Introducing a problem-based learning program: 12 tips for success

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.

Needs assessment of essential anatomy: The perspective of adult primary care resident physicians

Curricular development and modification involve first identifying a problem and then performing a needs assessment, which can guide the design of curricular components. Pedagogical changes, coupled with reductions in curricular time for gross anatomy, pose challenges and impose restrictions within medical school curricula. In order to make anatomy education effective and efficient, it is important to determine the anatomy considered essential for medical education through a targeted needs assessment. In this study, 50 adult primary care resident physicians in family medicine (FM) and internal medicine (IM) were surveyed to assess the importance of 907 anatomical structures, or groups of structures, across all anatomical regions from a curated list based on the boldface terms in four primary anatomy texts. There were no statistically significant differences in the ratings of structures between the two groups for any anatomical region. In total, 17.0% of structures, or groups of structures, were classified as essential, 58.0% as more important, 24.4% as less important, and 0.7% as not important. FM residents rated tissues classified as skeleton, nerves, fasciae, anatomical spaces, blood vessels, lymphatics, and surface anatomy (p < 0.0001) significantly higher than IM residents, but there were no differences in the rating of muscles or organs (p > 0.0056). It was notable that 100.0% of cranial nerves were classified as essential, and 94.5% of surface anatomy structures were classified as essential or more important. It is proposed that results of this study can serve to inform curricular development and revision.

Effectiveness of tutor shadowing on faculty development in problem-based learning

BACKGROUND

To enhance tutors' teaching skills, tutor shadowing for novice tutors of problem-based learning (PBL) in addition to conventional faculty development (FD) was applied. This study aimed to develop a tutoring-skill scale (TS-scale) and evaluate the effect of shadowing on PBL tutors.

METHODS

This study employed a before-and-after study design with three phases. In phase 1, a TS-scale was elaborated. A validity examination was performed in phase 2. Phase 3 was a study of the effectiveness using a TS-scale survey of novice PBL tutors before and after the FD course. The FD course for novice PBL tutors included an FD workshop and PBL shadowing activities.

RESULTS

A TS-scale with a 32-item questionnaire of self-rated confidence for PBL tutors was identified in phase 1. In phase 2, 7 experienced specialists in medical education were invited to evaluate the content validity of the scale. The item content validity index (I-CVI) ranged from 0.86 to 1, and the scale-CVI (S-CVI) was 0.95. A total of 85 novice PBL tutors completed the TS-scale before the FD course, yielding a Cronbach's alpha of 0.98. An exploratory factor analysis with varimax rotation was performed. The twenty-four items with significant loadings greater than 0.5 were incorporated into a new TS-scale and were grouped into three factors: student contact, medical expertise, and teaching expertise. In phase 3, 76 novice PBL tutors completed the 24-item TS-scale before (pretest) and after (posttest) the FD course. Their self-rated confidence improved significantly across the three factors after the FD course. The pretest and posttest scores did not differ according to the tutors' gender, the grades they taught, or their specialty background.

CONCLUSIONS

Novice PBL tutors benefit from FD that incorporates tutor shadowing in the 3 key domains of tutoring competencies. The TS-scale developed in this study can be applied in future research on FD design.

Afghan Lecturers’ Perception of Problem-Based Learning: A Case Study of Takhar University

The study investigated the lecturers’ perceptions of problem-based learning (PBL); their attitudes towards PBL, their views of effects of PBL on the learning process and the factors for not employing PBL in their courses. A survey questionnaire was used to collect data from 40 randomly selected lecturers from Takhar University. Descriptive and inferential statistics were used to analyze the data. The findings showed that lecturers had strong positive attitudes towards PBL and they were interested in utilizing PBL in their teaching activities. They were aware of the effects of PBL on the learning process particularly students’ learning. They believed that PBL could help students develop a variety of generic skills, e.g., communication and problem-solving skills, which are necessary for employment. However, most of the participants did not make use of PBL in their courses for various reasons such as large number of students in their classes and lack of appropriate infrastructure. The lecturers’ gender, level of education and years of teaching experiences did not have any significant impact on their responses.

Does problem-based learning education improve knowledge, attitude, and perception toward patient safety among nursing students? A randomized controlled trial

Background

Patient safety is a top priority for any health care system. Most universities are looking for teaching methods through which they would be able to enhance students’ clinical decision-making capabilities and their self-centered learning to ensure safe and quality nursing care. Therefore, this study aimed to determine the effect of patient safety education through problem-based learning (PBL) on nursing students’ knowledge, attitude, and perceptions toward patient safety.

Methods

This randomized, controlled trial was conducted from September 2019 to January 2020. A total of 78 fourth-year nursing students participated in this study. The participants were randomly assigned to either the intervention group or the control group. In the intervention group, the educational materials were presented to the students using the PBL method during eight sessions of 45–60 min. In each control group, nursing students received eight education sessions through lectures and discussing the same educational content. Data were gathered 1 month after the intervention using demographic information and knowledge, attitudes, and perception questionnaires. Data were analyzed in SPSS ver. 22.0 using descriptive (mean and standard deviation) and inferential (chi-square test, independent t-test, paired t-test, and analysis of covariance (ANCOVA)) statistics.

Results

The results indicated that the difference in the mean scores of knowledge, attitudes, and perceptions of the nursing students about patient safety was statistically significant between the two groups after the PBL education (p = 0.001). The mean scores of students’ knowledge, attitude, and perceptions of patient safety increased significantly in the intervention group.

Conclusions

Implementing patient safety education through PBL positively affects knowledge, attitudes, and perceptions of patient safety among nursing students. Thus, the research team recommended the PBL method to be used by nursing professors to improve nursing students’ clinical skills and cognitive abilities to ensure safe patient care.

Trial registration

IRCT20190925044881N1; October 17, 2019.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12912-021-00588-1.

Should the PBL tutor be present? A cross-sectional study of group effectiveness in synchronous and asynchronous settings

BACKGROUND

The tutorial group and its dynamics are a cornerstone of problem-based learning (PBL). The tutor's support varies according to the setting, and it is pertinent to explore group effectiveness in relation to different settings, for example online or campus-based. The PBL groups' effectiveness can partly be assessed in terms of cognitive and motivational aspects, using a self-report tool to measure PBL group effectiveness, the Tutorial Group Effectiveness Instrument (TGEI). This study's aim was to explore tutor participation in variations of online and campus-based tutorial groups in relation to group effectiveness. A secondary aim was to validate a tool for assessing tutorial group effectiveness in a Swedish context.

METHODS

A cross-sectional study was conducted with advanced-level nursing students studying to become specialised nurses or midwives at a Swedish university. The TGEI was used to measure motivational and cognitive aspects in addition to overall group effectiveness. The instrument's items were translated into Swedish and refined with an expert group and students. The responses were calculated descriptively and compared between groups using the Mann-Whitney U and Kruskal-Wallis tests. A psychometric evaluation was performed using the Mokken scale analysis. The subscale scores were compared between three different tutor settings: the tutor present face-to-face in the room, the tutor present online and the consultant tutor not present in the room and giving support asynchronously.

RESULTS

All the invited students (n = 221) participated in the study. There were no differences in motivational or cognitive aspects between students with or without prior PBL experience, nor between men and women. Higher scores were identified on cognitive aspects (22.6, 24.6 and 21.3; p < 0.001), motivational aspects (26.3, 27 and 24.5; p = 002) and group effectiveness (4.1, 4.3, 3.8, p = 0.02) for the two synchronously tutored groups compared to the asynchronously tutored group. The TGEI subscales showed adequate homogeneity.

CONCLUSIONS

The tutor's presence is productive for PBL group effectiveness. However, the tutor need not be in the actual room but can provide support in online settings as long as the tutoring is synchronous.

Case-based modeling: fostering expertise development and small group learning

Purpose

This paper aims to present a detailed explication of a learner-centered instructional approach for adults labeled case-based modeling (CBM). The approach is an example of integrative pedagogy aimed at expertise development and is an extension of other instructional approaches, namely, problem-based learning (PBL) and case-based learning (CBL).

Design/methodology/approach

The design of the paper contains several integrated components to include: an explanation of the needs and characteristics of the adult learner, comparisons of CBM with both PBL and CBL, a complete theory grounding of the method, a detailed expression of the entire CBM method (phases and steps) for explanation and replication purposes, linkages of CBM with performance, and an empirical test of the CBM method with a sample of employees.

Findings

First, the CBM method is an extension of the well-researched methods of CBL and PBL. The script preparation and implementation phases of CBM easily could be appended to either CBL or PBL. Second, the empirical test of the CBM method demonstrates that it may be a positive, efficient tool for education/training with employees, although no significant differences were found in work performance comparisons of CBM-trained employees with traditionally trained employees.

Research limitations/implications

The empirical examination has some limitations to include: relatively small sample sizes, lack of demonstration of clear linkage between measures of training performance and measures of job performance, and variations in working conditions of participants.

Originality/value

The CBM approach offers to HR practitioners and persons involved with training an efficient yet comprehensive method. The method makes use of script development for the implementation of various interventions, which stimulate performance improvement and development of expertise.

Celebrating 40 years of Medical Teacher: As the "last man standing" I look back to help us look forward

INTRODUCTION

In this reflective, descriptive, analytical, first-person piece, I offer recollections, data, and literature to help elucidate the emergence of medical education as a scholarly field, as part of celebrating Medical Teacher's 40-year anniversary. I emphasize the impressive growth of the professional literature in medical education, and recognize that much remains to be done.

FINDINGS

Medical education as a domain for research and development has transitioned from being largely ignored during the first 20 of the past 60 years, through a slow growth phase, to rapid acceleration during the last 2 decades. By introducing the use and potential of "edumarkers," we can see that medical education as a focus of scholarly pursuits was absent to minimal before recent decades, and we can identify trends and questions that deserve further exploration. Concern and recommendations: Only a small subset of the large population assigned to instruct health professions learners actually conducts and responds to medical education scholarship. I raise several questions as possible guides to the future for those of us who are devoted to enhancing educational processes and outcomes for learners who are expected to help prevent and manage the health challenges faced by the world's people.

Ensuring Resident Competence: A Narrative Review of the Literature on Group Decision Making to Inform the Work of Clinical Competency Committees

Background The expectation for graduate medical education programs to ensure that trainees are progressing toward competence for unsupervised practice prompted requirements for a committee to make decisions regarding residents' progress, termed a clinical competency committee (CCC). The literature on the composition of these committees and how they share information and render decisions can inform the work of CCCs by highlighting vulnerabilities and best practices. Objective We conducted a narrative review of the literature on group decision making that can help characterize the work of CCCs, including how they are populated and how they use information. Methods English language studies of group decision making in medical education, psychology, and organizational behavior were used. Results The results highlighted 2 major themes. Group member composition showcased the value placed on the complementarity of members' experience and lessons they had learned about performance review through their teaching and committee work. Group processes revealed strengths and limitations in groups' understanding of their work, leader role, and information-sharing procedures. Time pressure was a threat to the quality of group work. Conclusions Implications of the findings include the risks for committees that arise with homogeneous membership, limitations to available resident performance information, and processes that arise through experience rather than deriving from a well-articulated purpose of their work. Recommendations are presented to maximize the effectiveness of CCC processes, including their membership and access to, and interpretation of, information to yield evidence-based, well-reasoned judgments.

Problem-Based Learning as an Effective Learning Tool in Community Medicine: Initiative in a Private Medical College of a Developing Country

BACKGROUND

Knowledge of community medicine is essential for health care professionals to function as efficient primary health care physicians. Medical students learning Community Medicine as a subject are expected to be competent in critical thinking and generic skills so as to analyze community health problems better. However, current teaching by didactic lectures fails to develop these essential skills. Problem-based learning (PBL) could be an effective strategy in this respect. This study was hence done to compare the academic performance of students who were taught Community Medicine by the PBL method with that of students taught by traditional methods, to assess the generic skills of students taught in a PBL environment and to assess the perception of students toward PBL methodology.

MATERIALS AND METHODS

This study was conducted among seventh-semester final-year medical students between June and November 2014. PBL was introduced to a randomly chosen group of students, and their performance in an assessment exam at the end of postings was compared with that of the remaining students. Generic skills and perception toward PBL were also assessed using standardized questionnaires.

RESULTS

A total of 77 students took part in the brainstorming session of PBL. The correlation between self-assigned scores of the participants and those assigned by the tutor in the brainstorming session of PBL was significant (r = 0.266, P = 0.05). Out of 54 students who took part in the presentation session, almost all 53 (98.1%) had good perception toward PBL. Demotivational scores were found to be significantly higher among males (P = 0.024). The academic performance of students (P < 0.001) and success rates (P = 0.05) in the examination were higher among students who took part in PBL compared to controls.

CONCLUSION

PBL helped improve knowledge of students in comparison to those exposed only to didactic lectures. As PBL enabled students to identify the gaps in their knowledge and enhanced their group functioning and generic skills, we recommend PBL sessions: They would help optimize the training in Community Medicine at medical schools. Good correlation of tutor and self-assessment scores of participants in the brainstorming session suggests that the role of tutors could be restricted to assessment in presentation sessions alone. Demotivation, which hinders group performance in PBL, needs to be corrected by counselling and timely feedback by the tutors.

Perception of the faculty regarding problem-based learning as an educational approach in Northwestern Saudi Arabia

Objectives:

To assess the knowledge, attitudes, and practice of medical teachers regarding problem-based learning (PBL) in Northwestern Saudi Arabia.

Methods:

This is a cross-sectional study conducted in the College of Medicine, Taibah University, Al Madinah Al Munawarah, Kingdom of Saudi Arabia, at the beginning of the academic year 2014/2015 where the PBL method had recently been introduced. Medical academic staff (n=110) were invited to participate in the study. Data about staff sociodemographic characteristics, PBL knowledge, attitudes, and practice were collected via a pre-designed structured questionnaire. The collected data were analyzed using appropriate statistical methods.

Results:

The overall response rate was 77.3% (85 out of 110). The proportion of staff having good PBL knowledge was 76.5% (95% CI= 68.5%-84.5%), with the higher proportion being observed among the male staff (79.1%), professors (86%), and associate professors (88%). Significantly higher positive perceptions were found among male and clinical sciences staff. The PBL practice of the studied staff was 35%, with a statistically significant difference observed between male and female staff. Problem-based learning practice was also higher among clinical staff (42%), associate professors (40%), and professors (38%).

Conclusion:

A considerably high proportion of the studied medical staff was found to have good knowledge and favorable attitudes towards PBL. Training courses by the college should be considered for the staffs who have not previously engaged in such learning methods, as well for the junior and new staff.

Group interaction in problem-based learning tutorials: a systematic review

INTRODUCTION

This review aimed at identifying studies on group interaction in problem-based learning (PBL) and elucidate methods used, factors affecting group interaction and the relationship between interaction and student's learning.

MATERIALS AND METHODS

PubMed, EMBASE, PsycINFO and HighWire were searched (January 1999 to June 2013) using a combination of pre-specified search terms. The search words were also used in searching nine journals in dental and medical education. Also edited research books on PBL were searched. Both qualitative and descriptive studies of group interaction were selected and critically appraised.

RESULTS

Finally, 42 of 10,606 papers were included (35 journal articles and seven from research books). The materials used in assessing group interaction varied depending on the methodology design. Forty-three percent of the studies used video recording to evaluate group interaction. Other studies used indirect approaches such as focus groups, interviews and questionnaires. Factors affecting group interactions were students' and tutors' perceptions, tutor's subject-matter expertise, training students, tutor's group dynamics. There was no conclusive evidence about the impact of interaction in PBL on learning. Most studies were from medicine (64%), and 35 papers were published in the last 10 years. The majority of studies were conducted in Europe, North America and Asia.

CONCLUSIONS

Although there is a progressive increase in publications on PBL group interaction during the last 10 years, there are knowledge gaps and deficiencies in this area and most studies are lacking solid theoretical basis and are descriptive. There is a deficiency in the literature in this area from dentistry and other allied health disciplines.

Twelve tips to revitalise problem-based learning

The role of the problem-based learning (PBL) facilitator has seen different interpretations ever since PBL first gained widespread use. What has remained unchanged is the challenge for facilitators to use their knowledge and expertise sparingly and to use their interpersonal skills to improve group dynamics. Medical undergraduates attending PBL sessions have also changed in their skill sets, expectations and the use of technology. Based on the published literature and a recent faculty workshop, we provide PBL facilitators and institutions with 12 tips on how to make PBL more vibrant and interesting. We discuss our tips with reference to published literature and International Academy of Medical Education (AMEE) guidance. Our tips help students to engage with PBL, avoid monotony and make this teaching format more vibrant and fun for all involved. Introducing greater variety to the PBL process may also help with group dynamics by catering for a broader audience with different learning styles.

Medical students' preferences for problem-based learning in relation to culture and personality: a multicultural study

OBJECTIVE

The aim of this study was to explore positive and negative preferences towards problem-based learning in relation to personality traits and socio-cultural context.

METHODS

The study was an anonymous and voluntary cross-sectional survey of medical students (N=449) in hybrid problem-based curricula in Nepal, Norway and North Dakota. Data was collected on gender, age, year of study, cohabitation and medical school. The PBL Preference Inventory identified students' positive and negative preferences in relation to problem-based learning; the personality traits were detected by the NEO Five-Factor Inventory. The determinants of the two kinds of preferences were analyzed by hierarchical multiple linear regressions.

RESULTS

Positive preferences were mostly determined by personality; associations were found with the traits Extra-version, Openness to experience, Conscientiousness and Neuroticism; the first three are related to sociability, curiosity and orderliness, the last, to mental health. The learn-ing environments of such curricula may be supportive for some and unnerving for others who score high on Neuroticism. Negative preferences were rather determined by culture, but also, they correlated with Neuroticism and Conscientiousness. Negative preferences were lower among females and students living in symmetrical relationships. Some high on Conscientiousness disliked group work, and the negative correlation with Agreeableness indicated that less sociable students were not predisposed to this kind of learning activity.

CONCLUSIONS

Preferences related to problem-based learning were significantly and independently determined both by personality traits and culture. More insights into the nature of students' preferences may guide aspects of curriculum modifications and the daily facilitation of groups.

Assessing the effectiveness of problem-based learning of preventive medicine education in China

Problem-based learning (PBL) is defined as a student-centered pedagogy which can provide learners more opportunities for application of knowledge acquired from basic science to the working situations than traditional lecture-based learning (LBL) method. In China, PBL is increasingly popular among preventive medicine educators, and multiple studies have investigated the effectiveness of PBL pedagogy in preventive medicine education. A pooled analysis based on 15 studies was performed to obtain an overall estimate of the effectiveness of PBL on learning outcomes of preventive medicine. Overall, PBL was associated with a significant increase in students' theoretical examination scores (SMD = 0.62, 95% CI = 0.41–0.83) than LBL. For the attitude- and skill-based outcomes, the pooled PBL effects were also significant among learning attitude (OR = 3.62, 95% CI = 2.40–5.16), problem solved skill (OR = 4.80, 95% CI = 2.01–11.46), self-directed learning skill (OR = 5.81, 95% CI = 3.11–10.85), and collaborative skill (OR = 4.21, 95% CI = 0.96–18.45). Sensitivity analysis showed that the exclusion of a single study did not influence the estimation. Our results suggest that PBL of preventive medicine education in China appears to be more effective than LBL in improving knowledge, attitude and skills.

Introducing integrated laboratory classes in a PBL curriculum: impact on student's learning and satisfaction

BACKGROUND

With the introduction of integrated problem-based learning (PBL) program in the medical curriculum, there is a need to create laboratory classes that suit students' learning needs and the changes introduced to the curriculum. This paper outlines the development and implementation of four integrated laboratory classes (ILCs) at King Saud University College of Medicine. It also examines whether core concepts addressed in these classes were learned and retained and how the students perceived the ILCs.

METHODS

ILCs are based on enhancing enquiry-based learning, and encouraging students to work on tasks in small groups (apply and integrate knowledge from biochemistry, pathology and microbiology) and conduct a laboratory procedure (practical part). In two of these ILCs, a pretest comprising 15 multiple-choice questions were administrated at the start of the class and an identical posttest was administrated at the end of these classes. Performance of the students in the Objective Structured Practical Examination (OSPE) at the end of the blocks was also evaluated. Students' perceptions were evaluated using a questionnaire completed at the end of each class.

RESULTS

A total of 247, 252, 238, and 244 students participated in practical classes covering cerebrospinal fluid infection, small intestine, liver function tests and adrenal gland function, respectively. Students got higher scores in posttests compared to pre-test scores in two classes (12.68 ± 2.03 vs 6.58 ± 3.39 and 13.02 ± 2.03 vs 7.43 ± 2.68, respectively). Paired t-test showed that the difference was significant (P < 0.001) in both tests. The mean scores of students in stations dealing with ILCs at the end of the block examinations were not significantly different from the mean scores for other stations not related to ILCs. The questionnaire indicated that most students expressed positive attitude towards working on tasks and applying knowledge learnt. Students also felt that conducting laboratory procedures and interpreting laboratory findings were valuable to their learning.

CONCLUSIONS

Given the increase in the posttest scores (short-term retention) and the satisfactory performance of students at the end of block examinations (long-term retention) together with the students' satisfaction, the study suggests that the core concepts addressed in these classes were learned and retained.

Comparison of three problem-based learning conditions (real patients, digital and paper) with lecture-based learning in a dermatology course: a prospective randomized study from China

BACKGROUND

The precise effect and the quality of different cases used in dermatology problem-based learning (PBL) curricula are yet unclear.

AIM

To prospectively compare the impact of real patients, digital, paper PBL (PPBL) and traditional lecture-based learning (LBL) on academic results and student perceptions.

METHODS

A total of 120 students were randomly allocated into either real-patients PBL (RPBL) group studied via real-patient cases, digital PBL (DPBL) group studied via digital-form cases, PPBL group studied via paper-form cases, or conventional group who received didactic lectures. Academic results were assessed through review of written examination, objective structured clinical examination and student performance scores. A five-point Likert scale questionnaire was used to evaluate student perceptions.

RESULTS

Compared to those receiving lectures only, all PBL participants had better results for written examination, clinical examination and overall performance. Students in RPBL group exhibited better overall performance than those in the other two PBL groups. Real-patient cases were more effective in helping develop students' self-directed learning skills, improving their confidence in future patient encounters and encouraging them to learn more about the discussed condition, compared to digital and paper cases.

CONCLUSION

Both real patient and digital triggers are helpful in improving students' clinical problem-handling skills. However, real patients provide greater benefits to students.