1. 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

2. 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

3. Innovation in medical education worldwide: Th. Ten Cate, 20063

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

5. 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

6. 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

7. 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

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

9. 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

10. 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

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

12. 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

13. 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.

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

15. 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

16. 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.

18. 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.

19. 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

20. 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

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

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

23. 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.

24. SPECIFIC PROJECT OBJECTIVE/S
Introduction of problem based learning method at four pilot departments of the SUMPh by the end of year
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

25. 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.

26. 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  

27. 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.

28. 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.

29. Educational materials published in the framework of JEP-25195-200429

30. “Study landscape” – an interactive study center at the SUMPh30

31. The rezults of students’ rating of PBL31

32. 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.

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

34. Thank you for attention