Problem-based learning versus lecture-based learning in a course of basic pharmacology: a controlled, randomized study

Pre-clinical pharmacology training in a student-centered veterinary curriculum

The appropriate use of therapeutics is important to both human and animal health. The field of pharmacology is rapidly progressing such that it is impossible to convey to students every possible piece of information they will need to know throughout their veterinary careers. Instead, it is more important to train students for lifelong and self-directed learning so that they will be able to adapt to the ever-changing pharmaceutical landscape. Western University of Health Sciences College of Veterinary Medicine teaches pharmacology using a student-centered and problem-based curriculum designed to teach students not only the basics of pharmacology and clinical pharmacology, but also the personal skills needed to continue to learn beyond their formal education. The aim of this manuscript is to document the pharmacology curriculum during phase I of the veterinary curriculum. Review of the graduating class of 2010's exposure to pharmacology learning issues reveals broad-based coverage of major functional and mechanistic drug classes as well as peripheral topics, including pharmacokinetics, legal and ethical issues, and dosing regimen calculations. Previous classes have scored well on external examinations leading to a belief that this pharmacology curriculum provides adequate training for graduate veterinarians.

The effects of problem-based learning integration in a course on rational drug use: a comparative study between two Croatian medical schools

PURPOSE

Young doctors write prescriptions regularly from their first day of practice. We investigated final-semester students' perceptions of their training in relation to prescribing in two Croatian medical schools with different clinical pharmacology (CPT) teaching styles (Zagreb: problem-based and Rijeka: lecture-based course).

METHODS

A total of 315 students (220 in Zagreb, 95 in Rijeka) underwent a 4-week-long course in CPT in the academic year 2006/2007. We compared the impact of different educational methods on student performance using an MCQ assessment. After the training, students completed a paper questionnaire on prescribing skills and knowledge of pharmacotherapy.

RESULTS

Students in Rijeka were significantly more satisfied with their traditional lecture-based course. Only 56% of Zagreb students and 54% of students from Rijeka felt confident about their prescription-writing skills. Only 8% of Zagreb and none of Rijeka students had written more than six prescriptions during their entire medical curriculum. There was no difference in the participants' levels of factual knowledge of rational pharmacotherapy.

CONCLUSION

The style of learning about medicines did not affect students' factual knowledge. Only half of the student cohort felt confident about their ability to prescribe medicines, and few had practiced this skill during their medical training.

Teaching integrative physiology using the quantitative circulatory physiology model and case discussion method: evaluation of the learning experience

One of the problems that we have found when teaching human physiology in a Spanish medical school is that the degree of understanding by the students of the integration between organs and systems is rather poor. We attempted to remedy this problem by using a case discussion method together with the Quantitative Circulatory Physiology (QCP) program. QCP is a Windows-based computer simulation program that offers almost real-time simulation and allows users to examine the time-dependent interactions of over 750 parameters. We evaluated students' perceptions by an anonymous questionnaire. Teachers' perceptions of this teaching approach were highly positive, as it improved students' perceptions of the complexity of biological processes, their ability to differentiate between acute and chronic responses, and promoted an integrative understanding of human body function. Teachers also identified some problems with the approach, including student difficulties in adopting self-directed learning, a lack of precision in student questions during the discussion sessions, and the lack of a tradition of using several textbooks to explain the changes observed. The results of the student questionnaire revealed that >70% of the students reported that this type of learning gave them a better understanding of the complexity of physiological processes and the role of coordinated actions of several systems in the homeostatic response and enabled them to acquire a better understanding of human body functions. Thus, we conclude that this approach promotes an integrative understanding of cardiovascular and renal functions that is difficult to achieve with other methods.

Problem-based learning and larger student groups: mutually exclusive or compatible concepts - a pilot study

BACKGROUND

Problem-based learning is recognised as promoting integration of knowledge and fostering a deeper approach to life-long learning, but is associated with significant resource implications. In order to encourage second year undergraduate medical students to integrate their pharmacological knowledge in a professionally relevant clinical context, with limited staff resources, we developed a novel clustered PBL approach. This paper utilises preliminary data from both the facilitator and student viewpoint to determine whether the use of this novel methodology is feasible with large groups of students.

METHODS

Students were divided into 16 groups (20-21 students/group) and were allocated a PBL facilitator. Each group was then divided into seven subgroups, or clusters, of 2 or 3 students wh each cluster being allocated a specific case. Each cluster was then provided with more detailed clinical information and studied an individual and distinct case-study. An electronic questionnaire was used to evaluate both student and facilitator perception of this clustered PBL format, with each being asked to rate the content, structure, facilitator effectiveness, and their personal view of the wider learning experience.

RESULTS

Despite initial misgivings, facilitators managed this more complex clustered PBL methodology effectively within the time restraints and reported that they enjoyed the process. They felt that the cases effectively illustrated medical concepts and fitted and reinforced the students' pharmacological knowledge, but were less convinced that the scenario motivated students to use additional resources or stimulated their interest in pharmacology. Student feedback was broadly similar to that of the facilitators; although they were more positive about the scenario stimulating the use of additional resources and an interest in pharmacology.

CONCLUSION

This clustered PBL methodology can be successfully used with larger groups of students. The key to success lies with challenging and well situated clinically relevant cases together with enthusiastic facilitators. Facilitator enjoyment of the PBL process may be related to adequate training and previous PBL experience, rather than academic background. The smaller number of facilitators required using this clustered PBL approach allows for facilitators with 'a belief in the philosophy of PBL' to volunteer which would again impact on the success of the process.

The semi-structured triple jump--a new assessment tool reflects qualifications of tutors in a PBL course on basic pharmacology

In spite of major efforts, there are only a few assessment tools reflecting learning outcomes particularly attributed to problem-based learning (PBL). We aimed to design a more appropriate assessment method by merging elements of the key features and the triple-jump approach. In a prospective, two-phase study, we designed and validated a new assessment tool, called the semi-structured triple jump (sTJ). At the end of a course on basic medical pharmacology, it was performed in addition to a final exam composed of multiple-choice questions. Since in a previous study we had shown tutor expertise to influence students' perception of the learning process, we examined the effect of tutor expertise on results obtained with these assessment tools. We newly developed a questionnaire for student evaluation of the PBL learning process that was validated and tested for reliability. Our aim was to answer two major questions: (1) Does our newly designed assessment tool come up with methodical claims like validity, objectivity and reliability? (2) Does our newly designed assessment tool reflect differences in tutors' expertise? The semi-structured triple jump turned out to be a valid and highly objective assessment tool showing a moderate reliability as found with other triple-jump modifications before. Interestingly, several steps of the sTJ showed a significant correlation to either tutors' subject- or method-matter expertise, respectively. Our data support the approach of supplementing the assessment by structured case-based tools to make it more appropriate for PBL.

Comparison of student performance after lecture-based and case-based/problem-based teaching in a large group

The purpose of this study was to compare traditional lecture-based (LB) and case-based/problem-based (CB/PB) learning in a large group. Year 3 veterinary students at Kansas State University were asked to participate in a randomized controlled study. Students were grouped and randomly assigned to be taught by a CB/PB or a LB method. Students took identical multiple-choice examinations, one given within a week of the last class and a different one given four months later. There was no direct effect of teaching method on group scores for either examination. CB/PB students scored higher on higher-difficulty questions on the first examination (p < 0.003), but there was no effect on questions of lower and medium difficulty. There was no effect of teaching method on student performance for the second examination; however, the question difficulty category scores were all different (p < 0.017). Evaluation of examination scores suggests that the two teaching methods were of similar efficacy.

Problem-based learning in veterinary education

Problem-based learning (PBL) replicates life experiences to stimulate learning, the integration of knowledge, and lifelong learning skills, all of which are requirements for veterinary medical education. As the curricular content of veterinary schools expands to immense proportions following advances in medical knowledge and biotechnology, it becomes impracticable to ensure that all students at the beginning of their careers have such a wide knowledge base. Students who are faced with vast amounts of information to learn by rote, much of which may seem irrelevant to their prospective career, may become disillusioned with their chosen course, hence the temptation to convert to a PBL curriculum. The PBL strategy of teaching is becoming increasingly popular in veterinary faculties worldwide, encompassing both curriculum content and a process of learning. In PBL, clinical cases are carefully selected to provoke deep student learning by the acquisition of both basic scientific and clinical knowledge critical to the case; cultivate problem-solving abilities; and encourage the development of team-building, self-directed learning, communication, and self- and peer-assessment skills. Problem-solving skills, understanding of the basic sciences, and clinical performance are all improved by the PBL process. The aim of this paper is to review a decade of literature pertaining to the inclusion of PBL in veterinary and medical curricula.

[Anaesthesiology as a compulsory subject in the new German medical school curriculum. Evaluation of a curricular model at the University Hospital Aachen]

BACKGROUND

Since October 2003 new regulations for qualifications to practice medicine in Germany now require compulsory courses in anaesthesiology. Therefore, existing curricular activities had to be changed from facultative courses for a small number of interested students to compulsory activities for all students.

METHODS

Previous data of the department of anaesthesiology at the University Hospital Aachen (Germany) were collected and taken into consideration for the development of a new curriculum: The result was a course consisting of a tutorial with integrated "basic skill training", practical training in the operating theatre and a simulation-based session, in addition to two series of lectures. An evaluation by the students was carried out using EvaLuna as a tool for web-based on-line evaluation and faculty members had to fill out a standardized questionnaire.

RESULTS

The different parts of the curriculum received the highest scores of all courses in the undergraduate medical school curriculum. Best results were achieved by the anaesthesia-simulation session followed by the tutorial and the practical training.

CONCLUSION

The feedback of faculty members as well as the results of students' evaluation approved the developed concept of integrating anaesthesia-relevant issues into the formal medical school curriculum. Nevertheless, the on-line evaluation system EvaLuna provided additional suggestions for future improvements in the newly created curriculum.

Problem based learning and the case method--medical students change preferences during clerkship

BACKGROUND

The Case Method (Case) and Problem Based Learning (PBL) are two student active methods, increasingly used in medical education.

AIM

The aim of this study was to compare medical student satisfaction with the two different active methods of learning and to see if there was any variation in preference between two stages in medical training.

METHODS

A short questionnaire was given out to 254 students during the eighth and eleventh term of medical training. Answers were obtained from 221 students. The results were computer analysed.

RESULTS

Students in the eighth term rated both methods high, while students in the eleventh term rated Case even higher while PBL decreased in popularity. Traditional lectures were given constant neutral rating. Case was rated better for problem solving.

CONCLUSIONS

It seems that Case is more suitable than PBL for the later stages of medical training when clinical problem-solving skills need to be honed.

Interactive large-group teaching in a dermatology course

This is a prospective study to find out whether an interactive large-group case-based teaching approach combined with small-group bedside teaching improves student satisfaction and learning outcome in a practical dermatology course. During two consecutive terms a rotating system of large-group interactive case-study-method teaching with two tutors (one content expert, one process facilitator) and bedside teaching with randomly appointed tutors was evaluated with a nine-item questionnaire and multiple-choice test performed at the beginning and the end of the course (n = 204/231 students evaluable). The results of three different didactic approaches utilized over the prior year served as a control. The interactive course was rated significantly better (p < 0.0001) than the standard course with regard to all items. The aggregate mark given by the students for the whole course was 1.58-0.61 (mean +/- SD, range 1 (good)-5 (poor)). This was significantly better than the standard course (p < 0.0001) and not different from small-group teaching approaches. The mean test results in the final examination improved significantly (p < 0.01). The combination of large-group interactive teaching and small-group bedside teaching was well accepted, improved the learning outcome, was rated as good as a small-group didactic approach and needed fewer resources in terms of personnel.

Evaluation of curricula in higher education: challenges for evaluators

Evaluation of teaching at universities is traditionally realized in terms of student ratings. Curriculum evaluation is rarely done in a systematic manner. More often, the emphasis is placed on a particular aspect, which is only of little help in terms of modifying education. A very prominent example is that of medical education. Here, evaluations of curricula primarily focus on new curricula by contrasting them to traditional ones. The article at hand deals with a different evaluation approach, in which five phases have to be considered and contrasting results to other teaching formats are not the main focus. In this article, the authors concentrate on the first phase (baseline evaluation) of the systematic evaluation of a medical curriculum. They describe several challenges of such an evaluation approach and illustrate the strategies used to overcome them. In addition, associated relevant empirical findings from this evaluation study are presented.

Teaching antiarrhythmic therapy and ECG in simulator-based interdisciplinary undergraduate medical education

BACKGROUND

Third-year students in the Dresden Medical School Programme undergo a 6 week course 'Basics of Drug Therapy' in a problem-based learning curriculum. As part of this course a practical seminar about antiarrhythmic drugs and ECG was set up. This study was conducted to evaluate the use of a simulator in this course.

METHODS

A total of 234 students were randomly allocated to receive instructions with (Group S) or without (Group C [control]) the use of a simulator. After a lecture on antiarrhythmic drugs, arrhythmias were presented to Group S using an advanced life support (ALS) manikin. The students were asked to administer a drug or to defibrillate, and the outcome was shown on the monitor. The students in Group C were presented with ECG charts without a simulator. The course was evaluated by a questionnaire and multiple-choice questions (MCQ) about arrhythmias.

RESULTS

We received 222 questionnaires. The content-time ratio was rated almost perfect in both groups, but the students in Group S rated the course better suited to link theory and practice. Students in Group S considered the simulator helpful and a good tool for teaching, and the extra effort to be worthwhile. A significantly higher number of students in Group S preferred electric cardioversion as therapy for ventricular tachycardia.

CONCLUSIONS

An ALS manikin can be an effective tool in teaching clinical pharmacology.

PBL in undergraduate medical education: a qualitative study of the views of Canadian residents

BACKGROUND AND OBJECTIVES

At McMaster University, the birthplace of problem-based learning (PBL), administrators and curriculum planners have begun the process of renewing the undergraduate MD curriculum. One step has been to conduct an environmental scan that includes input from medical residents.

METHODS

Individual interviews with 17 medical residents and fellows currently enrolled at McMaster University and are graduates of six Canadian medical schools.

RESULTS

PBL appears to be well known even by graduates of non-PBL Canadian medical schools. Tutors are key to a successful PBL program, should be knowledgeable about the content area under study and able to effectively facilitate groups. Tutorial problems should be realistic, up-to-date, and challenge students to investigate more than the medical aspects of the case in question. Students need to be prepared, willing to participate in peer teaching, and supportive of the group learning process. PBL programs can be improved if they incorporate elements of traditional medical programs (e.g., mini-lectures, clear learning objectives, and unbiased evaluation of student progress) while retaining the essence of student-generated learning.

CONCLUSIONS

Medical residents are an underutilized source of information about undergraduate medical programs. According to our participants, more emphasis on faculty development and upgrading health care problems will improve PBL-based undergraduate medical education.

Evaluation of a new approach to implement structured, evidence-based emergency medical care in undergraduate medical education in Germany

Since June 2002, revised regulations in Germany allow medical faculties to implement new curricular concepts. The medical faculty of the Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen, Germany, decided to start a major reform experiment in winter 2003, focussing on an interdisciplinary integration of organs and organ systems such as the cardiovascular or respiratory system. Furthermore, students will have contact with patients at an early stage of their studies. Thus, re-organisation of course contents should lead to a chance to improve practical experience. With the public having the right to expect that physicians and all physicians in training possess a basic knowledge of emergency medical care and the necessary skills to manage acute problems, it was decided to start the first year of the Medical Reform Curriculum Aachen with 3 weeks interdisciplinary introduction into emergency medical care. The task consisted of defining interdisciplinary core objectives and the need to implement teaching and learning principles necessary for further education. Due to this, the content of this course should have practical relevance for the students concerning their practical experiences in the future. The result is an introductory course in emergency medical care in the first semester, coordinated with the lectures. Besides skill training on basics of emergency medical care (basic life support (BLS), early defibrillation), practical training in other lifesaving techniques (e.g., immobilisation skills) and basic principles of daily clinical care are included. In addition, personal safety and a standard algorithm for assessing the patient are covered by problem-based learning sessions. The course evaluation data clearly showed acceptance of the new approach and enhances possibilities of extending implementation of relevant topics concerning emergency medical care within the Medical Reform Curriculum Aachen.

[Problem-based learning for surgery. Increased motivation with less teaching personnel?]

BACKGROUND

Traditional teacher-centred education strategies often do not meet the needs and student abilities of adult learning. The introduction of small learning groups requires considerable increases in staff. Problem-based learning could increase the motivation to acquire knowledge but without being as staff-intensive.

METHODS

Medical students (n=98) in their fourth clinical semester were randomly assigned to either a structured course (SC) or problem-based learning (PBL) for surgery. Their motivation and acceptance of the courses were recorded at the end of term in anonymous questionnaires using Likert scales, with scores ranging from 1 (very good) to 6 (unsatisfactory).

RESULTS

Both course structure and the teachers received much better ratings from the PBL students (P<0.01 each). The motivation of students to deal with surgical problems beyond the course material was significantly higher after PBL, with 1.8 (0.7), than after the structured course with 3.1 (1.2) (P<0.01). The overall rating was substantially worse for the structured course, with 3.1 (1.2) than for PBL at 1.4 (0.6) (P<0.01).

CONCLUSIONS

Problem-based learning in the surgical curriculum increases student acceptance and motivation with little demand on staff. It should be increasingly implemented.

Comparison of knowledge scores of medical students in problem-based learning and traditional curriculum on public health topics

BACKGROUND

The purpose of the study was to compare the knowledge scores of medical students in Problem-based Learning and traditional curriculum on public health topics.

METHODS

We planned a cross-sectional study including the fifth and sixth year medical students of Dokuz Eylul University in Turkey. The fifth year students (PBL group, n = 56) were the pioneers educated with PBL curriculum since the 1997-1998 academic year. The sixth year students (traditional education group, n = 78) were the last students educated with traditional education methods. We prepared 25 multiple-choice questions in order to assess knowledge scores of students on selected subjects of Public Health. Our data were collected in year 2002.

RESULTS

Mean test scores achieved in PBL and traditional groups were 65.0 and 60.5 respectively. PBL students were significantly more successful in the knowledge test (p = 0.01). The knowledge scores of two topics were statistically higher among PBL students. These topics were health management and chronic diseases.

CONCLUSION

We found that mean total evaluation score in the PBL group was 4.5 points higher than in the traditional group in our study. Focusing only on the knowledge scores of students is the main limitation of our study. Upon the graduation of the first PBL students in the 2002-2003 academic year, we are planning additional studies regarding the other functions of a physician such as skill, behaviour and attitude.

A simulator-based curriculum to promote comparative and reflective analysis in an internal medicine clerkship

PURPOSE

To develop and evaluate a novel curricular framework using high-fidelity patient simulation in an internal medicine clerkship.

METHOD

Two 90-minute simulator-based modules of ischemic heart failure and hypoxemic respiratory failure were developed from adult and experiential learning principles. Three short simulated cases focused on each pathophysiologic concept were intermixed with two short teaching sessions and a period of comparative analysis. In 2002-03, the program was piloted among 90 third-year medical students at Harvard Medical School assigned to complete their core internal medicine clerk-ship. An entry and two follow-up questionnaires were used to assess the process. The instructors conducted quantitative and qualitative data analysis and directly observed students' performances.

RESULTS

Instructors consistently noted students' ability to appropriately extract a history, perform a basic examination, and order appropriate tests. However, students demonstrated repeated errors in the application of knowledge to the clinical circumstance. A final comparative discussion was essential to new learning and students recognized this integrative analysis as the most critical component of the exercise. Every student reported the experience as useful. Ninety-four percent (n = 85) felt the simulator should become a routine part of the clerkship and 68% (n = 71) desired three or more sessions during their internal medicine clerkship.

CONCLUSIONS

Simulator-based curricular modules are feasible in an internal medicine clerkship and can successfully complement existing curricula. By comparing similar cases in a compressed time frame, students may achieve enhanced efficiencies in reflective and meta-cognitive learning. As medical simulation is increasingly available, such a curriculum may represent valuable additions to the internal medicine educational environment.

Measuring teaching effectiveness in a pre-clinical multi-instructor course: a case study in the development and application of a brief instructor rating scale

BACKGROUND

Despite widespread use, misunderstandings persist about student evaluations of teaching. These evaluations have not been well examined in the common medical school setting of the multi-instructor, preclinical lecture course.

PURPOSE

The study evaluated the psychometrics of a brief student evaluation of a teaching instrument developed for a multi-instructor 2nd-year course and described its application.

METHODS

An 11-item instrument was developed and administered to 276 students to evaluate 27 lecturers per year in 3 years of an introductory clinical psychiatry course. A fully crossed research design allowed for a thorough analysis of variability in ratings.

RESULTS

Generalizability analysis showed good reliability and relatively large Student x Lecturer interactions. Profile analysis generated distinct lecturer teaching profiles.

CONCLUSIONS

Judicious use of a psychometrically sound student evaluation of a teaching instrument can be used to assist faculty and course development. Administering the evaluation instrument to an entire class produces no better reliability than administration to randomly selected subgroups of students.

Interprofessional education in a midwifery curriculum: the learning through the exploration of the professional task project (LEAPT)

OBJECTIVE

to develop interprofessional education for students of midwifery, nursing and medicine. To foster collaborative working and learning between students of midwifery, nursing and medicine.

DESIGN

a quasi-experimental method to evaluate the outcomes of an intervention (a problem-based learning (PBL) scenario) with interprofessional students and facilitators. Data were collected using pre- and post-test questionnaires.

SETTING

a University and National Health Service healthcare facilities in the North of England.

PARTICIPANTS

40 students of midwifery, nursing and medicine.

FINDINGS

student midwives participating in the PBL scenario in this interprofessional format improved their attitudes to working in this environment. All students enjoyed the opportunity to learn in an interprofessional team, and they felt that the experience provided a safe environment to help prepare for their future roles. The learning opportunity enabled all students to reflect on each other's role and to discuss differing perspectives of care, although the student midwives had mixed feelings about the PBL experience.

IMPLICATIONS FOR PRACTICE

interprofessional learning using PBL is a useful environment for students to learn about each others' role, and to prepare for working together as qualified professionals in a collaborative manner. However, time and commitment is required to plan joint working in order to maximise the benefits.

["Meet the AIX-PERTs." Emergency medical care at the beginning of the medical reform curriculum in Aachen]

BACKGROUND

Extensive knowledge and skills in the basics of emergency medical care are of paramount importance for every physician and should therefore be an integral part of medical education.

METHODS

Regulations for medical licensure in Germany were revised by the administrative authorities in 2002 and as a consequence the Medical Faculty of the University of Aachen (Germany) decided to start the Medical Reform Curriculum Aachen. A multidisciplinary, problem-oriented and organ-related approach to medical education replaces the classical discrimination between basic and clinical sciences.

RESULTS

With AIX-PERT (AIX-la-Chapelle Program for Emergency medical care and Resuscitation Training), a program consisting of problem-based learning sessions was developed for introduction to the first year students. Defined teaching objectives in emergency medicine are now incorporated in undergraduate medical education.

CONCLUSION

The extremely positive evaluation of the new approach encouraged us to promote AIX-PERT further. In the future the effects of success of this approach will be assessed by longitudinal studies of skills and knowledge during the continuing curriculum.

Small-Group Discussion Versus Lecture Format for Third-Year Students in Obstetrics and Gynecology

OBJECTIVE

To compare lecture and small-group discussion for third-year medical students in obstetrics and gynecology.

METHODS

Over a 2-year period, 91 third-year medical students in the obstetrics and gynecology clerkships were given educational sessions on diabetes and hypertension in pregnancy by a single instructor, either in a traditional lecture format or in a small-group discussion. After the instructional sessions, students anonymously completed a 20-question multiple-choice examination on the covered topics. They also completed an evaluation form on the instructional format, using a 5-point Likert scale, ranging from 1 (strongly disagree) to 5 (strongly agree). At the completion of each clerkship, students repeated the same multiple-choice examination.

RESULTS

There was a significantly higher level of enjoyment (median value 5 versus 4, P <.001) and sense of educational stimulation (median value 5 versus 4, P <.001) in the discussion group, and students in the discussion group were less desirous of the alternate instructional format than those in the lecture group (median value 2 versus 3, P <.001). However, there were no differences in the test scores, either immediately after the instructional sessions or at the end of the clerkships. There was a 90% power to detect a 15% difference in postinstructional test scores.

CONCLUSION

Third-year medical students learning about hypertension and diabetes in pregnancy during their obstetrics and gynecology clerkship strongly preferred small-group discussions over traditional lectures. However, this preference did not lead to improved test scores on these subjects.

Prospective randomised comparison of traditional, personal bedside and problem-oriented practical dermatology courses

PURPOSE

This paper reports a prospective, randomised study comparing a problem-oriented practical (POP) course based on paper cases to a personal bedside teaching (PBT) practical course and a standard practical course.

METHODS

During 2 consecutive terms, students were randomly allocated to either 2 POP groups/term (n = 10/group), 2 PBT groups/term (n = 10/group) or the standard practical course, which consisted of a rotating system of lectures and bedside teaching with randomly appointed tutors. Each course was evaluated with the same 12-item questionnaire and multiple-choice test administered at the beginning and end of the course.

RESULTS

The numbers of students evaluated were 36 for the POP groups, 37 for the PBT groups, and 155 for the standard course. The PBT and POP courses were rated significantly better (P < 0.001) than the standard course for all items. Aggregate marks (mean +/- SD) were: 1.59 +/- 0.8 for the POP course; 1.69 +/- 0.68 for the PBT course, and 2.71 +/- 0.98 for the standard course. There were no significant differences between the POP and PBT courses. Significantly better learning rates as indicated by an increase in the number of correctly answered questions were observed in students attending the POP and PBT courses.

CONCLUSION

This prospective study demonstrated that there was no difference in the rating of a POP course and a bedside teaching course by students randomly assigned to 1 of 3 different pedagogical approaches. Furthermore, both alternative options achieved better ratings than the standard course, which is current teaching practice in our medical school. The PBT and POP approaches provided superior learning success and POP helped solve the problems of standardisation and patient recruitment.

Learning from the problems of problem-based learning

BACKGROUND

The last decade has witnessed a rapid expansion of biomedical knowledge. Despite this, fashions in medical education over the same period have shifted away from factual (didactic) teaching and towards contextual, or problem-based, learning (PBL). This paradigm shift has been justified by studies showing that PBL improves reasoning and communication while being associated with few if any detectable knowledge deficits.

DISCUSSION

Analysis of the literature indicates that the recent rapid rise of PBL has closely paralleled the timing of the information explosion. The growing dominance of PBL could thus worsen the problems of information management in medical education via several mechanisms: first, by creating the impression that a defined spectrum of core factual knowledge suffices for clinical competence despite ongoing knowledge expansion (quality cost); second, by dissuading teachers from refining the educational utility of didactic modalities (improvement cost); and third, by reducing faculty time for developing reusable resources to impart factual knowledge more efficiently (opportunity cost).

SUMMARY

These costs of PBL imply a need for strengthening the knowledge base of 21st-century medical graduates. New initiatives towards this end could include the development of more integrated cognitive techniques for facilitating the comprehension of complex data; the design of differentiated medical curricula for producing graduates with defined high-priority skill sets; and the encouragement of more cost-effective faculty teaching activities focused on the prototyping and testing of innovative commercializable educational tools.

The randomised controlled trial design: unrecognized opportunities for health sciences librarianship

OBJECTIVE

to describe the essential components of the Randomised Controlled Trial (RCT) and its major variations; to describe less conventional applications of the RCT design found in the health sciences literature with potential relevance to health sciences librarianship; to discuss the limited number of RCTs within health sciences librarianship.

METHODS

narrative review supported to a limited extent with PubMed and Library Literature database searches consistent with specific search parameters. In addition, more systematic methods, including handsearching of specific journals, to identify health sciences librarianship RCTs.

RESULTS

While many RCTs within the health sciences follow more conventional patterns, some RCTs assume certain unique features. Selected examples illustrate the adaptations of this experimental design to answering questions of possible relevance to health sciences librarians. The author offers several strategies for controlling bias in library and informatics applications of the RCT and acknowledges the potential of the electronic era in providing many opportunities to utilize the blinding aspects of RCTs. RCTs within health sciences librarianship inhabit a limited number of subject domains such as education. This limited scope offers both advantages and disadvantages for making Evidence-Based Librarianship (EBL) a reality.

CONCLUSIONS

The RCT design offers the potential to answer far more EBL questions than have been addressed by the design to date. Librarians need only extend their horizons through use of the versatile RCT design into new subject domains to facilitate making EBL a reality.

Long-term follow up of factual knowledge after a single, randomised problem-based learning course

BACKGROUND

The long-term effect of problem-based learning (PBL) on factual knowledge is poorly investigated. We took advantage of a previous randomised comparison between PBL and traditional teaching in a 3rd year course to follow up factual knowledge of the students during their 4th and 5th year of medical school training.

METHODS

3rd year medical students were initially randomized to participate in a problem-based (PBL, n = 55), or a lecture-based (LBL, n = 57) course in basic pharmacology. Summative exam results were monitored 18 months later (after finishing a lecture-based course in clinical pharmacology). Additional results of an unscheduled, formative exam were obtained 27 months after completion of the first course.

RESULTS

Of the initial sample of 112 students, 90 participated in the second course and exam (n = 45, 45). 32 (n = 17 PBL, n = 15 LBL) could be exposed to the third, formative exam. Mean scores (+/- SD) were 22.4 +/- 6.0, 27.4 +/- 4.9 and 20.1 +/- 5.0 (PBL), or 22.2 +/- 6.0, 28.4 +/- 5.1 and 19.0 +/- 4.7 (LBL) in the first, second and third test, respectively (maximum score: 40). No significant differences were found between the two groups.

CONCLUSION

A small-scale exposure to PBL, applied under randomized conditions but in the context of a traditional curriculum, does not sizeably change long-term presence of factual knowledge within the same discipline.

Reflective critique and collaborative practice in evaluation: promoting change in medical education

The School of Medicine at the University of Tasmania has recently begun to implement a process of curriculum evaluation,which aims to reflect contemporary best practice in evaluation in tertiary pedagogy and medical education. Best practice must accommodate a broadening interest in cooperative and collaborative evaluation strategies among stakeholders, advances in applied qualitative educational research and recognition that critical reflection on practice is the cornerstone of professional education. This paper reports a recent evaluation strategy in a specific year-long unit in the second year of a six-year undergraduate medical degree. The paper begins by presenting the context; it then discusses and rationalises the evaluation strategy and presents findings. The paper concludes by arguing that curriculum evaluation as best practice must be reflective, informed by the scholarship of medical education, and internalized as a dynamic process that can promote sustainable change and improvement in medical curricula. Such an approach will contribute to an undergraduate medical curriculum that prepares students for the demands and complexities of medical practice.

Support of a Problem-Based Learning Curriculum by Basic Science Faculty

Although published reports describe benefits to students of learning in a problem-based, student-centered environment, questions have persisted about the excessive faculty time commitments associated with the implementation of PBL pedagogy. The argument has been put forward that the excessive faculty costs of such a curriculum cannot be justified based upon the potential benefits to students. However, the magnitude of the faculty time commitment to a PBL curriculum to support the aforementioned argument is not clear to us and we suspect that it is also equally unclear to individuals charged with making resource decisions supporting the educational efforts of the institution. Therefore, to evaluate this cost - benefit question, we analyzed the actual basic science faculty time commitment in a hybrid PBL curriculum during the first phase 18 months of undergraduate medical education. The results of this analysis do demonstrate an increase in faculty time commitments but do not support the argument that PBL pedagogy is excessively costly in terms of faculty time. For the year analyzed in this report, basic science faculty members contributed on average of 27.4 hours to the instruction of medical students. The results of the analysis did show significant contributions (57% of instructional time) by the clinical faculty during the initial 18 months of medical school. In addition, the data revealed a four-fold difference between time commitments of the four basic science departments. We conclude that a PBL curriculu m does not place unreasonable demands on the time of basic science faculty. The demands on clinical faculty, in the context of their other commitments, could not be evaluated. Moreover, this type of analysis provides a tool that can be used to make faculty resource allocation decisions fairly.

Comparison of problem-and lecture-based pharmacology teaching

Problem-based learning (PBL) is gaining interest in many medical schools. Although various approaches have been labelled PBL, it remains unclear which approach is most appropriate for pharmacology courses. Moreover, some teachers remain sceptical about whether PBL is adequate to convey the numerous facts medical students need to memorize about drugs. However, comparisons of PBL methods with conventional lecture-based learning (LBL) methods within general pharmacology courses for medical students show that PBL students are at least as successful in standardized tests but enjoy their course to a greater extent than do LBL students.