1. PHASE 1 PHILOSOPHY AND DESIRED OUTCOMES Problem Based Learning

2. What is Problem based learning?

3. PBL Defining features? Encourages students to develop clinical reasoning Student centred style of learning that uses problems / case scenarios as the impetus for discussion and learning

4. PBL Encourages students to support their hypotheses with a basic science explanation Focuses the student on relevant anatomy, physiology, pathophysiology as well as patient factors Requires the student to justify their hypotheses based on the interpretation of the clinical information presented in the case

5. PBL Goals Goals of PBL (Barrows 1986) 1. Structuring knowledge for use in working contexts 2. Developing effective reasoning processes 3. Developing self directed learning skills 4. Increased motivation for learning 5. Developing group skills, working with colleagues

6. PBL process Small group (8 students) Identify the problems in each case scenario Generate hypotheses (possible causes etc) Look for more information(construct an enquiry plan) Refine the hypotheses Find learning goals and identify knowledge gaps Research information to achieve the goals

7. Why use PBL? Cognitive / clinical reasoning skills (the thinking and decision making process which is integral to clinical practice) Self directed learning Application of knowledge Interpersonal and communication skills teamwork

8. Why use PBL in the medical curriculum? Collective wisdom Clinical reasoning is a central component to physician competence (and objectives related to the mastery of clinical reasoning skills appear in the documentation of most medical schools) Norman G: 2005

9. Why use PBL in the medical curriculum? One of the core tasks assigned to clinical teachers is to enable students to sort through a cluster of features presented by a patient and accurately assign a diagnostic label Eva K: 2004

10. Why use PBL in the medical curriculum? Clinical reasoning is the foundation of professional clinical practice; in the absence of sound clinical reasoning, clinical practice becomes a technical operation requiring direction from a decision maker. Higgs J and Jones M: 2000

11. Student PBL skills Develop ability to deal with uncertainty Generate hypotheses Develop an enquiry plan Integrate knowledge from basic and clinical sciences Identify learning goals Use resource to construct new information Interpret the results of investigations and apply new knowledge

12. PBL tutor/ facilitator Facilitation is not about detailed content, answering questions or providing a lecture It is about : helping the group deal with big concepts Identifying open ended questions to encourage discussion Understanding the learning needs of the group Keeping the group task focussed Guiding achievement of goals

13. Shortcomings of PBL Resource intensive May not suit all learning styles May inhibit talents and skills of expert teachers Some teachers may not be able to facilitate the PBL process effectively Time intensive for students

14. Effective Teaching 3 models of thinking about teaching: (First 2 are “blame” models) 1. Blame the learner (Focus on what students are) 2. Blame the teacher (Focus on what teachers do) 3. Third model integrates learning and teaching. (Focus on what the student does)

15. Effective Teaching This defines 3 levels of thinking about teaching 1. Level 1- teachers role is to display information, students to absorb it. If the student is unable to do this then this is the students problem 2. Level 2- the teachers role is to explain concepts and principles and present information. They need various skills, techniques and competencies to do this and so the focus is on what the teacher does rather than on the student 3. Level 3- focus is on what the student does- are they engaging? If not, what sort of context would best help them? How can I know they have achieved intended outcomes?

16. Focus on what the Student DOES Level 3 ! Student centred model of teaching 2 main theories behind this concept (phenomenography and constructivism) Both agree that effective learning changes the way we see the world. The acquisition of information in itself does not bring about a change but rather the way we structure that information and think with it.

17. Effective Teaching and Learning 1. Is it clear to both student and teacher what the intended outcomes of learning are? 2. Does the student experience the need to “get there”? If not initially motivated, the art of good teaching will communicate the need to the student 3. Does the student feel free to focus on the task? 4. Can the students work collaboratively and in dialogue with others?

18. Effective Teaching and Learning Surface Versus Deep

19. Surface approach to learning Student side: Student intention to achieve minimal pass Non academic > Academic priorities Insufficient time / Misunderstand requirements Teacher side: Teaching piecemeal by bullet lists Assessing for independent facts Teaching in a way that encourages cynicism ( I hate teaching this session but we have to cover it) Providing insufficient time to cover tasks Creating undue anxiety or low expectations of success (“anyone who can’t understand this shouldn't be here”)

20. Deep approach to learning Student side Intention to engage the task meaningfully and appropriately Appropriate background knowledge Ability to focus at high conceptual level Genuine preference, and ability for working conceptually rather than with unrelated detail Teacher side

21. Deep approach to learning Teacher side Teaching in a way to bring out structure of the topic Teaching to elicit an active response Teaching by building on what students already know Confronting and eradicating students misconceptions Assessing for structure rather than independent facts Teaching and assessing to encourage a positive working atmosphere so students can make mistakes and learn from them Emphasising depth of learning rather than breadth of cover Using teaching and assessment methods that support the explicit aims and intended outcomes of the course (constructive alignment)

22. Effective Teaching and Learning Biggs and Tang Third edition

23. Effective Learning Problem Based Learning How do these teaching and learning characteristics relate to “PBL”?

24. Effective learning whilst doing PBL Because students learn a variety of skills, not just knowledge. PBL is designed to develop:  Integrated, context-specific knowledge base  Decision-making / critical thinking processes and skills  Self-directed, life-long learning skills  Interpersonal, collaborative and communication skills  Constructive self, peer and group assessment skills  Professional ethics and behaviour PROVIDED THE PRINCIPLES OF PBL ARE BEING ADHERED TO

25. What does PBL look like? What are learning issues? (2002. Faculty and student guide: PBL tutorials. Division of Educational Development & Research, Teacher & Educational Development, University of New Mexico School of Medicine)

26. Learning Issues (LOs) Are best phrased as ‘how’ (rather than ‘what’) focused questions Identify what is needed to move students to the next level of understanding Provide a bridge for linking pre-existing knowledge to new knowledge Can be identified at any step and at any time as the learning process unfolds Should be researched between sessions and discussed the following session Should be researched by all members of the group rather than divided up

27. Effective Learning Teaching for Quality Learning at University, Biggs & Tang 3 rd Edition p 152 “PBL is alignment itself. If the aim is to become a Doctor then the best way of becoming one is being one, under appropriate guidance and safeguards. If the ILO is to make clinical diagnoses then making clinical diagnoses is the obvious teaching/learning activity and how well they are made is the obvious assessment task.”

28. Effective Learning Teaching for Quality Learning at university, Biggs & Tang 3 rd Edition p 152 “In a fully blown PBL program the learner is ready to move directly into the workforce. Less content may well be covered than in a traditional programme but the knowledge so gained is acquired in a working context and is put back to use in that context. Coverage, so dominant in discipline centred teaching is considered less important. Instead, students learn the skill for seeking out the required knowledge as the occasion demands.”

29. PBL variables PBL varies according to 2 major variables: i. The degree to which the problem is structured ii. The extent of the teacher direction The optimal amount of structure to the problem, and of teacher direction depends at least initially with the educational philosophy of the teachers and tutors participating and what freedom the students can handle.

30. PBL session structure PBL cases comprise 3 tutorials Tutorial 1 (Med 1000- Friday afternoon, Med2000 – Tuesday morning) 2 hours Tutorial 2 (Med1000- Wednesday morning, Med2000 – student led, no tutor input, Friday afternoon) 2 hours Tutorial 3 (Med1000 – Friday morning, Med2000 – Tuesday morning) 1 hour

31. Tutorial 1 Students should: Identify key information in triggers “What do we know?” Generate a list of hypotheses for each problem identified Develop an enquiry plan “What do we need to know?” Use information from basic sciences to build mechanisms to explain each hypothesis Formulate Learning Goals

32. Tutorial 1 Tutors should: Facilitate the students in the PBL process by asking questions, assist in refining hypotheses and formulating questions to address learning goals Remember all groups will be different in terms of experiences and background so learning goals will differ from group to group Review the Key Learning Objective Questions for each trigger to ensure they are covered by students

33. Tutorial 2 Students should: Discuss learning goals identified in tutorial 1. Use knowledge gained to explain issues raised Identify information sources that could help refine the hypotheses Analyse, evaluate and interpret the data provided from any tests and investigations Refine the hypotheses and identify evidence to support these views Discuss overall management goals and available options

34. Tutorial 2 Tutors should: Monitor how the group is working as a team and the contribution each member is making Assist the students in interpreting data Utilise opportunities to integrate empathy and reflection into the PBL Incorporate relevant experiences as a practising clinician into the PBL Review the key learning objective questions for each trigger

35. Tutorial 3 Students should: Review the case and determine if there are any identified learning goals or issues that have not been addressed Review how they have functioned as a group and if there are any issues that need addressing

36. Tutorial 3 Tutors should: Monitor how the group is working as a team and the contribution that each member is making to the process Review the key learning objective questions for the case Remember NO NEW INFORMATION should be introduced. This tutorial is for FINALISING learning goals