New trends in methods of medical education: Problem Based Learning Prof. Victor Vovc State University of Medicine and Pharmacy “Nicolae Testemitanu” of the Republic of Moldova 1

Reasons for change Medical knowledge expands too rapid and too much to be covered in education Health care becomes multidisciplinary, education should follow Changing health care circumstances for education: patient mix and restricted labour time Educational theory has progressed New technologies enter health care and education Communication, collaboration and professionalism emerge as increasingly important in health care

Innovation in medical education worldwide: Th. Ten Cate, 2006 3

Major trends in medical education Fore-front countries in medical education: Canada UK USA Australia The Netherlands 4

Major trends in medical education From input-based to outcome-based training From passive to active learning From tradition to educational theory based methods of teaching From departmentalized to centralized, integrated curriculum coordination Incorporation of technology and the internet Skills labs and simulation techniques New assessment methodologies Staff development and teacher training 5

New-Innovative Curricula Traditional Medical Curricula SPICES  Continuum  S Teacher-centered Student-centered P Information gathering Problem-based I Discipline-based Integrated C Hospital based Community-based E Standard Elective S Apprenticeship-based Systematic

From input to outcome Don’t start with asking: How much should we teach? (input) But ask first: What competencies should graduates have? (outcome) Objectives of medical training should reflect the needs of society in Moldova Objectives of medical training should meet international standards 7

From Passive listening to Active learning BMJ 2003;326:438 8

From Passive listening to Active learning lecture reading audiovisual demonstration discussion group practicing by doing teaching others 5 10 20 30 50 75 80 average long term retention rate (%) “Learning pyramid”, adapted from: Bales, National Training Laboratories, Bethel, Maine, USA, 1996 9

From Passive listening to Active learning What helps to stimulate activity? Lectures with dialogue Small group teaching Problems to be solved Application of knowledge, not only reproduction in examinations Peer-presentations and other active roles 10

Vertical integration: from H to Z model clinical application theory basis clinical application theory basis 11

Tomorrow’s Doctors, 1993 Reduction in factual overload Increase in learning through curiosity (PBL) Emphasis on clinical skills /communication skills Understanding of Research technology Development of the skills and attitudes that befit a doctor 12 12

Definition of PBL An instructional student-centered approach which uses carefully constructed clinical problems as a context for students to: define their learning needs, conduct self-directed enquiry, integrate theory and practice, and apply knowledge and skills to develop a solution to a defined problem.

The problems (clinical cases) serves as a stimulus for learning

Problem-solving vs. problem-based learning - different but inter-related - Problem-solving: arriving at decisions based on prior knowledge and reasoning Problem-based learning: the process of acquiring new knowledge based on recognition of a need to learn 15

Rationale for introducing PBL into the undergraduate curricula Principles of adult learning Adults are motivated by learning that: Is perceived as relevant Is based on, and builds on, their previous experiences Is participatory and actively involves them Is focused on problems Is designed so that they can take responsibility for their own learning Can be immediately applied in practice Involves cycles of action and reflection Is based on mutual trust and respect The rationale for PBL lies in its comparability with modern educational principles. Its approach is based on principles of adult education and self-directed learning.

Example: PBL tutorial process 1. Case presentation: The tutor provides the group with some introductory clinical information about a hypothetical patient. Mary Smith, a 28-year-old office worker and part-time swimming instructor, comes to see her GP because of pain in her chest and shortness of breath. This has been a recurring problem in recent months and seems to be gradually worse. On the previous evening, while participating in a swimming gala, she became so short of breath that she found it difficult to walk.

Identifying key information Generating and ranking hypotheses: e.g., Infection, cardiac problem, allergy, asthma, broken rib. Allergy ˃ cardiac problem Generate an enquiry strategy: What additional information is required? e.g., Previous medical problems and relevant drug, family & psychosocial histories, physical exam, lab. tests. discuss, extract, identify, summarize brainstorm decide

Hybrid curricula In preclinical phase, PBL can be designed and timetabled so as to complement other teaching methods such as: Lectures Practicals, other laboratory work Computer-assisted learning

TEMPUS Project CD_JEP-25195-2004 PROBMEDFORM PROBLEM BASED MEDICAL EDUCATION FOR MOLDOVA TEMPUS Project CD_JEP-25195-2004

CONSORTIUM Università Cattolica del Sacro Cuore Utrecht University - School of Medical Sciences State University of Medicine and Pharmacy "Nicolae Testemitanu"

WIDER OBJECTIVE Improving the quality of medical education at SUMPh through the introduction of problem based learning (PBL) medical education and participative students evaluation of the teaching process.

SPECIFIC PROJECT OBJECTIVE/S Introduction of problem based learning method at four pilot departments of the SUMPh by the end of year 2006 - 2007. Introduction of evaluation of medical education at four pilot departments of the SUMPh through teachers and students participation in the evaluation process based on medical questionnaires. 24

OUTPUTS AND OUTCOMES Teachers/professors at selected pilot departments became familiar with problem based learning and case studies method. Problem based learning method was introduced in the teaching process at the four pilot departments. Interactive learning techniques were introduced in the teaching process at the four pilot departments.

OUTPUTS AND OUTCOMES A "computer resource centre" was created at SUMPh “Nicolae Testemitanu” Questionnaires of evaluation were developed and used to assess the courses held at the four selected pilot departments Teachers motivation to make the course more interesting have increased; student's awareness of their participation into the improving the quality of their studies were increased  

Dissemination Two reports on the Central Educational Methodological Council of SUMPh; Publication and diffusion at local, national and international level of teaching materials developed within the framework of the project Bulletins of information sent to the target groups; Regular publications on University's newspaper "Medic" as well as in local press; Workshops and seminars for SUMPh teaching staff for dissemination of project results.

Sustainability The PBL and "case based study" will be main goals of future curriculum reform in medical education for Moldova. SMPhU Senate will support the PBL method introduction at every department as an institutional reform. When the PBL method will be implemented at majority of Departments of SMPhU the activities for preparing and perform this kind of teaching will become obligatory for all teaching staff and will be financed by University budget. The "computer resource lab" will remain in place and will continue its activity with funding from SMPhU budget.

Educational materials published in the framework of JEP-25195-2004 29

“Study landscape” – an interactive study center at the SUMPh 30

The rezults of students’ rating of PBL 31

Our students’ opinion about PBL Advantages over traditional approaches: Greater relevance to the practice of medicine; Ability to promote retention and application of knowledge; Encouragement of self-directed life-long learning; Increase motivation to learn.

Disadvantages of PBL Costly Difficult to implement when class sizes are large

Thank you for attention