Problem-based Learning (PBL) An introduction to the Concept, its Rationale and Process Gene A. Kallenberg, M.D. Suraj Achar, M.D. MEDS – 11/2/06

Goal: To generate interest in further development of PBL curricular offerings at UCSD Objectives: By the end of the presentation participants will: 1)understand the rationale and be familiar with the process of conducting PBL session 2)develop an interest in developing an/or participating in a PBL pilot – and in developing a PBL strand at UCSD

Background of PBL in US Medical Schools: Started at McMaster University in 1969 Started at McMaster University in % use PBL in some way (03-04 data) 70% use PBL in some way (03-04 data) 45% use it for half of their time 45% use it for half of their time Of the 30% not using, 22% had used it in the past and 2% planning to use it in the future Of the 30% not using, 22% had used it in the past and 2% planning to use it in the future Widespread experimentation/adoption in many countries around the world (Canada, Australia, NZ, Europe, Asian nations, SA nations, India, Africa) Widespread experimentation/adoption in many countries around the world (Canada, Australia, NZ, Europe, Asian nations, SA nations, India, Africa)

Background of PBL in US Medical Schools: con’t. Results: Results: –Has not demonstrated any decrease in objective KB testing and in a number of situations demonstrates an associated improvement in performance –Most reports of attitudes of faculty and students are positive (though there are some negative reports) –Concerns include: Resource-intense to mount (faculty facilitators) Resource-intense to mount (faculty facilitators) Lack of demonstrated measured superiority over the long haul Lack of demonstrated measured superiority over the long haul Less “efficient” than traditional methods Less “efficient” than traditional methods Tutor/facilitator background and training Tutor/facilitator background and training

General Pedagogical Rationale for PBL: Actively involves students in the process of defining the learning objectives Actively involves students in the process of defining the learning objectives Exposes students to meta-cognition through the act of assessing what s/he does and does not know Exposes students to meta-cognition through the act of assessing what s/he does and does not know –Allows students to function in the future as their learned KB changes with the advance of science –Allows students to adjust to the variations in cases they will see in practice from the “classic case” they learned on

General Pedagogical Rationale for PBL: con’t. Promotes problem-solving and reflection on material as it applies clinically Promotes problem-solving and reflection on material as it applies clinically Promotes clinical judgment in distinguishing important/relevant facts from those which are often present as background context/”noise” Promotes clinical judgment in distinguishing important/relevant facts from those which are often present as background context/”noise” Promotes group process skills including peer evaluation skills Promotes group process skills including peer evaluation skills Models the way clinicians work in real practice settings Models the way clinicians work in real practice settings

How to Conduct a PBL Session: Identification of roles of tutor/facilitator; student leader (if present), group Identification of roles of tutor/facilitator; student leader (if present), group Case presentation in appropriate dosing Case presentation in appropriate dosing Use of general structure: Use of general structure: –Problems [or Problem List] –Hypotheses [or Differential Diagnosis] –“To Do” List –Learning Issues – importance of defining these properly

How to Conduct a PBL Session: con’t. Division of Learning Issues and “Homework” Division of Learning Issues and “Homework” –Nature of homework Relevance to answering questions about managing this case Relevance to answering questions about managing this case Inclusion of process of finding/gathering information (e.g. choice of resources, search strategies used, etc.) Inclusion of process of finding/gathering information (e.g. choice of resources, search strategies used, etc.) –Sharing of homework with group members prior to f/u session

How to Conduct a PBL Session: con’t. Follow-up session: Follow-up session: –Review case to present –Discuss managing case and order topics along a progression from etiology, diagnosis, therapy –Calling on the “experts” rather than mini- lectures –Identify additional issues for resolution –distribute additional data if present and continue process or wrap up

PBL at George Washington University School of Medicine Overall objectives span 3 content areas: Overall objectives span 3 content areas: –biomedical – chosen by BS faculty but adhering to the principle of being “epidemiologically correct” –psychosocial – developed by PC faculty –clinical decision-making – developed by PC faculty Case teams of basic science, specialist and primary care faculty developed the cases with central oversight for uniformity Case teams of basic science, specialist and primary care faculty developed the cases with central oversight for uniformity Library/information systems searching skills taught early in program Library/information systems searching skills taught early in program

PBL at George Washington University School of Medicine con’t. Cases spanned the life cycle twice through the 2 years as normal growth and development was a standard component of the psychosocial objectives Cases spanned the life cycle twice through the 2 years as normal growth and development was a standard component of the psychosocial objectives Approximately 8-10 objectives for each case which spans a 4 week period Approximately 8-10 objectives for each case which spans a 4 week period One continuity faculty “tutor” who can be either a clinician or a basic scientist One continuity faculty “tutor” who can be either a clinician or a basic scientist 3 2-hour sessions a week apart followed by an all-class wrap up session with a real patient and his/her PCP 3 2-hour sessions a week apart followed by an all-class wrap up session with a real patient and his/her PCP Cases in year two second semester become 2 weeks long to parallel the Introduction to Clinical Medicine/Pathology system-based units Cases in year two second semester become 2 weeks long to parallel the Introduction to Clinical Medicine/Pathology system-based units PBL triple-jump exam PBL triple-jump exam

PBL Pilot Efforts at UCSD: Conversion of “clinical correlation” sessions to PBL Conversion of “clinical correlation” sessions to PBL 2-week cases in ERM at the end of MSI year: 2-week cases in ERM at the end of MSI year: –Atherosclerosis (CAD/PVD) and hyperlipidemia –Polycystic Ovary Syndrome (PCOS) [see handout] –Calcium metabolism and osteoporosis case (to be done spring 07) –Planning for an asthma case in CBB with Joe Ramsdell 2-session case in Anatomy in MSII: 2-session case in Anatomy in MSII: –Sports Medicine case [see handout] Primary Care Clerkship: Primary Care Clerkship: –Fatigue case SOM Principles to Practice–MSIV–Renate Pilz, M.D. SOM Principles to Practice–MSIV–Renate Pilz, M.D.

Vision for the Future at UCSD: a continuous thread of PBL cases throughout MSI-II-(III) a continuous thread of PBL cases throughout MSI-II-(III) a continuity tutor/facilitator + a collaborating content expert from each course [during the contemporaneous time of each course] a continuity tutor/facilitator + a collaborating content expert from each course [during the contemporaneous time of each course] cases that include a complete span of objectives represented by the biopsychosocial model of care cases that include a complete span of objectives represented by the biopsychosocial model of care cases would be developed with full input from select basic science and clinical [specialty, primary care and psychiatry/psychology] faculty with oversight by the Associate Dean for Undergraduate Medical Education cases would be developed with full input from select basic science and clinical [specialty, primary care and psychiatry/psychology] faculty with oversight by the Associate Dean for Undergraduate Medical Education a unique UCSD component could be a sub-thread on how the management of each disease entity will evolve in the next years – which would take advantage of the outstanding science that is being carried out at UCSD a unique UCSD component could be a sub-thread on how the management of each disease entity will evolve in the next years – which would take advantage of the outstanding science that is being carried out at UCSD