1. Problem-based learning in public health Instruction: a pilot study of an online simulation as a problem-based learning approach Spinello, E., & Fischbach, R. (2004). Problem-based learning in public health Instruction: a pilot study of an online simulation as a problem-based learning approach. Education for Health: Change in Learning & Practice, 17(3), 365-373. 指導教授： Min-puu Chen 報告者 ： Hui-lan Juan 報告日期： 2006.11.14

2. Introduction Although increasingly used as a modality in medical education, problem-based learning (PBL) remains somewhat overlooked in the training of undergraduate public health students (Pham & Blumberg, 2000). This project involved a pilot test of a web-based community simulation as a PBL platform in an undergraduate health behavior course.

3. PBL In a PBL curriculum,‘‘students are given ill-structured problems through which they develop high order thinking and problem-solving skills’’(Yip,2002,p.303) PBL differs from traditional lecture-based curriculums in that it relies on the use of real or simulated problems to develop critical thinking skills. PBL provides a stimulus and a framework for applying problem-solving skills.

4. Limitations to PBL One limitation is that case studies lack flexibility. Students using traditional case studies can only rely on the Information presented with no ability to interact with individuals involved in the scenario. A second limitation of a text-based scenario is that it may not adequately depict the problem so that a student can ultimately relate it to a real-world situation. Medical students may be at a loss when confronted with a real- world patient. A third limitation involves time and space constraints. Time can be compressed or expanded in a simulation so that the PBL experience can fit into an academic time frme.

5. Purpose The purpose of this study was to develop and pilot test an online community simulation as a PBL curriculum for an undergraduate health behavior course in order to assess the feasibility of an online simulation as a PBL modality. This pilot study : This pilot study involved a semester-long web-based simulation of Lincoln County, a hypothetical US community. The public health challenge concerned an elevated and growing number of tuberculosis cases.

6. Method 28 undergraduate students. Students formed 4 groups. 2 groups were randomly assigned to the simulation exercise, while 2 groups were assigned the traditional course project. A survey was administered to all students to determined their attitudes about the two learning modalities. Students were asked to assess their interest in the simulation, anxiety in completing the exercise, group interaction and the perceived usefulness of the simulation, all in comparison to assignment in other courses they had taken. Two focus groups were held with students.

7. Results (1/4) What they disliked most about the simulation, students focus on technical aspects of the environment. Occasional long delays between the time. The lack of formatting for communications from students to the simulation characters. A lack of understanding as to what was possible within the environment. The environment included a hyperlink that was used for students to submit recommendations.

8. Results (2/4) What changes should be made to the simulation, students also tended to focus on technical aspects of the simulation. Making available examples of the types of communications that could be initiated by the students. Providing the ability to communicate in a synchronous environment with simulation characters. Providing more biographical information about the simulation characters. Providing a planning calendar to which group members could contribute in order to help organize scheduling.

9. Results (3/4) Students most frequently reported the following positive aspects of the simulations: Students believed the issues faced in resolving a real-world health problem. Ability to see public health outcomes associated with an intervention. Flexibility to work on the problem at convenient times and places. The experience of applying newly acquired skills to a realistic problem.

10. Results (4/4) ANOVA Final scores showed no significant difference in the average overall score (p=0.64) for the non-simulation students in comparison to those participating in the simulation. Simulation produced less anxiety than traditional group (p=0.12); The ability to view outcomes resulting from their interventions was valuable part of the exercise (p=0.13) Simulation students reported the experience was more interesting (p=0.37) and more motivating (p=0.19) in comparison to non-simulation students. (no statistically significant)

11. Conclusions Students participating in the simulation perceived the experience as helpful in providing a clear context for the application of health behavior theory and as a motivating experience overall. Feedback provided by students will be used to produce an enhanced simulation that will be evaluated further to determine its educational potential as compared to the traditionally assigned reality-based project.