Building learning around problems and clinical presentations

Published on 01/06/2015 by admin

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Last modified 01/06/2015

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14 Building learning around problems and clinical presentations

A clinical problem or task undertaken by a healthcare professional can serve as the basis for learning. The student is motivated by the more authentic learning experience.

A traditional medical course focused on imparting to students the large body of basic science and clinical knowledge and the skills required of a doctor. An alternative focus for students’ learning is the problems, clinical presentations or tasks undertaken by a doctor.

Problem-based-learning (PBL)

Definition

Problem-based learning has been widely adopted in medical education as an education strategy but its use has not been without controversy. The principal idea behind PBL is that the starting point for the learning is a clinical problem. This is the focus for the student’s learning and drives the learning activities on a ‘need to know’ basis. PBL has made a major contribution to medical education, but there has been a lack of clarity or a conceptual fog surrounding what is meant by the term. The underpinning educational principle is that students, when presented with examples from clinical practice, work out the principles or rules from the basic and clinical sciences that allow them to understand and interpret the problem (Fig. 15.1).

Reasons for a move to PBL

PBL offers a number of advantages, if implemented correctly:

• Students find the process enjoyable and motivating.

• Students are actively engaged in the learning. Activity is one of the FAIR principles for effective learning described in Chapter 2.

• Learning is related to medical practice and is seen by students as relevant – another FAIR principle.

• PBL addresses learning outcomes such as teamwork and problem solving, competencies often overlooked in the conventional curriculum.

• PBL encourages the development of an integrated body of knowledge that is usable in future clinical practice.

Implementation of PBL

Approaches have varied as to the steps in the process, the nature and format of ‘the problem’, and the level of support given to students. PBL is based usually on small group work, with 8–10 students per group, although larger numbers of students can be engaged. A member of staff usually facilitates the group, but students can act as facilitators. Although small group work is seen by some as an essential feature of PBL, the technique can be used in the lecture situation or with individual students working independently online.

An example of the steps in the PBL process is described below. The sequence is normally completed over the course of a week.

1. Students receive the problem scenario. Traditionally this has been in print format, typically a short description of a patient’s presentation. The problem may be presented using a multi-media approach with a computer, video-tape or simulator. Simulated patients have also been used.

2. Students identify and clarify unfamiliar terms, then define and agree the problem or problems to be discussed. It is important that students do not spend too much time figuring out what they should learn at the expense of time spent learning.

3. Students consider possible explanations of the situation presented on the basis of their prior knowledge and identify areas where further learning is required. The tutor helps to ensure that the learning outcomes identified by the student are appropriate taking into account the learning outcomes for the course and what is achievable in the time available.

4. Students work independently and gather information relating to the learning outcomes. The group may agree to subdivide the task and allocate different responsibilities to individual members. Some of this work may be done online in the small group setting using a search engine such as Google.

5. The group reconvenes and shares the results of their private study. What they learn is then applied to the problem presented.

6. Additional information about the patient may be presented to the students and the above process is repeated.

Various points have been defined on the continuum between a problem-based approach and an information-orientated approach as described in the SPICES model (Harden and Davis 1999). This is summarised in Appendix 9. PBL is usually adopted in the context of an integrated medical curriculum but the strategy can also be used in a curriculum where the emphasis is on subjects or disciplines.

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