a practice ready workforce. To respond to this need, an online healthcare program developed an innovative model for student collaboration across professions and institutions through a virtual interprofessional education (VIPE) program. The VIPE model aims to simulate clinical practice via an asynchronous and synchronous pedagogical approach that combines PBL/CBL with psychological safety. VIPE demonstrated statistically significant gains in knowledge and positive attitudes toward interprofessional collaborative practice as a result of participation in the VIPE program. During COVID-19, the demand for high quality IPE for health professions' students in virtual settings has grown, VIPE has the potential to be a solution for this. VIPE requires a dedicated committee and technical lead. Further research could involve longitudinal studies and nonaggregate models.

Promote collaborations in online problem-based learning in a user experience design course: Educational design research

Since the Covid-19 pandemic, there has been an increasing growing need for learning experience or instructional designers. As a result, online courses on user experience (UX) design for learning are in demand to prepare those much-needed professionals. This paper reports the first circle of educational design research (EDR) on such a completely online problem-based course using group contracts and peer-evaluations to promote collaborations. Multiple datasets were collected from a range of data sources from a graduate-level course and were analyzed by two researchers. The study yielded several meaningful results: (1) group contracts helped students work smoothly and keep goals focused on collaborative learning in PBL; (2) the instructor could facilitate the group formation process; (3) peer evaluations helped group collaboration and monitoring; and (4) collaborative technologies are critical for collaboration. The findings also revealed important design principles for collaborative learning in PBL that can be used in similar courses. In addition, this study provides a successful example of how to teach UX design in an online PBL environment, and sheds light on how to further improve similar practices while contributing to the limited body of research on UX design for learning.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10639-022-11495-6.

HIV advocacy: knowledge translation and implementation at three diverse sites in sub-Saharan Africa

PURPOSE

To explore how the gap in knowledge translation around HIV and rehabilitation could be addressed using advocacy. This article describes and reflects on lessons learned from incorporating content on HIV and advocacy into the curricula at three diverse physiotherapy (PT) programs in sub-Saharan Africa.

METHODS

A realistic evaluation approach was followed. Three study sites were purposively chosen to reflect diverse settings with respect to pedagogical approach, university or college, degree or diploma programs, use of technology, and regional prevalence of HIV. A multi-faceted intervention was implemented that included three activities: (i) to develop three core components of a novel knowledge translation intervention designed to improve knowledge, attitudes, and self-efficacy in HIV and rehabilitation advocacy among PT students; (ii) to tailor and implement the knowledge translation intervention by local faculty according to the context and needs of their program and to implement this with a cohort of PT students at each of the three study sites; and (iii) to evaluate the adaptation and implementation of the intervention at each site.

RESULTS

Differences exist between the three-country programmes, specifically in the length of time the degree takes, the extent of HIV inclusion in the curriculum and years of the study included in the project.

CONCLUSIONS

This research adds to the call to shift the focus of HIV care from just test-and-treat, or on just keeping people alive, towards a broader approach that centres the whole person, that focuses not only on surviving but on thriving, and which commits to the goal of optimising functioning and living full, whole lives with HIV. Advocacy across the continuum of care plays a pivotal role in translating research findings into practice.Implications for rehabilitationResults are relevant for policymakers in government and at senior levels within universities whose mandates include informing, reviewing, and driving educational programs and curricula.The result from this project illuminates the role for rehabilitation and allows for incorporating HIV into curriculum and practice for physiotherapists and other related stakeholders so that they can advocate for and with patients.

Effects of Problem-Based Learning Strategies on Undergraduate Nursing Students' Self-Evaluation of Their Core Competencies: A Longitudinal Cohort Study

To respond to patients' increasing demands and strengthen nursing professionals' capabilities, nursing students are expected to develop problem-solving skills before they enter the workforce. Problem-based learning (PBL) is expected to provide effective simulation scenarios and realistic clinical conditions to help students achieve those learning goals. This article aims to explore the effects of PBL strategies on nursing students' self-evaluation of core competencies. This longitudinal cohort survey study evaluated 322 nursing students attending Chung Shan Medical University, Taiwan, in 2013 and 2014, where PBL teaching strategies are used in all four undergraduate years from freshman to senior. Based on their undergraduate academic levels, students were categorized into three groups- one-year PBL exposure, two-year PBL exposure, and three-year exposure. A core competency questionnaire was administered twice to ask participants to self-assess five professional competencies: learning attitude, problem identification, information analysis, execution, and life-long learning. The results showed that students with the longest exposure to PBL (Group 3) had higher self-evaluated scores for all core competencies than the other groups, except for the execution competency. The mean total competency score increased by 0.12 points between the pre-and-test. In addition, the mean score increased significantly more in Group 3 than in Groups 1 and 2. These trends were consistent for the information analysis, execution, and life-long learning competencies. In conclusion, the changes in the self-evaluated scores between groups indicate PBL strategies effectively improve nursing students' core competencies. The longest exposure group reported higher self-evaluated core competency scores than the other groups, especially for the information analysis, execution, and life-long learning competencies.

Gender and Sexual Diverse Health Education: A Needs Assessment Among Internal Medicine Residents

Purpose: The purpose of this study was to assess perception of competency and comfort level of internal medicine (IM) residents in caring for gender and sexual diverse (GSD) patients, and to identify residents' preferred educational modalities and perceived facilitators and barriers to GSD curriculum implementation. Methods: A survey was distributed among IM residents during a mandatory didactic session between November 9 and December 18, 2020. Categorical variables were analyzed using Fisher's exact test. Open-ended questions were analyzed using content and theme analysis. Results: Of 138 residents, 89 (64%) completed the survey. Residents had varying levels of comfort and perceived competence. Small group (n = 61, 69%) and case-based learning (n = 58, 66%) formats were preferred. Content and theme analysis resulted in four major themes on facilitators and three major themes on barriers to GSD curricular implementation. Conclusion: This study provides unique insight to facilitate implementation of a learner-centered and developmentally appropriate curricular approach to GSD health education.

A study of students’ learning perceptions and behaviors in remote STEM programming education

In recent years, STEM education has developed students’ fundamental subject knowledge, and has allowed students to integrate STEM cross-domain knowledge. Universities emphasize innovative thinking, practice and application, problem-solving, and teamwork to nurture students while learning STEM cross-domain knowledge development in remote STEM program education. When students take online STEM programs, they may encounter unanswered questions and may give up on trying to solve them. Therefore, this study proposed a problem-based learning approach with an online programming system integrated into an online STEM programming course. To help students solve the past programming assignments, the assignments were simplified, decomposed, and reorganized. The teacher guided the students to understand the STEM programming problems and taught them to use appropriate problem-solving skills to motivate them to complete the STEM programming assignments. The experiment was conducted with students in an online STEM programming course at a university in northern Taiwan. In the experimental activities, we used a problem-based learning approach for the online STEM programming activity. The problem-based learning method can be divided into four steps, namely stating the problem, understanding the problem, developing a solution plan, and executing the plan, reflecting, and debugging. This study used a problem-based learning approach and an online programming system integrated into a STEM programming curriculum to explore the differences in students’ perceptions of STEM learning, learning outcomes, and learning behaviors. The experimental results found a significant difference between students’ prior knowledge and learning outcomes. Students showed significant gains in learning the STEM programming content using the problem-based learning approach and the online programming system. In the analysis of their STEM learning perceptions, we found that there were significant differences in students’ responses for each dimension. This shows that using the problem-based learning approach with the online programming system helped students learn the course content. The analysis of students’ behaviors in answering the STEM programming assignments indicated that some students had the habit of taking notes. This helped them to easily associate and integrate STEM cross-domain knowledge with what they had learned in the online course, and enhanced their ability to implement STEM programs. In addition, students could take the initiative and focus on repeatedly watching the teacher solve the material in the online course. Students could try different solving plans to pass the code validation of the STEM programming assignments. This revealed that students wanted to complete the STEM programming assignments to achieve good learning performance.

PBL teaching in ultrasonography resident standardization training in the COVID-19 pandemic

OBJECTIVE

To study the effect of the problem-based learning (PBL) method in ultrasonography (US) resident standardization training during the COVID-19 pandemic.

METHODS

Fifty residents were divided into two groups to participate in a 30-day US training program. The residents in the observation group underwent PBL combined with the lecture-based learning (LBL) method, while the residents in the control group experienced the LBL method alone, with 25 residents in each group. A basic theoretical test, practical examination, and questionnaire were used to evaluate the teaching effect of the PBL + LBL method and the LBL method alone.

RESULTS

The basic theoretical pretest score of the observation group was not significantly different from that of the control group. However, the posttest theoretical score and practical score were significantly higher in the observation group than in the control group (P < 0.01). The results of the questionnaire showed that the resident satisfaction level in the observation group with PBL combined with the LBL method was 96%, which was significantly higher than that of the control group with the LBL method alone (80%) (P < 0.05).

CONCLUSION

The combination of PBL with the LBL method has obvious advantages over the LBL method alone in regard to the training of US residents during the COVID-19 pandemic.

Health professions education as a discipline: Evidence based on Krishnan's framework

Health professions education (HPE) emerged as a specific domain of higher education in the 1960s. The interim decades brought the development of advanced training in health professions education and the implementation of HPE offices at many institutions of healthcare and education across the world. Despite these advancements, organizations considering the establishment of HPE offices, or advanced HPE training programs are still challenged by approving authorities to demonstrate that HPE is a discipline and not simply a branch of higher education. Although other scholars have proposed defined characteristics to guide the recognition of study fields as separate academic disciplines, Krishnan's framework is easily operationalized and its use has been broadly reported in the management, education, and intelligence studies literature, among others. Krishnan contends that an academic discipline generally presents the following characteristics: (1) an object of study and research that, although particular to the discipline, can be common to others; (2) a body of specialized knowledge, relative to the subject of study and research, typically unique to the discipline; (3) theories and concepts that frame and organize the specialized knowledge of the discipline; (4) specific terminologies or technical language related to the subject of study and research; (5) research methods adapted to the particular demands of the discipline; and (6) an institutional presence demonstrated by teaching at the graduate level of subjects specific to the discipline, and by the existence of academic departments and professional associations. The purpose of this paper is to present arguments in support of the status of HPE as an academic discipline using Krishnan's framework. It is our hope that these arguments will facilitate the efforts of organizations planning for the establishment of HPE offices or advanced HPE training programs at their institutions.

The Effects of Sequencing Strategies in Teaching Methods on Nursing Students’ Knowledge Acquisition and Knowledge Retention

Background: No existing research has determined which teaching sequence strategy is the best for nursing students. Purpose: To find out which sequence is most effective in knowledge acquisition and knowledge retention and to further verify knowledge acquisition between problem-based learning (PBL) and lecture-based learning (LBL). Methods: This was a quasi-experimental design with a comparison of two nursing student groups selected from students in their final program year who were invited to participate. Generalized estimating equation was used to compare Group I (LBL-PBL-clinical practicum) and Group II (PBL-LBL-clinical practicum) by using knowledge acquisition and knowledge retention as outcome variables. Findings: Fifty-six senior students joined this study. Group I was significantly better than Group II on both knowledge acquisition (β = 7.05, p = 0.04) and knowledge retention (β = 9.40, p = 0.03). Discussion: The sequence of LBL-PBL-clinical practicum or policy of allowing practicum and courses in the same semester might be the best strategy to enhance knowledge retention.

Effective Learning in Virtual Conferences: The Application of Five Principles of Learning

In this article, we examine the adaptation of learning among scientists and healthcare professionals in conferences and symposia from face-to-face to fully virtual meetings accelerated in the last years. Advantages and limitations for both settings have been described in different research studies but the effectiveness of learning can be reflected similarly by applying five fundamental principles of learning, which are based on empirical research in cognitive psychology. From a practical context, we compared the individual learning outcomes from two satellite symposia conducted face-to-face in 2019 and virtually in 2021 at the European Congress of Urology, EAU. Although both conference formats were almost identical, the five principles of learning were applied in both symposia. There were also some differences due to adaptation to online conferences, and our findings suggest that the virtual conference was perceived as significantly more effective than the face-to-face conference on all five criteria, and digital learning is a valid alternative to face-to-face conferences. What still needs to be better understood and analysed is the informal learning that is taking place during conferences, but suggesting an active design of any digital event by combining "technical literacy· with "learning literacy" will enable us to better analyse and study the impact of learning using the five learning principles in the design of other events in the future.

Weak and strong ties and its connection to experts' problem-solving styles in scaffolding students' PBL activities on social media

Background: Studies have acknowledged that social media enables students to connect with and learn from experts from different ties available in the students’ personal learning environment (PLE). Incorporating experts into formal learning activities such as scaffolding problem-solving tasks through social media, allows students to understand how experts solve real-world problems. However, studies that evaluate experts’ problem-solving styles on social media in relation to the tie strength of the experts with the students are scarce in the extant literature. This study aimed to explore the problem-solving styles that the experts portrayed based on their ties with the students in problem-based learning (PBL) on Facebook. Methods: This study employed a simultaneous within-subject experimental design which was conducted in three closed Facebook groups with 12 final year management students, six business experts, and one instructor as the participants. The experts were invited by the students from the weak and strong ties in their PLE. Hinging on the Strength of Weak Ties Theory (Granovetter, 1973) and problem-solving styles (Selby et al., 2004), this study employed thematic analysis using the ATLAS.ti qualitative data analysis software to map the experts’ comments on Facebook. Results:  The experts from strong and weak ties who had a prior relationship with the students showed people preference style by being more sensitive to the students' learning needs and demonstrating firmer scaffolding compared to the weak ties' experts who had no prior relationship with the students. Regardless of the types of ties, all experts applied all manner of processing information and orientation to change but the degree of its applications are correlated with the working experience of the experts. Conclusion: The use of weak or strong ties benefited the students as it expedited their problem-solving tasks since the experts have unique expertise to offer depending on the problem-solving styles that they exhibited.

Bioinspiration as a method of problem-based STEM education: A case study with a class structured around the COVID-19 crisis

Bioinspiration is a promising lens for biology instruction as it allows the instructor to focus on current issues, such as the COVID-19 pandemic. From social distancing to oxygen stress, organisms have been tackling pandemic-related problems for millions of years. What can we learn from such diverse adaptations in our own applications? This review uses a seminar course on the COVID-19 crisis to illustrate bioinspiration as an approach to teaching biology content. At the start of the class, students mind-mapped the entire problem; this range of subproblems was used to structure the biology content throughout the entire class. Students came to individual classes with a brainstormed list of biological systems that could serve as inspiration for a particular problem (e.g., absorptive leaves in response to the problem of toilet paper shortages). After exploration of relevant biology content, discussion returned to the focal problem. Students dug deeper into the literature in a group project on mask design and biological systems relevant to filtration and transparency. This class structure was an engaging way for students to learn principles from ecology, evolution, behavior, and physiology. Challenges with this course design revolved around the interdisciplinary and creative nature of the structure; for instance, the knowledge of the participants was often stretched by engineering details. While the present class was focused on the COVID-19 crisis, a course structured through a bioinspired approach can be applied to other focal problems, or subject areas, giving instructors a powerful method to deliver interdisciplinary content in an integrated and inquiry-driven way.

Efficacy of Case-Based Learning in Anatomy

Introduction

In the present Competency-Based Medical Education (CBME), learning is more student-centered where the students take the responsibility for their learning. Anatomy is an important basic science that lays the foundation for clinical courses in the Bachelor of Medicine and Bachelor of Surgery (MBBS) curriculum. To make it interesting and clinically useful, several innovative teaching-learning methods like case-based learning (CBL) and problem-based learning (PBL) are introduced. The present study was taken up to know the effectiveness of CBL as a teaching-learning method in Anatomy in improving the knowledge and retention of acquired knowledge.

Material and Methods

This was an interventional cross-over study carried out at NRI Medical College and General Hospital, Guntur, Andhra Pradesh. Two hundred students studying in first-year MBBS were included in the study and divided into two batches. The batches - A and B - were exposed to CBL and didactic lecture, respectively, in the first month for Topic I, and then cross-over was done in the second month for Topic II. The knowledge of the students before and after the sessions was assessed by pre-session and post-session multiple-choice question (MCQ) tests. Knowledge retention was assessed by another MCQ test conducted four weeks after the post-session test.

Results

The average difference of the scores between pre-session and post-session tests in the CBL group for Topics I and II (4.01±1.17 and 3.8±1.6) are significantly more compared to the didactic lecture method (3.3±1.3 and 1.9±1.2). The average difference of the scores between the post-session tests and retention-tests in the CBL group (0.122±1.05 and 0.18±1.04) were further compared to the lecture method (0.016±0.95 and 0.09±0.8) for Topics I and II, respectively. There was a significant increase in the proportion of students with scores above 50% in the post-session test and retention test in the CBL group compared to the didactic lecture group.

Conclusion

Results from the pre-session tests, post-session tests, and retention tests for both the topics indicate that CBL as a teaching-learning method in Anatomy is a more effective method for improving and retention of knowledge.

A processual view on the use of problem-based learning in high school physiology teaching

In problem-based learning (PBL), the steps and processes present in the PBL tutorial cycle are essential for constructive, self-directed, collaborative, and contextual student learning. This article presents a procedural study of a PBL tutorial cycle with high school students new to the method regarding human respiration and circulation physiology. We observed group dynamics and the learning process that occurred throughout the PBL tutorial cycle. The results indicate that conceptual changes were close to the planned learning objectives and that students enjoyed studying applying PBL. Moreover, a positive correlation was observed between group dynamics, self-directed learning and learning outcomes. Our results provide grounds for restructuring the tutorial cycle, especially important for novice PBL students, such as problem reformulation and the development and diversification of applied learning scaffolds. We conclude that the qualitative analysis performed herein can yield a deeper understanding of the PBL tutorial cycle and may be used to foster PBL implementation in institutions with little experience with the method and monitor its outcomes in organizations with mature PBL use.

Perception and Attitude of Medical Students towards Cadaveric Dissection in Anatomical Science Education

Background

Cadaveric dissection is essential and effective teaching method of anatomy in medical schools. In cadaveric dissection, the learner plays the central role of the teaching process and to view structures in their natural location. Cadaveric dissection is however perceived as tedious and time consuming by most students which influence their perception and attitude towards the teaching method. This study was therefore designed to evaluate UHAS medical students' perception and attitude toward dissection in the teaching and learning of human anatomy.

Method

This was a cross-sectional and descriptive study. A Likert-style questionnaire, comprising 26 items was sent to study population via online using google form. Ethical issues were duly dealt with approval and consent.

Result

Majority of the students (84.5%) perceived dissection more interesting, and the better way to really learn and understand the human body. About 87% of students also indicated that it assists in retention of what they learnt in theory. Majority of the students (74.5%) felt dissection should not be replaced by other forms of learning.

Conclusion

There is a strong positive perception and attitude towards the use of cadaveric dissection as a teaching and learning method of anatomy. Cadaveric dissection brings about the skills, courageous and the ability to confidently work on the human body without any fear for future practice. It is therefore, recommended that more time should be allocated to cadaveric dissection.

It's what you do, not the way you do it - online versus face-to-face small group teaching in first year medical school

BACKGROUND

Major disruptions imposed on medical education by the COVID-19 pandemic and the rapid shift to online teaching in medical programs, necessitated need for evaluation of this format. In this study we directly compared knowledge outcomes, social outcomes, and wellbeing of first year student small group teaching in either face to face (f2f) or online format.

METHODS

At the end of the first course of our medical program, students were invited to participate in an online questionnaire with 10 quantitative items and 1 qualitative item. These were analysed using Factor Analysis Pattern Matrix and linear regression to group items and assess relatedness. Qualitative responses were thematized using Qualtrics software (Qualtrics, Provo, UT, USA). Summative assessment results were compared, both between current cohorts to historical cohorts.

RESULTS

From a cohort of 298 students there was a 77% response rate. Overall, there were no differences in knowledge gains, either between groups or when compared to historical cohorts. Questionnaire items fell reliably into groups that related to either learning outcomes, social outcomes, or wellbeing. Independent T tests showed that format for teaching (online versus f2f) had an impact on social outcomes but no direct impact on learning outcomes. Linear regression revealed that the social outcomes have a direct impact on wellbeing and almost the double the impact on learning outcomes than mode of learning i.e.. F2f or online (β = .448 and β = .232 respectively).

CONCLUSION

In this study, we were able to show with statistical strength that social outcomes for students such as engaging with peers and facilitator, contributing to the group, and making friends have a direct impact on wellbeing and indirectly impact learning outcomes (such as motivation, satisfaction, integration of knowledge). In a rapidly changing educational landscape, in our opinion, it is vital that these aspects are a focus of design and delivery of medical education. The data from this study supports the notion that activity design and the expertise of the teacher in facilitating the small group activities, has greater impact than the mode of educational delivery itself on students' learning processes.

Designing Oral Health Curriculum That Facilitates Greater Integration of Oral Health Into Overall Health

For several decades, health professions education has been transforming; pedagogical constructs such as active learning, recorded lectures, electronic assessment, asynchronous content delivery, and interprofessional education and practice. However, the typical oral health curriculum has need for further transformation to ensure graduates' ability to function in an integrated health system. There is significant literature outlining associations between oral health and overall health, therefore, it is paramount that oral health learners develop skills to collaborate in an integrated model. Satcher, in 2000, outlined the gravity of oral health inequities and the importance of oral health. He said, “Too little time is devoted to oral health and disease topics in the education of non-dental health professional.” However, on the contrary typical oral health curriculum provide knowledge acquisition of topics related to overall health but isn't specifically designed to guide integrated care. In order to increase integrated care, groups like the Interprofessional Education Collaborative (IPEC) have developed competencies for interprofessional education and collaborative practice that guides the training of health professionals. One way to improve integration is accreditation standards that guide transformation as well incorporate IPEC competencies. Having competencies is important to prepare learners to function in clinics like Kaiser Permanente's medical-dental integration model that rely upon teams and teamwork and clarity of roles and responsibilities. This manuscript outlines principle of oral health curriculum that facilitate graduates ability to work in an integrated health system and how that contributes to the improvement overall health of patients.

Teaching on Rounds and in Small Groups

Bedside teaching plays a vital role the training future physicians, allowing for instruction in history taking, physical examination skills, differential diagnosis development, professionalism, teamwork integration, effective communication, and discussions of medical ethics. Due to changes in the health care system, accreditation bodies, and shortened admittance of patients, rates of bedside teaching have declined. Attending surgeons feel increased external pressures to meet performance metrics while resident physicians adhere to duty hour restrictions. This article highlights popular methods, including bedside rounds, near-peer teaching, and resident versus attending preceptors, and discusses how teaching on rounds has an impact on patients.

Precision Cancer Medicine: Dynamic Learning of Cancer Biology in a Clinically Meaningful Context

PURPOSE

Precision medicine is revolutionizing healthcare practices, most notably in oncology. With cancer being the second leading cause of death in the USA, it is important to integrate precision oncology content in undergraduate medical education.

METHODS

In 2015, we launched a Clinical Cancer Medicine Integrated Science Course (ISC) for post-clerkship medical students at Vanderbilt University School of Medicine (VUSM). In this ISC, students learned cancer biology and clinical oncology concepts through a combination of classroom and patient care activities. Student feedback from mid- and end-of-course surveys and student match data were analyzed and used to develop ongoing course improvements.

RESULTS

To date, 72 medical students have taken the Clinical Cancer Medicine ISC. Over 90% of students who completed end-of-course surveys agreed or strongly agreed that this course advanced their foundational science knowledge in clinical cancer medicine, that clinical relevance was provided during non-clinical foundational science learning activities, and that foundational science learning was embedded in course clinical experiences. Students who took this course most commonly matched in Internal Medicine, Pathology, Pediatrics, and Radiation Oncology. VUSM students who matched into Pathology and Radiation Oncology were more likely to take this ISC than students who matched in other specialties.

CONCLUSION

The Clinical Cancer Medicine ISC serves as a model for incorporating precision oncology, cancer biology foundational science, and oncology patient care activities in undergraduate medical education. The course prepares students to care for oncology patients in their fields of interests during their future career in medicine.

Some Learning Theories for Medical Educators

Perspectives on the nature of learning influence decisions about curriculum design, teaching and learning strategies, and assessment of students. Current literature on medical education suggests that medical teachers have much interest in using theories to inform their practice. This article describes the following learning theories that have been discussed to various degrees in previous literature on medical education: cognitivism, constructivism, experiential learning, adult learning, self-directed learning, community of practice and situated learning, cognitive apprenticeship, and reflective learning. Each theory is explained in sufficient detail to help readers grasp its essence. Then, medical education literature is cited to show how the theory has been used or can be used to guide practice in medical education. Finally, this article analyzes the problem-based learning approach as an example to illustrate how the theories may be reflected in practice. Throughout the introduction of the various theories, this article aims at their application in medical education and attempts to draw connections among the theories rather than represent them as unrelated or competing ideas.

Problem-Based Learning About Problem-Based Learning: Lessons Learned from a Student-Led Initiative to Improve Tutor Group Interaction

This article summarizes a student-led effort to improve tutor group interactions among second-year medical students in a hybrid problem-based learning (PBL) curriculum. Dissatisfaction with PBL had led to superficial tutorial discussions that students escaped to study for board certification exams. Following the PBL principle of using intrinsically motivating problems, the student investigators created board-style questions with accompanying facilitation guides for tutors to present as 'mini-problems' to stimulate case-related discussion. Tutor groups used and enjoyed the questions, but interaction quality did not improve. Like the hybrid curriculum itself, the intervention embodied conflicting educational philosophies; implementation challenges reflected the tension between them.

Capacity Building of Health Professionals on Genetics and Genomics Practice: Evaluation of the Effectiveness of a Distance Learning Training Course for Italian Physicians

BACKGROUND

The rapid spread of personalized medicine requires professionals to manage the "omics revolution." Therefore, the genetics/genomics literacy of healthcare professionals should be in line with the continuous advances in this field, in order to implement its potential implications for diagnosis, control and treatment of diseases. The present study investigates the effectiveness of a distance learning course on genetics and genomics targeted at medical doctors.

METHODS

In the context of a project funded by the Italian Ministry of Health, we developed a distance learning course, entitled Genetics and Genomics practice. The course focused on genetic/genomics testing, pharmacogenetics and oncogenomics and was developed according to andragogical training methods (Problem-based Learning and Case-based Learning). We used a pre-test vs. post-test study design to assess knowledge improvement on a set of 10 Multiple Choice Questions (MCQs). We analyzed the proportion of correct answers for each question pre and post-test and the mean score difference stratified by gender, age, professional status and medical discipline. Moreover, the test was submitted to the participants 8 months after the conclusion of the course (follow-up), in order to assess the retained knowledge.

RESULTS

The course was completed by 1,637 Italian physicians, most of which were primary care physicians (20.8%), public health professionals (11.5%) and specialist pediatricians (10.6%). The proportion of correct answers increased in the post-test for all the MCQs. The overall mean score significantly increased, from 59.46 in the pre-test to 71.42 in the post-test (p < 0.0001). The comparison in test performance between follow-up and pre-test demonstrated an overall knowledge improvement.

CONCLUSION

Genomics literacy among healthcare professionals is essential to ensure optimal translation to healthcare delivery of research. The results of this course suggest that distance-learning training in genetic/genomics practice represents an effective method to improve physicians' knowledge in the immediate and mid-term time scale. A preprint version of this paper is available at: https://www.researchsquare.com/article/rs-10083/v1.

The use of structured debate as a teaching strategy among undergraduate nursing students: A systematic review

BACKGROUND

Nurse educators are required to prepare graduates for the increasing complexities of the practice environment. Debate is an active teaching strategy long recognised in many disciplines to promote student-centred learning by enhancing the development of communication skills, collaboration, and critical thinking, all of which are essential skill for future nurses.

OBJECTIVES

The aim of this study was to compare in-class university structured debate implementation methods among undergraduate nursing students, and to identify the effect of such debate methods in the students' learning.

DESIGN

A systematic review of the literature.

DATA SOURCES

Publications in English identified in multiple databases (PubMed, CINAHL, Web of Science, Medline and ERIC) from the launch of the database until 26th November 2019.

REVIEW METHOD

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guided the review. Studies that investigated the use of in-class debate among undergraduate nursing students as a pedagogical tool were eligible. Information related to the study design, debate process characteristics, evaluation method of the teaching strategy and results were collected.

RESULTS

We identified 14 relevant studies describing structured implementation of debate, 11 of which were instructional design and 3 quasi-experimental studies. Heterogeneity was found across the papers regarding topics, timing schedules, group formation and positioning. Most of the studies evaluated implementation using satisfaction questionnaires or subjective observations. Three quasi-experimental studies reported that implementation of debating improved declarative capacity, argumentative capacity, idealistic moral judgment, and realistic moral judgment.

CONCLUSIONS

Current studies do not provide enough evidence to understand the scope of structured debating as an instrument to develop personal competences needed in nursing. However, based on the evidence reviewed, we have identified elements to establish a debate-based learning format that might enhance student's learning and future studies.

Exploring mechanisms underlying learning from deliberate reflection: An experimental study

INTRODUCTION

Previous research suggests that, relative to generating a differential diagnosis, deliberate reflection during practice with clinical cases fosters learning from a subsequently studied scientific text and promotes interest in the subject matter. The present experiment aimed to replicate these findings and to examine whether motivational or cognitive mechanisms, or both, underlie the positive effects of reflection.

METHODS

A total of 101 5th-year medical students participated in an experiment containing four phases: Students (a) diagnosed two clinical cases of jaundice-related diseases either through deliberate reflection or differential diagnosis; (b) reported their situational interest and awareness of knowledge gaps; (c) studied a text about jaundice, either under free or restricted time; and (d) recalled the text. Outcome measures were text-recall, situational interest and awareness of knowledge gaps.

RESULTS

A main effect of diagnostic approach on recall of the text was found, with the reflection group recalling more studied material than the differential diagnosis group (means: 72.56 vs 58.80; P = .01). No interaction between diagnostic approach and study time (free or restricted) emerged, nor was there a main effect of the latter. Relative to the differential diagnosis group, students who reflected upon the cases scored significantly higher on both situational interest (means: 4.45 vs 3.99, P < .001) and awareness of knowledge gaps (means: 4.13 vs 3.85, P < .01).

DISCUSSION

Relative to generating differential diagnoses, reflection upon clinical cases increased learning outcomes on a subsequent study task, an effect that was independent of study time, suggesting that cognitive mechanisms underlie this effect, rather than increases in motivation to study. However, higher scores on situational interest and awareness of knowledge gaps and a tendency towards larger gains when time was free suggest that higher motivation may also contribute to learning from reflection.

Medical education in times of COVID – 19: an experience at Faculdade Pernambucana da Saúde

Abstract Objectives: to describe and discuss interventions and strategies carried out at Faculdade Pernambucana de Saúde (FPS) during the COVID-19 pandemic to mitigate impairment in learning and preserve students, tutors, and staff’s health. Experience report: the teaching methodology used by FPS is problem-based learning, which greatly facilitated the non-discontinuity of theoretical activities carried out in-person in tutorial sessions involving a tutor and 10 to 12 students. This format was transferred to Webex Meetings rooms and held remotely. Practical laboratory activities were suspended and resumed when allowed in July. The teaching outpatient activities (third and fourth year) were suspended and resumed in August. Two years of internship were interrupted for 30 days (fifth year) and for 15 days (sixth year). External activities of practices in primary care were also suspended and resumed gradually. All assessments and activities that required face-to-face meetings, integrations, scientific initiation program orientations, collegiate meetings, meetings of the self-assessment committee were and are being carried out remotely. Conclusions: we believe that we were able to mitigate impairment in students' learning without compromising the conclusion of the school year that was facilitated by Problem Based Learning method.