Schmidt, H.G. (1993). Foundations of problem-based learning: Some explanatory notes. Medical Education, 27: 422-432.
This paper presents the theoretical premises that underlie decisions to use PBL as part of an approach to develop critical thinking. A key premise is that knowledge cannot be transferred, as in a lecture. The learner has to “master it”. An important aspect of learning is that the topic being studied must actually be understood.
The paper identifies 6 fundamental principles of learning derived from cognitive neuroscience and educational psychology, which show how this understanding can be achieved.
Problem-based learning is therefore an approach to teaching and learning where students work together in small groups, with guidance from a facilitator, and try to solve problems (in our context, clinical cases).
In order to activate prior knowledge, the clinical problem must first be discussed by the students without them having “the answers”, or reference to the literature. The goals of this preliminary discussion are:
It is clear therefore, that students should not have the facts given to them (e.g. with a lecture) prior to discussion of the case in their small groups. They should also be discouraged from simply identifying and allocating research questions to cover individually. The discussion is an essential aspect of the process, based on established theories of learning that aim to drive understanding.
If the clinical case is well-designed, students will begin to identify areas where they lack understanding and will soon begin to ask questions that need answers before they can proceed. The questions that are derived after the discussion will help them to find information that will therefore build on prior knowledge.
Upon returning to their groups with the new information, obtained by finding answers to questions derived in the first discussion, students then share and discuss their new information, which helps to structure the new knowledge in new semantic networks. Central to this process is the idea that while thinking, studying and talking about the clinical case, students are building a context-sensitive cognitive structure, which may help them to understand more complex clinical problems that they encounter later.
Conclusion The problem-based approach to teaching and learning is premised on 6 fundamental theories of learning that are derived from cognitive neuroscience and educational psychology. These principles include:
I was discussing a PhD project with a colleague at the HELTASA conference a few weeks ago and she was describing her plan to me. She’s interested in the possibilities that mobile technology brings to higher learning, specifically in nursing education. I gathered that she was talking about mobile as a combination of hardware and software as a means of accessing content, although we didn’t really get into how she was defining mobile for her study.
What I found most interesting was that she was starting from the point that she would be using mobile, and then looking for a problem that she could use it to solve. This seems to be the wrong way around.
We often find people wanting to add complexity (e.g. using mobile devices in the clinical context) without really thinking about whether that added complexity brings with it any benefits. And then asking if the cost of the added complexity brings about a greater benefit. Before adding anything to the curriculum we need to ask ourselves, “What are we going to get in return?”
My colleague wanted to use mobile devices to figure out students’ prior knowledge i.e. she began from the premise that she would be using mobile devices. When I asked her why she didn’t just use pen and paper, she was confused. She said that she couldn’t use pen and paper because she would be using mobile devices. And therein lies the problem. She didn’t say that she wanted students to collaboratively come up with a dataset of “prior knowledge”, or that she wanted all students to see each others’ work, or any other reason that digital or mobile would have an advantage. Her sole reason for wanting to use mobile is that she wanted to use mobile.
By adding complexity to the curriculum without conducting a cost/benefit analysis, you will most likely include a set of unintended consequences, like increasing the actual financial cost of the course, increasing the workload of teachers, or confusing students. Without having a definite objective in mind, which would be enhanced or otherwise facilitated through the addition of the new feature, it’s difficult to argue convincingly for its inclusion.
I just had a brief conversation with a colleague on the nature of the teaching method we’re using in my department. Earlier this year we shifted from a methodology premised on lectures, to the use of case-based learning. I’ve been saying for a while that content is not important, but I’ve realised that I haven’t been adding the most important part, which is that content is not important, relative to thinking.
Of course content is important, but we often forget why it’s important. Content doesn’t help students to manage patients (not much anyway). The example I often use is that a student can know many facts about TB, including, for example, its pathology. But, that won’t necessarily help them to manage a patient who has decreased air entry because of the TB.
What will help the student is the ability to link data obtained from the medical folder, patient interview and physical exam, with the patients signs and symptoms. By establishing relationships between those variables, the student develops an understanding of how to proceed with the patient management process, which includes treatment. There is very little content that the student needs in order to establish those relationships. In those situations, what the content does focus on is a recipe list of commonly used assessment and treatment interventions, which the student can memorise and apply to a patient who presents in a certain way. This is NOT what we want though. This approach doesn’t help students’ adapt and respond to changing conditions.
Knowing the pathology of TB may tell the student WHY there is decreased air entry to the basal aspect of the lungs, but not WHAT TO DO about it (unless you want students to follow recipes). Clinical reasoning is the important part, not content. This is what I’ve been missing when I tell people that content isn’t important. It’s not, but only relative to thinking.
Later this month we’ll be implementing a blended approach to teaching and learning in one module in our physiotherapy department. This was to form the main part of my research project, looking at the use of technology enhanced teaching and learning in clinical education. The idea was that I’d look at the process of developing and implementing a blended teaching strategy that integrated an online component, and which would be based on a series of smaller research projects I’ve been working on.
I was quite happy with this until I had a conversation with a colleague, who asked how I planned on determining whether or not the new teaching strategy had actually worked. This threw me a little bit. I thought that I had it figured out…do small research projects to develop understanding of the students and the teaching / learning environment, use those results to inform the development of an intervention, implement the intervention and evaluate the process. Simple, right?
Then why haven’t I been able to shake the feeling that something was missing? I thought that I’d use a combination of outputs or “products of learning” (e.g. student reflective diaries, concept mapping assignments, semi-structured interviews, test results, focus groups, etc.) to evaluate my process and make a recommendation about whether others should consider taking a blended approach to clinical education. I’ve since begun to wonder if that method goes far enough in making a contribution to the field, and if there isn’t something more that I should be doing (my supervisor is convinced that I’ve got enough without having to change my plan at this late stage, and she may be right).
However, when I finally got around to reading Laurillard’s “Rethinking University Teaching”, I was quite taken with her suggested approach. It’s been quite an eye opener, not only in terms of articulating some of the problems that I see in clinical practice with our students, but also helping me to realize the difference between designing teaching activities (which is what I’ve been concentrating on), and evaluating learning (which I’ve ignored because this is hard to do). I also realized that, contrary to a good scientific approach, I didn’t have a working hypothesis, and was essentially just going to describe something without any idea of what would happen. Incidentally, there’s nothing wrong with descriptive research to evaluate a process, but if I can’t also describe the change in learning, isn’t that limiting the study?
I’m now wondering if, in addition to what I’d already planned, I need to conduct interviews with students using the phenomenological approach suggested by Laurillard i.e. the Conversational Framework. I don’t yet have a great understanding of it but I’m starting to see how merely aligning a curriculum can’t in itself make any assertions about changes in student learning. I need to be able to say that a blended approach does / does not appear to fundamentally change how students’ construct meaning and in order to do so I’m thinking of doing the following:
I hope that this will allow me to make a stronger statement about the impact of a blended approach to teaching and learning in clinical education, and to be able to demonstrate that it fundamentally changes students constructs from superficial to deep understanding. I’m just not sure if the Conversational Framework is the most appropriate model to evaluate students’ problem-solving ability, as it was initially designed to evaluate multimedia tools.
I’ve recently finished the analysis of the first round of the Delphi study that I’m conducting as part of my PhD. The aim of the study is to determine the personal and professional attributes that determine patient outcomes, as well as the challenges faced in clinical education. These results will serve to inform the development of the next round, in which clinical educators will suggest teaching strategies that could be used to develop these attributes, and overcome the challenges.
Participants from the first round had a wide range of clinical, supervision and teaching experience, as well as varied domain expertise. Several themes were identified, which are summarised below.
In terms of the knowledge and skills required of competent and capable therapists, respondents highlighted the following:
In terms of the personal and professional attributes and attitudes that impact on patient care and outcomes, respondents reported:
In terms of the challenges that students face throughout their training:
These results are not significantly different from the literature in terms of the professional and personal attributes that healthcare professionals deem to be important for patient outcomes.
The second round of the Delphi is currently underway and will focus on the teaching strategies that could potentially be used to develop the attitudes and attributes highlighted in the first round.
Today was the final day of AMEE 2011. Here are the notes I took.
The influence of social networks on students’ learning
Collaborative learning is supposed to facilitate interaction and it’s impact on student learning
Difficult to quantify the role of informal learning
Informal social interaction: behaviour is the result of interactions and relationships between people
Many variables can impact on student learning (e.g. motivation)
How does the effect of SN on students’ learning relate to possible confounders?
Social interaction in informal contexts has a substantial influence on learning
Could it also be true that good learners are also well-developed social beings? If learning is inherently social, then people who are more social might just be better learners, and it has nothing to do with the social network?
Veterinary students’ use of and attitude toward Facebook
Physicians share information on Facebook that could potentially upset their patients
People disclsoe more personal information on Facebook than they do in general
32% of students’ profiles contained information that could reflect poorly on the student or profession → venting, breaches of confidentiality, overtly sexual images / behavioural issues, substance abuse
78% of students believe that their profile pictures accurately reflected who they were at that time, 56% of students believed that their current profile pics accurately represents them as a future professional
More professionals believed that posting comments and pictures about clients on Facebook was acceptable, than students
Should professional students’ be held to a higher standard than other students?
Should Facebook information be used in hiring decisions?
An awareness of consequences causes students’ to disclose less on Facebook than they do in general
Individuals have a right to autonomy → education and guidelines can minimise risks
The issue of disclosure is important when it comes to using online social networks
Developing a network of veterinary ICT in education to suppor informal lifelong learning
S Baillie and P an Beukelen
Goals were to generate evidence of benefits and limitations of informal, lifelong learning using ICT
Questions in focus group that would affect participation in an online group:
Was important to have behavioural guidelines for participation in the online network e.g. respect, etc.
Can YouTube help students in learning surface anatomy?
Aim: to determine if YouTube videos can provide useful information on surface anatomy
For each video, the following was recorded:
No simple system is available for assessing video quality, but looked at (yes = 1, no = 0):
57 out of 235 videos were deemed to be relevant, but only 15 of those were determined to have educational usefulness. Several videos were created by students and were often of a high quality
Conclusion was that YouTube is currently an inadequate source of information for learning surface anatomy, and that medical schools should take responsibility for creating and sharing resources online
Social media and the medical profession
What is public and private? How do we separate out our personal and professional identities? Should we separate them out?
Discussion of the role of, and use of, social media by medical professionals (http://ama.com.au/node/6231)
Why do people think that using social media takes anything away from what we already do? Social media doesn’t take anything away from the hallway conversations…it’s not “better” or “worse” than “the old” way of doing things.
From “knowledge transfer” to “knowledge interaction” – changing models of research use, influence and impact
Research, evidence and practice → moving from “knowing differently” to “doing differently”
There’s a lot of noise, but are we having any impact on practice? Who are we talking to? What kinds of conversations are we having? How can our collective input have an impact?
Currently, the model entails doing research, publishing it and hoping that clinicians change behavioural based on the results. No questions about how the knowledge transfer takes place?
How does knowledge “move around” complex systems?
The current system is too:
Current outcomes are variable, inefficient, ineffective, unsafe, and sometimes, inhumane
Why is it that when we know more than ever before, do we perform so poorly within our healthcare systems?
Even though organisations are highly social, yet the belief is that caregivers act as they do because of personal knowledge, motives and skills
Major influences on outcomes are through the organisations and systems through which services are delivered, not individual characterstics (applies equally to educational outcomes)
Context matters → it’s situational, not dispositional (behaviour is as much about the context as it is about dispositions)
Reductive and mechanistic approaches only get us so far. “Rocket science” is merely complicated. Tackingly educational and health issues is genuinely complex because of connections of people, each with own unpredictable behaviours and contexts that changes over time in non-linear ways
Throwing information at people doesn’t generate appropriate responses / behaviours
For some, “evidence” is reduced to research on “what works”. Consequnces of this:
Knowledge required for effective services is more broad than “what works”?
Challenge of integrating “knowledge”:
Also, not just what knowledge:
Knowledge is not “a thing”, is it a process of “knowing”?
Knowledge is what happens when you take data from research, and combine it with experience, and shared through dialogue
Uncovering evidence and understanding its complexity
“If there’s evidence, I feel confident. If there’s no evidence, I’m uncomfortable”
Evidence is only useful if it meets the needs of the user. Who is the user?
Features of learning through simulation (BEME guide 4), a systematic review:
Discipline expertise doesn’t mean you can teach
Implementing clinical training in a complex health care system is challenging
Understanding the complexity of medical education → relationships between:
Journals have a limited role to play in knowledge interaction, and appeal mainly to people who just want to do more research
Without context and explicit intention, medical education will never have the impact on society that it would like to (Charles Boelen)
I just finished giving feedback to my students on the concept mapping assignment they’re busy with. It’s the first time I’ve used concept mapping in an assignment and in addition to the students’ learning, I’m also trying to see if it helps me figure out what they really understand about applying the theory we cover in class to clinical contexts. They’re really struggling with what seem to be basic ideas, highlighting the fact that maybe the ideas aren’t so basic after all. I have to remind myself that clinical reasoning is a skill that takes many years to develop through reflection and isn’t really something I can “teach”. Or is it?
For this assignment I wanted the the students to set a learning objective for themselves (I gave examples of how to do this, including using SMART principles of goal setting). They also needed to highlight a particular clinical problem that they wanted to explore and how they would use concepts from the Movement Science module to do this. They needed to describe a clinical scenario / patient presentation and use it to identify the problem they wanted to explore. From that short presentation, they should derive a list of keywords that would become the main concepts for the concept map.
Here’s a list of the most common problems I found after reviewing their initial drafts:
After going through their initial drafts, I had another session with them to go through the feedback I’d given and providing more examples of what I expected from them. This assignment is proving far more difficult for the students than I’d expected. However, I’m not sure if it’s because they can’t apply theoretical concepts to clinical scenarios, or if they just don’t have a good understanding of how to create concept maps. I think that they’re having difficulty thinking in terms of relationships between concepts. The maps they’ve been drawing are appropriate in terms of the interventions they’d choose to manage their patients, but the students can’t seem to transfer the concepts from the classroom into clinical contexts.
They’re used to memorising the content because that’s how we assess them i.e. our assessments are knowledge-based. Then they go into clinical contexts and almost have to re-learn the theory again in the clinical environment. There doesn’t seem to be much transfer going on, in terms of moving knowledge from the classroom context to the clinical one. I haven’t researched this yet, but I wonder what sort of graduate we’d get if we scrapped classroom teaching altogether and just did everything on the wards and in the clinics? I understand the logistical issues of an apprentice-based approach to teaching large groups but if we didn’t have classroom time at all, maybe it’d be possible?