Problem Based Learning in Orthopedics

Prof G.S.Patnaik

Deteriorating undergraduate medical education

Less stress on didactic lectures Assessment systems like MEQs, OSCE.,MCQs

PBL as a learning Tool Manipal Experience

Preface

Problem-Based Learning (PBL) begun in 1950’s as a movement to restructure medical school education unlike traditional instruction that culminates in a problem after basic instruction on facts and skills, PBL begins with a problem, teaching facts and skills in a relevant context.

These are all difficult concepts for traditional medical teachers

Introduction……

Problem-based learning is an innovative and challenging approach to medical education

…innovative because it is a new way of using clinical material to help students learn, and

...challenging because it requires the medical teacher to use facilitating and supporting skills rather than didactic, directive ones.

‘’A learning method based on the principle of using problems as a starting point for the acquisition and integration of new knowledge.” H. S. Barrows 1982

Students divided into groups

Real problem is presented and discussed

Students identify what is known, what information is needed, and what strategies or next steps to take

Individuals research different issues, gather resources

Basic Steps of PBL

Resources evaluated in group Cycle repeats until students feel the problem has been framed adequately and all issues have been addressed

Possible actions, recommendations, solutions, or hypotheses are generated

Tutor groups conduct peer/self-assessments

Basic Steps of PBL (continued)

Problem-based learning – what is it

Learning in context of a problem Student-driven Student – generates issues, finds answers, shares answers

Active learning Group process Facilitated > taught

Problem-based learning (PBL) is a student-centered pedagogy in which students learn about a subject in the context of complex, multifaceted, and realistic problems

Not to be confused with project-based learning.

The goals of PBL are to help the students develop flexible knowledge, effective problem solving skills, self-directed learning, effective collaboration skills and intrinsic motivation

A facilitator is key to these learning environments

Models higher-order process skills Probes for student understanding Never identifies issues or states an opinion while students frame problems

Facilitators and PBL

For the student, problem-based learning emphasizes the application of knowledge and skills to the solution of problems rather than the recall of facts.

It is an approach much favored by curriculum planners in new and more progressive medical schools.

Very well operates in undergraduate medical education.

PBL is a learner-centered educational methodIn PBL, learners are progressively given more and more responsibility for their own education.

PBL produces independent learners who can continue to learn on their own in life and in their chosen careers.

The responsibility of the teacher in PBL is to provide the educational materials and guidance that facilitate learning.

PBL is based on real world problemsPBL is based on the messy, complex problems encountered in the real world as a stimulus for learning, integrating, and organizing learned information in ways that will ensure its recall and application to future problems. The problems in PBL are also designed to challenge learners to develop effective problem-solving and critical thinking skills.

The series of problems encountered by learners with this process make up the curriculum.

The problems are put together as a group to stimulate learning of content appropriate to the course.

In the PBL process learners characteristically learn far more in areas relevant to their personal needs.

The PBL curriculum

The principle role of the teacher in PBL is that of a facilitator or educational coach guiding the learners in the PBL process.

As learners become more proficient in the PBL learning process the tutor becomes less active.

This is a new skill for many teachers and specific training is required

The role of the PBL teacher

PBL is a motivating way to learn as learners are involved in active learning, working with real problems and what they have to learn in their study is seen as important and relevant to their own lives.

PBL is a motivating way to learn

Problem-based learning – example

“40 year old man with jaundice. Sustained fracture of femur shaft . History of asthma ,went to a local quack , Doesn’t want any treatment.”

How will you deal with the issues that he

presents?

Problem-based learning – possible solution

Talk through scenario, understand it, decide on the problems

Define/analyse the problems Brainstorming Prioritise the problems, restructure Decide on learning objectives Every member has a task – private study

Feedback on what they have discovered

Everyone contributes

Reflection

Problem-based learning – follow up

Problem-based learning – what is a good problem?

Realistic, common, important

Sufficiently open

Complexity – a number of components

Maybe a problem that actually happened and that was poorly managed

Clinical scenarios on paper

Laboratory data Photograph Video Real/simulated patient

Problem-based learning – what is a good trigger?

Greater recall of knowledge, retention

interdisciplinary, can require accessing and using information from a variety of subject domains; better integration of knowledge

Development of life-long learning skills: how to research, how to communicate in groups, how to handle problems

Advantages of PBL

Increased motivation, interest in subject areas

increased student-student interaction, and student-instructor interaction

Real- life cases Not with a specific discipline Student- centered Close, more equal student-faculty relationship

Enjoyable Presentational skills

Advantages of PBL

PBL – the problems with PBL

Cost Time Workload Tutor quality Unscheduled time Students with no supervision ……….. The tutor takes over

One faculty member for each group of students!

“ One of the hardest things about running a problem-based learning curriculum is making sure that what is happening is actually PBL.”

David Taylor

“ Problem based learning is successful only if the scenarios are of high quality.”

Diana Wood

PBL – the problems with PBL

PBL– mixing it with other methods

Simulation/simulated patients

Interprofessional education – should the group include nurses/AHPs?

E-learning

“PBL should be regarded

as a tool, a means, and not as an end.”

Shimon Glick

Problem-based learning – last word?

Problem-based learning - references

Donner RS, Bickley H. Problem-based learning in American medical education: an overview. Bull Med Libr Assoc. 1993 Jul;81(3):294-8.

Wood DF. Problem based learning. BMJ. 2003 Feb 8;326(7384):328-30.

Kilroy DA. Problem based learning. Emerg Med J. 2004 Jul;21(4):411-3.

Walton HJ, Matthews MB. Essentials of problem-based learning. Med Educ. 1989 Nov;23(6):542-58.

Mellon AF, Mellon J. Logical debate on problem based learning. BMJ. 2006 Mar 4;332(7540):550-1.

Wood DF. Problem based learning. BMJ. 2008 May 3;336(7651):971.

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