1 Problem Based Learning and organ / system based integration Dr. Md. Ekhlasur Rahman Associate Professor of paediatrics Mymensingh Medical College

2 ‘Spoon feeding in the long run teaches us nothing but the shape of the spoon’ - E M Forrester

3 Learning objectives At the end of the session, the participants will be able to ïlist innovations in ME ïdescribe the changing medical education in South - East Asia Region ïdescribe a health problem ïlist goals of PBL ïnarrate the clinical reasoning process ïdescribe the role of a facilitator

4 Preamble Many Medical schools globally place too much emphasis on memorization of facts & too little on problem solving of self directed learning WHO promoting ROME to address the needs of the community by inclusion of innovations of Medical Education in South-East Asia region, since mid seventies.

5 Innovations in Medical education include Behavioral Sciences Community orientation Problem Based learning Self directed learning Integrated teaching Educational media Assessment and information technology Innovations in Medical education

6 Changing Medical Education in South -East Asia Region Thailand : Curriculum Development 1. Traditional curriculum (1974)Knowledge + Clinical sk ills 2. MESRAP (1978)COME + PBL  Attitude, Problem solving  3. CTPB (1988)COME+PBL, Problem solving , Attitude  4. CT LB PB (1993) COME covers 16% of curriculum time. CU (1947), a regional training center

7 Changing Medical Education in South -East Asia Region... India The CHAD program in CMC Vellore provides integrated community based, Problem oriented Medical Education, and using block posting. A regional training center. COME covers 12% of curriculum. Myanmar Introduced COME 15 years back, and PBL into an established curriculum in premedical course (1st year) since COME and PBL covers 15% of curriculum.

8 Changing Medical Education in South -East Asia Region …... Nepal Foreign Consultants developed curriculum. COME and PBL introduced; COME is effective, but PBL is on the verge of failure. COME covers 23% of curriculum. Indonesia COME is practiced. Little PBL has been introduced, little chance of success

9 Changing Medical Education in South -East Asia Region …... Srilanka The whole island is well covered, down to the grass root level, by health services. Developed a system of post-graduate medical education -PGIM began to function properly since It provides degrees and training on different specialities including Medical Education and Community Medicine since 1993.

10 Changing Medical Education in South -East Asia Region …... Bangladesh 1988 undergraduate medical curriculum was made community oriented by incorporating Community Medicine from 1st year to the 5th year MBBS course. Topic specific integrated teaching had also been recommended. The newer curriculum developed under the auspices of FIMC has been made more community and problem oriented. WHO recently has selected Mymensingh Medical College, for the first time in Bangladesh, to pilot PBL.

11 “ One change always leaves the way open for the introduction of others” - N Machiavelli

12 Health problem A health problem is a situation about which the learner knows some information, and by seeking in some prescribed way, can find more. Health problems should satisfy Some or all of the following Criteria 1. Prevalence 2. Life threatening 3. Prototypically 4. Professional skills 5. Interdisciplinary nature 6. usefulness of illustrating basic mechanism

13 Patterns of health problems Stage 1: Introductory problems with emphasis on basic concepts for example : injury response, Immunization, electrolyte regulation. Stage 2: Problem desgined around organ / systems for example : Congestive Heart failure, Hypertension (CVS), Hematuria, Acute renal failure (Renal system). Stage 3: Multi-system Problems for example : Convulsion, Anasarca, Dyspnoea, Abdominal pain.

14 Health problems... Health problems may be presented as –Scenario ( paper problems), – real patient, – video recordings of a real patient or simulated by an actor Health problems are usually presented to a student with a learning guide; tutor guide is prepared by the teacher.

15 Problem based learning (PBL) PBL is an educational format that is based on discussion and learning about a clinically -based problem.

16 Goals of PBL 1. To improve the motivation of the students 2. To stimulate integration of disciplines 3. To stimulate small group learning and development of interpersonal communication skills 4. To improve self directed and long term learning 5. To improve critical thinking, clinical reasoning, decision making and problem solving 6. To make education more student oriented 7. To stimulate formative evaluation.

17 “ You can not teach a man anything, you can only help him find it within himself” - Galileo

18 Outline of the clinical reasoning process Identify problems General Hypothesis of causes (D/D) Rank hypothesis Test hypotheses a. Current data and knowledge b New Data and knowledge Re-rank hypothesis (most likely hypothesis is the provisional diagnosis) Make hypothesis of mechanism - how problems occur Treat (to manage problems

19 Role of a tutor 1. Follow problem based learning concept (using tutor guide) 2. Identify resources 3. Stimulate thinking 4. Keep discussion on track, facilitate discussion 5. Assist student to achieve objectives 6. Give information (if necessary by non-directed answers, can contribute) 7. Feedback and evaluation

20 “Nothing can be taught, everything can be learnt.” Chinese proverb