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

Evaluation of problem-based learning for pharmacology based on a comprehensive analysis in undergraduate students

BACKGROUND

Problem-based learning (PBL) has been widely employed in pharmacology teaching. However, the benefits of PBL for undergraduate students have not been clearly demonstrated. We performed a meta-analysis to compare the effects of PBL and lecture-based learning (LBL) in undergraduate pharmacology education.

METHODS

We systematically searched literature databases for comparative studies related to PBL pedagogy in the undergraduate pharmacology curriculum from the inception of the databases to December 2023. The obtained literature was screened according to the selection criteria, and Review Manager 5.4 was used for the meta-analysis of the included studies.

RESULTS

A total of 33 comparative studies involving 4425 undergraduate students were enrolled. The standardized mean differences (95% confidence intervals) of the examination scores and students' self-rated scores on learning interest, comprehension of knowledge and thinking ability between PBL and LBL were calculated to be 2.03 (1.53-2.53), 0.50 (0.26-0.74), 0.69 (0.46-0.92), and 1.65 (1.21-2.09), respectively. The risk ratios of the proportion of satisfaction on improving students' learning interest, comprehension of knowledge, thinking ability, self-study ability, and communication skills were calculated to be 2.08 (1.17-3.71), 1.84 (1.26-2.67), 1.42 (1.19-1.69), 1.44 (1.16-1.79), and 1.66 (1.22-2.27), respectively.

CONCLUSIONS

The current evidence indicates that PBL is more effective than LBL in improving examination scores and student satisfaction in undergraduate pharmacology education.

Intimidating Attendings: The Importance of Near-Peer Mentorship During Third-Year Surgical Clerkship

INTRODUCTION

Near-peer instruction has grown in popularity in medical education; however, limited data exist to support its effectiveness. This study investigates the perceptions of near-peer style instruction in third-y medical students undergoing a surgical clinical clerkship. We hypothesized that near-peer instruction would provide a beneficial educational experience to third-y medical students during their surgical clinical clerkship.

METHODS

The authors anonymously surveyed third-y medical students undergoing their clinical clerkship in surgery on their perception of the near-peer instruction and mentorship they received from fourth-y medical students at the beginning of the clerkship. Near-peer instruction included teaching suturing techniques, surgical procedures and anatomy, operating room literacy, and sharing anecdotal experiences. Surveys were distributed 24 h after receiving the formal instruction.

RESULTS

A total of 85 students completed the survey (78% response rate). Students reported a similar or increase in value of learning from near-peer mentors compared to attending physicians (less valuable: 1.2%; just as valuable: 52.9%; more valuable: 45.9%). The majority of students indicated they would like to experience more near-peer style instruction in medical school as demonstrated in surgical clerkship training (absolutely no: 0%; probably not: 0%; on the fence: 4.7%; probably yes: 25.9%; absolutely yes: 69.4%). After experiencing near-peer instruction and mentoring, students were more interested in becoming near-peer mentors (less interested: 1.2%; just as interested: 29.4%; more interested: 69.4%).

CONCLUSIONS

Students appreciate and desire near-peer instruction, seeing it as an effective learning method. Mentees undergoing near-peer style instruction have an increased interest in becoming near-peer mentors.

Problem-Based Learning for Interprofessional Education: A Review of the Concept and Its Application in a Geriatric Team

The global population is aging, with those aged 65 years or over increasing in number and accounting for a growing share of the population. There are increasing demands for geriatric care which makes the development and delivery of effective geriatric team training a priority. Training in geriatrics is complex because of the multiplicity of medical, psychosocial, and functional issues in elderly individuals which need to be addressed by a multidisciplinary approach using interprofessional education (IPE). Problem-based learning, a student-centered educational model that brings several natural strengths to IPE, is a unique curriculum replacing the traditional lecture-based learning model. This model enhances physician competency after graduation, mainly in psychosocial and teamwork issues that are fundamentally essential for geriatrics. IPE has been shown to have a substantial positive impact on team collaboration, individual development, and healthcare improvement. In this paper, we summarize the current findings from recent studies on training professionals from different healthcare disciplines to deliver care for the elderly in collaborative practice. We also discuss if an interprofessional problem-based geriatric team program in geriatrics is a promising solution to enhance professional collaboration and quality of patient care.

Factors affecting pharmacology learning in integrated PBL in diverse medical students: a mixed methods study

INTRODUCTION

Problem-based learning (PBL) was introduced to address passive teaching limitations. However, it is not fully characterised as a teaching modality in pharmacology. The present study investigated the factors affecting pharmacology learning in an integrated PBL-based curriculum in diverse learners.

METHODS

Year 1 undergraduate medical students from two cohorts at St. George's University of London and University of Nicosia, participated. Statistical analysis of pharmacology knowledge scores, at the beginning (pre-test) and end of the academic year (post-test), investigated readiness to benefit from PBL based on diverse student characteristics (educational background, age, gender, country of origin, ethnicity, native language, PBL experience). Focus groups/interviews and a survey investigated aspects of integrated PBL impacting learning in depth.

RESULTS

Pre- and post-test scores were positively correlated. Students with biomedical sciences degrees performed better at the pharmacology pre- and post-tests, while post-graduate degree holders performed better only at the pre-test. Effect size was of moderate magnitude. However, progress in learning (post-test performance after controlling for pre-test scores) was unaffected. Qualitative analysis revealed three major themes: 1) PBL as a learning environment; 2) PBL as a learning environment in pharmacology; and 3) PBL as a learning environment and confidence in prescribing. Under theme one, skill development, knowledge acquisition through collaboration and self-directed learning, group dynamics and preferred teaching methods were discussed. Under theme two, contextual learning, depth of knowledge and material correctness were raised. Under theme 3, students expressed variability in prescribing confidence. They perceived that learning could be improved by better integration, further references earlier on, more lectures and PBL facilitators with greater content expertise. The survey findings were consistent with those from focus groups/interviews.

CONCLUSION

Pharmacology learning in a PBL-based curriculum is facilitated by constructive, collaborative and contextual learning. While baseline pharmacology knowledge may be advantageous, the other aforementioned characteristics studied may not affect readiness to benefit from PBL. However, further instructional scaffolding is needed, for example through further resources, lectures and self-assessment. The results from our study can inform evidence-based curriculum reform to support student learning further. Addressing learning needs could ultimately contribute to reducing medication errors through effective training of future prescribers.

Pharmacology education in the medical curriculum: Challenges and opportunities for improvement

The knowledge and application of pharmacology is essential for safe prescribing and administration of drugs. In this narrative review, the challenges to pharmacology education in the medical curricula were broadly identified to include issues around content and pedagogies. The increasing number of approved drugs and drug targets, expanding field of pharmacology and the often-changing treatment guidelines and board-defined competencies can make pharmacology education in the medical curriculum daunting. There has been a consensus around the deployment of innovative medical curricula with emphasis on vertical and horizontal integration. This strategy, effective as it has been, presents new challenges to pharmacology education. As a discipline often perceived by students to be hard-to-learn, the future of pharmacology education must include heavy reliance on active learning strategies. The continuing utilization of problem-based, team-based and case-based learning can be complemented with personalized learning which aims to identify the learning gaps in individual students. Technology-inspired student engagement can foster pharmacology learning and retention. Early exposure to pharmacology from premedical preparation through an enduring across-the-level integration can be an effective way to enhance pharmacology learning in the medical curricula.

A Bibliometric Analysis of the 100 Most Cited Articles on Problem-Based Learning in Medical Education

Problem-based learning (PBL) is an instructional approach used in medical education that is characterized by solving problems in small groups with tutor guidance. More than 50 years since PBL's inception, many questions remain to be addressed about its processes and learning outcomes. The purpose of the study was to examine the bibliometric characteristics of the 100 most cited articles on PBL in medical education and to identify landmark papers that have made significant contributions to PBL research. Results were systematically reviewed for citation frequency, publication year, journal, article type, article focus, authors, author collaboration, and country collaboration. The number of citations ranged from 81 to 3531 times cited with 31,041 total citations. The articles were contributed by 211 authors in 23 journals and most articles (68%) were published in Medical Education, Academic Medicine, and Medical Teacher. The majority of the articles (71%) originated from Netherlands, Canada, and the United States and six prolific authors were identified. Almost half of the articles are classified as empirical research. Article foci included theoretical foundations of PBL, curriculum design, learning outcomes and processes, tutors, assessment, guides to PBL implementation, commentaries, and student well-being. The strong author and country collaborations indicate continued global interest in the PBL instructional method, which is likely to remain an active topic of research as the evidence of its effectiveness over traditional instructional methods as well as its most impactful components is inconclusive.

Performance and preference of problem-based learning (PBL) and lecture-based classes among medical students of Nepal

Background: PBL (problem based learning) is new active learning educational strategy that has been extensively tested and used in recent years. Patan Academy of Health Sciences (PAHS) is one of medical schools from Nepal, a Low Income Country (LIC) implementing PBL for undergraduate medical education. This study aims to compare PAHS students' understanding and knowledge retention when taught through PBL and lecture-based classes and compare students' perceptions of PBL and lectures in medical education. Methods: This is a cross-sectional study of medical students of a PBL based medical school in Nepal, a non-Western low-income country. Ethical approval was given by the institutional research committee of the Patan Academy of Health Sciences. Understanding and knowledge retention was assessed with 50 vignette-based multiple-choice questions, half of which were taught through PBL sessions, and the remaining half were taught in didactic lectures during basic science years of medical school. A separate pre-validated perception questionnaire was used to assess students' preferences regarding PBL and lectures. Results: Out of 107 students, 99 participated in the understanding and knowledge retention questionnaires and 107 completed perception questionnaires. Understanding and knowledge retention of students was found to be the same for topics taught by PBL and lectures, with median scores of 17 and s16, respectively. PBL were mostly preferred for the physiology (59.81%), pathology (51.40%) and pharmacology (53.27%) concepts, and lectures were mostly preferred for the anatomy (78.50%), biochemistry (45.79%), and microbiology (42.99%) topics. Students wanted the same concepts to be taught through both PBL and lectures, especially for anatomy. Conclusions: Understanding and knowledge retention is the same for topics taught by either PBL or lectures during the basic science years of undergraduate medical education. Students prefer PBL for physiology, pathology, and pharmacology-related concepts, conventional didactic lecture for physiology and microbiology, and a combination of lecture and PBL sessions for anatomy.

Teaching and learning pharmacology in Brazil before COVID-19 pandemic: a case study in Rio de Janeiro

BACKGROUND

Knowledge of pharmacology is crucial for physicians to perform rational and safe medicine. Medical professionals are responsible for prescribing drugs and a weak performace of those can result in medication errors leading to disability, hospitalization, and death, among other situations. It occurs worldwide, including in Brazil, so that learning pharmacology impacts on public health service. We aim to investigate the current pharmacology educational practices in medical schools in the state of Rio de Janeiro, Brazil.

METHODS

We surveyed 14 of 22 medical schools in Rio de Janeiro. Pharmacology teachers (n=16) and medical students (n=89) answered a semi-structured questionnaire that included questions about the staff characteristics, pharmacology content, teacher's concepts, and common practices and resources that were used in pharmacology classes.

RESULTS

Our results revealed that the medical schools had similar overall curriculums. Pharmacology teachers work more than 30hs a week (75%) and conducted both research and teaching (62.5%). We also found that the multimedia projector was the most common resource (71.9%), and passive pedagogical methodologies (e.g., expository classes) remain a current strategy in pharmacology classes (89.9%). In general, medical students are poorly motivated (55%), which may be related to their performance in assessments. In addition, students believe that pharmacology is a complex (52%) or very complex subject (46%) since for its full understanding the student needs concepts from other disciplines, which can have an impact on the performance and motivation of students. As a result, these medical students do not fully understand the integration between pharmacology's basic concepts and their clinical applications.

CONCLUSION

These data seem to demonstrate that the adopted teaching and learning pharmacology strategies and methodologies can be improved in Rio de Janeiro.

Assessing predictors of students' academic performance in Ethiopian new medical schools: a concurrent mixed-method study

BACKGROUND

Since 2012 the Ethiopian Federal Ministry of Health and Education implemented a new medical curriculum in 13 institutions. The new curriculum introduced some questions on its admission policy: students can join with different educational backgrounds. Students' performance on qualifying exams and grade point average are lower than desired. Therefore, the aim of the study was to investigate what factors predict the academic performance of students in the New Medical Education Initiative in Ethiopia.

METHODS

A concurrent mixed method of survey and qualitative was used; for the survey, a structured self-administered questionnaire was distributed to students of four randomly selected medical schools from December 2018 to January 2019. The questionnaire includes questions about socio-demographic and educational background of participants. Multiple linear regression analysis was used in order to identify the factors associated with academic performance. In-depth interviews were conducted with 15 key informants to explore qualitatively.

RESULTS

In the multiple linear regressions, stress was associated with lower academic performance. Students with prior education in the field of health science outperformed students with other bachelors. The cumulative grade point average of the previous bachelor degree and the score on the entrance exam to join medicine also significantly predicted performance. Although some more variables are identified from the qualitative interviews, its findings supported the survey results.

CONCLUSIONS

Of the number of predictor variables analyzed in the model, only stress, prior educational degree, performance in the prior degree and entrance exam score were significantly correlated with the performance of students in their preclinical medical engagement.

WeChat as a platform for blending problem/case-based learning and paper review methods in undergraduate paediatric orthopaedics internships: a feasibility and effectiveness study

BACKGROUND

Paediatric orthopaedics is a significant and difficult for undergraduate students to master. During the COVID-19 pandemic, we used the WeChat platform to combine the advantages offered by problem-based learning (PBL), case-based learning (CBL) and paper review teaching methods to establish a new blended online teaching model and demonstrated its feasibility and effectiveness.

OBJECTIVE

This study aims to demonstrate the feasibility and effectiveness of a new blended pedagogical method that uses the WeChat platform and combines PBL, CBL and paper review.

METHODS

We enrolled 22 students participating in the Department of Paediatric Orthopaedics. They participated in the WeChat blended pedagogy mode. Their departmental rotation examination scores were compared with those of 23 students who participated in the traditional teaching method. Moreover, an anonymous questionnaire was used to evaluate students' perceptions and experiences.

RESULTS

The total average scores of students who participated in the WeChat blended pedagogy mode and the traditional teaching method were 47.27 and 44.52, respectively. There were no statistically significant differences between the online teaching mode and the traditional teaching method in terms of possessing professional accomplishment, gaining knowledge and promoting interpersonal skills (P = 0.07, P = 0.12 and P = 0.65, respectively). In terms of independent clinical thinking, self-improving capability and improving clinical skills, the scores associated with the WeChat blended pedagogy mode were 8.00, 8.00 and 6.00, whereas those associated with the traditional teaching method were 6.70, 6.87 and 7.48. The overall satisfaction with the WeChat blended pedagogy mode reached 100%. A total of 64%, 86%, 68%, 64% and 59% of students chose very large or large in response to the items concerning professional accomplishment, knowledge absorption, independent clinical thinking skills, English reading and literature exploring capacity, as well as interpersonal skills, respectively. Fifteen participants claimed that the WeChat blended pedagogy mode was less helpful to them with regard to promoting the improvement of their clinical skills. Nine students claimed that the WeChat blended pedagogy mode was time-consuming.

CONCLUSIONS

Our study verified the feasibility and effectiveness of the WeChat blended pedagogy mode for undergraduate paediatric orthopaedics internships.

TRIAL REGISTRATION

Retrospectively registered.

A case study on genomic imprinting facilitates student learning

Problem-based learning encourages students to deepen their understanding of a concept by working through a real-world example of course content. Case studies represent a form of problem-based learning that engages students in realistic scenarios to achieve a deeper understanding of concepts. Case studies have been shown to facilitate the learning of challenging subject matter. We hypothesized that the use of a case study would help students better learn the topic of genomic imprinting, an abstract phenomenon in molecular biology and genetics. We wrote an interrupted case study that focused on genomic imprinting. The case study consists of three short popular news articles that relate to genomic imprinting. Each article is followed by a set of two to four questions. Students read each article and discuss its associated questions in small groups and then with the entire class before moving on to the next article. We deployed the case study in an intermediate-level molecular biology course at a small, liberal arts university. We assessed student learning and attitudes toward the case study (50 pre/postmatched pairs). In four true/false assessment questions, our results showed that the students' performance on the assessment after the case study was significantly higher than their performance before the case study. Students also self-reported increased knowledge of concepts related to genomic imprinting. Finally, students were likely to agree that the case study was beneficial to their learning and was an enjoyable classroom activity. We conclude that the case study is an effective way to instruct students about the topic of genomic imprinting.NEW & NOTEWORTHY Students often struggle with the concept of genomic imprinting, in part because it violates Mendelian rules of inheritance. Students learned about genomic imprinting, and enjoyed doing it when completing this case study.

A small‐group activity to enhance learning of cardiovascular drugs for health science students

This small‐group activity provides two cases in cardiovascular pharmacology to engage students in a medical or other health professions curriculum. The goal of this activity is to apply students' basic knowledge of physiology and pharmacology to clinical case scenarios. Students were provided with the cases 1 week in advance and were encouraged to use their lecture notes and/or other references of their choosing to answer as many of the questions as possible and prepare to discuss the answers with their classmates at the session. Facilitators were provided with detailed notes and a video that explain the answers and provide suggestions for engaging and challenging the students. For the 2021 academic year, 201 students (139 first‐year medical students and 62 second‐year pharmacy students) at UC San Diego participated in the small‐group activity. Eighteen facilitators were recruited to lead this 110‐min session. Students' performance was assessed on the final exam of their integrated cardiovascular physiology‐pharmacology course. Students achieved 84% (SD 17.54) on questions related to the small‐group session compared to 78% (SD 15.60) on other cardiovascular pharmacology questions not related to the activity. Student perceptions of the facilitators leading the small‐group activity were very positive (average of 4.7 on a 5‐point Likert Scale). Using this approach, we demonstrate that a small‐group activity with clinical scenarios helps students master the pharmacology content related to cardiovascular drugs. The small‐group activity included constructed response questions to foster conceptual understanding.

Effectiveness of problem-based learning methodology in undergraduate medical education: a scoping review

BACKGROUND

Problem-based learning (PBL) is a pedagogical approach that shifts the role of the teacher to the student (student-centered) and is based on self-directed learning. Although PBL has been adopted in undergraduate and postgraduate medical education, the effectiveness of the method is still under discussion. The author's purpose was to appraise available international evidence concerning to the effectiveness and usefulness of PBL methodology in undergraduate medical teaching programs.

METHODS

The authors applied the Arksey and O'Malley framework to undertake a scoping review. The search was carried out in February 2021 in PubMed and Web of Science including all publications in English and Spanish with no limits on publication date, study design or country of origin.

RESULTS

The literature search identified one hundred and twenty-four publications eligible for this review. Despite the fact that this review included many studies, their design was heterogeneous and only a few provided a high scientific evidence methodology (randomized design and/or systematic reviews with meta-analysis). Furthermore, most were single-center experiences with small sample size and there were no large multi-center studies. PBL methodology obtained a high level of satisfaction, especially among students. It was more effective than other more traditional (or lecture-based methods) at improving social and communication skills, problem-solving and self-learning skills. Knowledge retention and academic performance weren't worse (and in many studies were better) than with traditional methods. PBL was not universally widespread, probably because requires greater human resources and continuous training for its implementation.

CONCLUSION

PBL is an effective and satisfactory methodology for medical education. It is likely that through PBL medical students will not only acquire knowledge but also other competencies that are needed in medical professionalism.

Dyadic explanations during preparatory self-study enhance learning: A randomised controlled study

OBJECTIVES

The objective of the present study was to investigate to which extent preparatory self-study can be improved by encouraging students to engage in individual self-explanations or dyadic explanations (ie in pairs). Individual self-explanations refer to an act of metacognition in which students, after having processed a certain amount of information, attempt to explain their understanding to themselves of what was just learned. Dyadic explanations refer to the same process, but instead of explaining to oneself, the student explains his/her understanding to another student.

METHOD

An experiment was conducted in which 120 medical students studied a video-recorded lecture on the role of protein synthesis inhibition on memory reconsolidation. Participants were randomly allocated to one of four conditions: (1) a control condition in which they listened to the lecture once; (2) a control condition in which they listened to the lecture twice; (3) an experimental condition in which they had to listen to the lecture and provide self-explanations individually; and (4) an experimental condition in which they had to listen to the lecture and provide dyadic explanations. Participants' knowledge regarding the topic was measured three times: at the start and end of the experiment, and one week after the experiment to determine knowledge retention. Data were analysed by means of a 2 × 2 and 4 × 3 repeated-measures ANOVA.

RESULTS

The results suggest that participants who engaged in individual self- or dyadic explanations significantly outperformed participants in the two control conditions in terms of learning and retention (F = 5.67, Wilks Λ = 0.94, P = .019, η²  = 0.05). Moreover, the results suggest that dyadic explanations were more effective than individual self-explanations (F = 3.70, Wilks Λ = 0.83, P = .002, η²  = 0.09).

CONCLUSIONS

These outcomes suggest that encouraging students to work in pairs or in small teams to prepare for a learning event results in superior preparation and learning.

Impact of a problem-based learning elective on performance in non-problem-based learning required courses

BACKGROUND AND PURPOSE

Use of problem-based learning (PBL) in health professions education has limited data supporting improved exam performance and confidence in problem solving, primarily within courses converted to a PBL format. This study aimed to demonstrate a similar benefit in simultaneous and subsequent required, non-PBL courses that involved critical thinking.

EDUCATIONAL ACTIVITY AND SETTING

This retrospective cohort study included students who were enrolled in the pharmacotherapeutics and case studies/laboratory course sequences in the second and third professional (P3) years. We compared performance across both course sequences of students who took a PBL elective course in the fall of the P3 year (PBL students) and students who did not take the elective course (non-PBL students).

FINDINGS

There was a statistically significant difference favoring PBL students in performance in both the therapeutics and case/lab courses offered simultaneously with the PBL elective. There was no significant difference noted between PBL and non-PBL student performance in the subsequent therapeutics and case/lab courses; however, results within individual cohorts differed strikingly from the aggregate analysis. Performance in the PBL elective had no impact on the outcomes of the study.

SUMMARY

This study demonstrated an overall benefit for students who participated in a PBL course on performance in simultaneous, critical thinking courses that did not incorporate PBL. However, the aggregate did not show a difference in performance in subsequent critical thinking, non-PBL courses. Further studies are needed to elucidate the true benefit of the PBL approach in other non-PBL courses that require advanced clinical reasoning.

Assessing Students' Satisfaction with a Redesigned Pharmacology Course Series

Objective. To describe the revision of a pharmacology course series taught over three quarters within a Doctor of Pharmacy (PharmD) curriculum and assess changes in students' attitudes toward and performance after the revision. Methods. Based in part on students' dissatisfaction regarding a pharmacology course series, a course director was hired and tasked with teaching a major portion of the course content, rewriting course examinations, and facilitating active learning in the course series. Course evaluations and examination scores of students who completed the course series after the implementation of the redesigned curriculum (classes of 2015 and 2016) were assessed and compared with those of students who completed the course before the revisions were made (classes of 2013 and 2014). Results. Qualitative analysis of second-year pharmacy student evaluations identified a lack of integration and coordination within the pharmacology course sequence. Poor examination quality and the absence of active teaching methods were other frequently described shortcomings of the pharmacology curriculum. Course evaluations dramatically improved after shortcomings were addressed and students' performance in the subsequent therapeutics course also increased significantly. Conclusion. Adding additional structure to and oversight for a pharmacology course series by adding a course director improved student satisfaction with the course and improved performance in the subsequent therapeutics course. This study highlights the importance of a well-designed pharmacology curriculum for continued success in core courses in the PharmD curriculum.

Effectiveness of flipped classrooms

Purpose

The purpose of this paper is to suggest a methodology for evaluating the effectiveness of the flipped classroom (FC) model over traditional lecture-based teaching. It also proposed a tool to measure students’ perception toward the flipped approach in context of Indian management education.

Design/methodology/approach

This study employs an experimental research design to assess the effectiveness of the FC pedagogy over traditional teaching methods. Both qualitative and quantitative research methods are used in order to judge student engagement, content understanding, students’ perception and student academic performance. Experimental research design, along with survey research, is implemented in order to judge the students’ perception toward FCs.

Findings

The study proposes a six-dimensional tool to measure learning in an FC setting. These dimensions are as follows: students’ in-class involvement, comprehensive content understanding, students’ academic performance, students’ cognitive capabilities, collaborative learning environment and students’ inclination toward teaching and learning process. Results of this research are promising and encouraging toward the adoption of the FC model.

Research limitations/implications

The present research work is limited to assess the effectiveness of FC teaching for a management subject. Future studies may be carried out in other management subjects and other streams.

Practical implications

The present study provides several valuable insights for future researchers, academicians and management institutions. Although implementation of flipped approach leads to a collaborative learning environment and prepares students for self-learning, it also offers educationalists to remodel their teaching pedagogy as per students’ learning and understanding needs.

Originality/value

The research demonstrates the successful implementation of qualitative and quantitative research techniques to evaluate the effectiveness of FC model in context of management education in India.

Using a Novel Student-centered Teaching Method to Improve Pharmacy Student Learning

Objective. To improve students' learning and develop their learning skills in pharmacy education. Methods. A novel teaching method composed of Self-study, Test, Question and Discussion (STQD) sessions uses self-, peer-, co-learning, active learning, inductive teaching, and formative assessment to promote student-centered teaching in pharmacy education. STQD has been implemented within courses focusing on instrumental analysis and analytical chemistry. In a four-year study, qualitative and quantitative approaches were used to evaluate the effectiveness of STQD in facilitating students' learning. Results. Students positively evaluated their experience in STQD class with an overall mean and standard deviation of 4.35 (0.64) in a 5-point Likert scale, where a score of 1 is "strongly disagree" and a score of 5 is "strongly agree." The final examination results showed students' average score in an STQD class was higher than students' average score in a traditional class. Most students indicated that the STQD improved their learning ability, communication ability and facilitated their learning. Conclusion. The use of STQD in an integrated basic science curriculum has the potential to develop students' learning skills and improve their learning in pharmacy education.

An innovative addition to team-based-learning pedagogy to enhance teaching and learning: Students' perceptions of team exams

BACKGROUND AND PURPOSE

The study investigates students' perceptions of the value of implementing a team exam to enhance learning prior to a summative assessment. Team exams are similar to midterm exams, except that answering questions is a team effort.

EDUCATIONAL ACTIVITY AND SETTING

Data was collected from second year pharmacy students at California Northstate University College of Pharmacy (CNUCOP) through a self-administered online survey. The survey questions included closed-ended questions to evaluate students' perception on preparedness for a summative assessment and to rank advantages and disadvantages of the team exams.

FINDINGS

Of the 40 students who completed the survey (38% response rate), 100% of participants agreed that having a team exam prior to a major exam made them feel more prepared for a major summative exam. Ninety-seven percent of students believed that the team exam helped them to identify gaps in their knowledge and 85% agreed that taking a team exam reinforced their knowledge by teaching other students. The survey results did not identify any major disadvantages to holding a team exam.

SUMMARY

Students perceived that taking a team exam prior to a midterm exam is an effective approach to review the course contents and identify areas of improvement.

Effect of Face-to-face Education, Problem-based Learning, and Goldstein Systematic Training Model on Quality of Life and Fatigue among Caregivers of Patients with Diabetes

BACKGROUND

Education is a fundamental component for patients with diabetes to achieve good glycemic control. In addition, selecting the appropriate method of education is one of the most effective factors in the quality of life. The present study aimed to evaluate the effect of face-to-face education, problem-based learning, and Goldstein systematic training model on the quality of life (QOL) and fatigue among caregivers of patients with diabetes.

MATERIALS AND METHODS

This randomized clinical trial was conducted in Hajar Hospital (Shahrekord, Iran) in 2012. The study subjects consisted of 105 family caregivers of patients with diabetes. The participants were randomly assigned to three intervention groups (35 caregivers in each group). For each group, 5-h training sessions were held separately. QOL and fatigue were evaluated immediately before and after the intervention, and after 1, 2, 3, and 4 months of intervention.

RESULTS

There was a significant increase in QOL for all the three groups. Both the problem-based learning and the Goldstein method showed desirable QOL improvement over time. The desired educational intervention for fatigue reduction during the 4-month post-intervention period was the Goldstein method. A significant reduction was observed in fatigue in all three groups after the intervention (P < 0.001).

CONCLUSIONS

The results of the present study illustrated that the problem-based learning and Goldstein systematic training model improve the QOL of caregivers of patients with diabetes. In addition, the Goldstein systematic training model had the greatest effect on the reduction of fatigue within 4 months of the intervention.

A pilot study assessing the value of 3D printed molecular modelling tools for pharmacy student education

BACKGROUND AND PURPOSE

Medicinal chemistry and pharmacology are difficult topics to both teach and learn given the complex nature of drug mechanisms and drug-receptor interactions. This highlights the need for innovative teaching methods to deliver this information to students. One such method is through three-dimensional (3D) printing of enzymes and ligands in the teaching of molecular modelling concepts relating to drug-receptor and enzyme interactions be ligands. This type of printing has been shown to be beneficial in several educational settings; however, to our knowledge, its effectiveness in pharmacy, medicinal chemistry and pharmacology learning and teaching is largely unknown. Therefore, the aim of this study was to evaluate pharmacy student perceptions and the educational benefits of 3D printed molecules in molecular modelling with regards to engagement and learning outcomes when used in a drug-target interaction topic.

EDUCATIONAL ACTIVITY AND SETTING

This aim was achieved through administering students a short questionnaire designed to evaluate their engagement and learning outcomes with students also free to provide comments.

FINDINGS

This study found that nearly all (>90%) students found the activity was useful in improving both student engagement and learning outcomes.

DISCUSSION AND SUMMARY

In conclusion, 3D printing may provide an alternative learning activity to help pharmacy students understand the drug-target interaction.

Top-Cited Articles in Problem-Based Learning: A Bibliometric Analysis and Quality of Evidence Assessment

The aims of this study were to identify characteristics of the top-cited articles in problem-based learning (PBL) and assess the quality of evidence provided by these articles. The most frequently cited articles on PBL were searched in April 2015 in the Science Citation Index Expanded database (List A) and Google Scholar database (List B). Eligible articles identified were reviewed for key characteristics. The Oxford Centre for Evidence-Based Medicine guidelines were used in assessing the level of evidence. The number of citations varied (62 to 923 on List A and 218 to 2,859 on List B). Countries that contributed the majority of articles in both lists were the United States, Netherlands, United Kingdom, and Canada. No significant correlations were found between number of citations and number of years since published (p=0.451), number of authors (p=0.144), females in authorship (p=0.189), non-medical authors (p=0.869), number of institutions (p=0.452), and number of grants (p=0.143), but a strong correlation was found with number of countries involved (p=0.007). Application of the Oxford hierarchy of evidence showed that 36 articles were at levels 4 and 5 of evidence. This study found that research articles represented approximately one-third of PBL articles assessed and reported mainly on questionnaire-based studies. The most highly cited articles occupied top-ranking positions in the journals in which they were published. The lower level of evidence observed in most top-cited articles may reflect the significance of innovative ideas or content of these articles. These findings have implications for dental educators and dental researchers.

Instructional design framework for the sex and gender-specific health multimedia case-based learning modules

The goal of the Sex and Gender Specific Health (SGSH) curriculum at the Texas Tech University Health Sciences Center (TTUHSC) is to advance the understanding of sex/gender differences, increase the awareness of gender-specific health issues, and improve the knowledge of sex and gender evidence-based medicine. The purpose of this paper is to explain the development and theoretical rationale for an important aspect of the curriculum: the SGSH Multimedia Case-Based Learning Modules (MCBLMs). The MCBLMs are designed to be used throughout the TTUHSC curriculum as a stand-alone or a supplementary instructional resource. The MCBLMs provide students with authentic learning opportunities that integrate the learning of SGSH with more traditional clinical knowledge and skills. The MCBLMs are specifically designed to enhance students’ clinical reasoning and decision-making skills by portraying realistic clinical scenarios. In this way, students are able to practice effective SGSH as competent health-care professionals.

Problem-based learning in resource-poor settings: lessons from a medical school in Ghana

Problem-based learning (PBL) is arguably one of the most important innovations in medical education in the last century. The evident benefits of PBL and the changing face of medicine and medical education have led many institutions including those in resource-poor settings to consider the adoption of PBL curricula. However, experts are uncertain about how successful PBL will be in such settings, as literature on the implementation of PBL in resource-poor settings appears to be inadequate. The University of Cape Coast is located in a resource-poor setting, however, its medical school has used PBL curriculum since 2007. In a descriptive prose, this article discusses the PBL implementation processes, the challenges faced, the mitigation strategies employed, and the lessons learned at University of Cape Coast School of Medical Sciences (UCCSMS). The arguments fall under the broad themes of curricular structure, resource constraints, faculty development, and assessment. The peculiar socioeconomic situation of Ghana, challenges in funding of tertiary education, and the resource implications of PBL provided the context for the arguments. It emerged out of the discussion that PBL has to be implemented as whole curriculum to be effective. Regular faculty development activities on PBL and the alignment of assessment methods with PBL also emerged as important issues in the discussion. The article argues that in spite of its cost implication, a PBL curriculum can be successfully implemented in resource-constrained settings.

Open problem-based instruction impacts understanding of physiological concepts differently in undergraduate students

Student populations are diverse such that different types of learners struggle with traditional didactic instruction. Problem-based learning has existed for several decades, but there is still controversy regarding the optimal mode of instruction to ensure success at all levels of students' past achievement. The present study addressed this problem by dividing students into the following three instructional groups for an upper-level course in animal physiology: traditional lecture-style instruction (LI), guided problem-based instruction (GPBI), and open problem-based instruction (OPBI). Student performance was measured by three summative assessments consisting of 50% multiple-choice questions and 50% short-answer questions as well as a final overall course assessment. The present study also examined how students of different academic achievement histories performed under each instructional method. When student achievement levels were not considered, the effects of instructional methods on student outcomes were modest; OPBI students performed moderately better on short-answer exam questions than both LI and GPBI groups. High-achieving students showed no difference in performance for any of the instructional methods on any metric examined. In students with low-achieving academic histories, OPBI students largely outperformed LI students on all metrics (short-answer exam: P < 0.05, d = 1.865; multiple-choice question exam: P < 0.05, d = 1.166; and final score: P < 0.05, d = 1.265). They also outperformed GPBI students on short-answer exam questions (P < 0.05, d = 1.109) but not multiple-choice exam questions (P = 0.071, d = 0.716) or final course outcome (P = 0.328, d = 0.513). These findings strongly suggest that typically low-achieving students perform at a higher level under OPBI as long as the proper support systems (formative assessment and scaffolding) are provided to encourage student success.

Medical students' preferences for problem-based learning in relation to culture and personality: a multicultural study

OBJECTIVE

The aim of this study was to explore positive and negative preferences towards problem-based learning in relation to personality traits and socio-cultural context.

METHODS

The study was an anonymous and voluntary cross-sectional survey of medical students (N=449) in hybrid problem-based curricula in Nepal, Norway and North Dakota. Data was collected on gender, age, year of study, cohabitation and medical school. The PBL Preference Inventory identified students' positive and negative preferences in relation to problem-based learning; the personality traits were detected by the NEO Five-Factor Inventory. The determinants of the two kinds of preferences were analyzed by hierarchical multiple linear regressions.

RESULTS

Positive preferences were mostly determined by personality; associations were found with the traits Extra-version, Openness to experience, Conscientiousness and Neuroticism; the first three are related to sociability, curiosity and orderliness, the last, to mental health. The learn-ing environments of such curricula may be supportive for some and unnerving for others who score high on Neuroticism. Negative preferences were rather determined by culture, but also, they correlated with Neuroticism and Conscientiousness. Negative preferences were lower among females and students living in symmetrical relationships. Some high on Conscientiousness disliked group work, and the negative correlation with Agreeableness indicated that less sociable students were not predisposed to this kind of learning activity.

CONCLUSIONS

Preferences related to problem-based learning were significantly and independently determined both by personality traits and culture. More insights into the nature of students' preferences may guide aspects of curriculum modifications and the daily facilitation of groups.

The effectiveness of the problem-based learning teaching model for use in introductory Chinese undergraduate medical courses: a systematic review and meta-analysis

Background

Although the problem-based learning (PBL) emerged in 1969 and was soon widely applied internationally, the rapid development in China only occurred in the last 10 years. This study aims to compare the effect of PBL and lecture-based learning (LBL) on student course examination results for introductory Chinese undergraduate medical courses.

Methods

Randomized and nonrandomized controlled trial studies on PBL use in Chinese undergraduate medical education were retrieved through PubMed, the Excerpta Medica Database (EMBASE), Chinese National Knowledge Infrastructure (CNKI) and VIP China Science and Technology Journal Database (VIP-CSTJ) with publication dates from 1st January 1966 till 31 August 2014. The pass rate, excellence rate and examination scores of course examination were collected. Methodological quality was evaluated based on the modified Jadad scale. The I-square statistic and Chi-square test of heterogeneity were used to assess the statistical heterogeneity. Overall RRs or SMDs with their 95% CIs were calculated in meta-analysis. Meta-regression and subgroup meta-analyses were also performed based on comparators and other confounding factors. Funnel plots and Egger’s tests were performed to assess degrees of publication bias.

Results

The meta-analysis included 31studies and 4,699 subjects. Fourteen studies were of high quality with modified Jadad scores of 4 to 6, and 17 studies were of low quality with scores of 1 to 3. Relative to the LBL model, the PBL model yielded higher course examination pass rates [RR = 1.09, 95%CI (1.03, 1.17)], excellence rates [RR = 1.66, 95%CI (1.33, 2.06)] and examination scores [SMD = 0.82, 95%CI (0.63, 1.01)]. The meta-regression results show that course type was the significant confounding factor that caused heterogeneity in the examination-score meta-analysis (t = 0.410, P<0.001). The examination score SMD in “laboratory course” subgroup [SMD = 2.01, 95% CI: (1.50, 2.52)] was higher than that in “theory course” subgroup [SMD = 0.72, 95% CI: (0.56, 0.89)].

Conclusions

PBL teaching model application in introductory undergraduate medical courses can increase course examination excellence rates and scores in Chinese medical education system. It is more effective when applied to laboratory courses than to theory-based courses.

Preliminary investigation into application of problem-based learning in the practical teaching of diagnostics

Background

Problem-based learning (PBL) is a pedagogical approach based on problems. Specifically, it is a student-centered, problem-oriented teaching method that is conducted through group discussions. The aim of our study is to explore the effects of PBL in diagnostic teaching for Chinese medical students.

Methods

A prospective, randomized controlled trial was conducted. Eighty junior clinical medical students were randomly divided into two groups. Forty students were allocated to a PBL group and another 40 students were allocated to a control group using the traditional teaching method. Their scores in the practice skills examination, ability to write and analyze medical records, and results on the stage test and behavior observation scale were compared. A questionnaire was administered in the PBL group after class.

Results

There were no significant differences in scores for writing medical records, content of interviewing, physical examination skills, and stage test between the two groups. However, compared with the control group, the PBL group had significantly higher scores on case analysis, interviewing skills, and behavioral observation scales.

Conclusion

The questionnaire survey revealed that PBL could improve interest in learning, cultivate an ability to study independently, improve communication and analytical skills, and good team cooperation spirit. However, there were some shortcomings in systematization of imparting knowledge. PBL has an obvious advantage in teaching with regard to diagnostic practice.

Problem-based learning in pharmaceutical education: a systematic review and meta-analysis

OBJECTIVE

To assess the effects of problem-based learning (PBL) on the learning achievements of pharmacy students.

METHODS

We searched for controlled studies that compared PBL to traditional learning in pharmacy courses (graduate and undergraduate) in the major literature databases up to January 2014. Two independent researchers selected the studies, extracted the data, and assessed the quality of the studies. Meta-analyses of the outcomes were performed using a random effects model.

RESULTS

From 1,988 retrieved records, five were included in present review. The studies assessed students' impressions about the PBL method and compared student grades on the midterm and final examinations. PBL students performed better on midterm examinations (odds ratio [OR] = 1.46; confidence interval [IC] 95%: 1.16, 1.89) and final examinations (OR = 1.60; IC 95%: 1.06, 2.43) compared with students in the traditional learning groups. No difference was found between the groups in the subjective evaluations.

CONCLUSION

pharmacy students' knowledge was improved by the PBL method. Pharmaceutical education courses should consider implementing PBL.

Psychiatry clerkship core curriculum renewal: assessing the shift to larger-group learning

BACKGROUND/OBJECTIVE

A curriculum renewal of the third-year psychiatry clerkship rotation at University of Toronto Medical School resulted in a shift from case-based, small-group teaching at multiple teaching sites to the delivery of core material in a larger-group format. The authors examine the effects of this change in curriculum delivery.

METHOD

Student examination performance and student evaluations of the clerkship rotation and teaching were compared for the years before and after adoption of the updated, larger-group format curriculum.

RESULTS

Student examination performance was unchanged, comparing those who participated in small-group seminars versus those receiving larger-group core teaching. Student evaluations of the curriculum as a whole and of the core teaching were also unchanged, other than more negative evaluation of the course organization in the year immediately after implementation of the new curriculum.

CONCLUSIONS

Delivering core curriculum in larger- versus smaller-group format did not have any discernible effect on student psychiatry clerkship performance, and overall student assessment of the rotation remained largely positive. The involvement of highly-rated teachers and the higher number of uninterrupted clinical days may balance out with the trend for students to generally prefer small-group to larger-group learning. Ongoing evaluation and refinement of the psychiatry clerkship experience and core curriculum will be crucial to continued assurance of a high-quality learning experience for our medical students.

Student evaluation of problem-based learning in a dental orthodontic curriculum--a pilot study

OBJECTIVE

The present questionnaire survey investigated student reception of problem-based learning (PBL) in the orthodontic curriculum with regard to acceptance, sense of purpose and motivation, knowledge and understanding, as well as tutorial support.

METHODS

Over a period of two terms, we compared two different didactic methods (PBL and short presentations) by randomizing the participants of a course on orthodontic diagnostics into two different groups, who inversed methods after the first term.

RESULTS

The two student groups did not show any significant differences with regard to assessments or examination performance. Therefore, acceptance of the PBL concept seems to be mainly associated with the motivation of individuals to use this method. The higher the motivation, the more positive is the attitude towards the PBL concept. Students seem to work more constructively and efficiently with PBL if they can judge the concept meaningful for themselves.

CONCLUSION

In consideration of the relevant literature and the present results, PBL can be principally integrated into the dental curriculum as a method of learning. However, student motivation is vital to learning success.

The learning styles and the preferred teaching-learning strategies of first year medical students

INTRODUCTION

The purpose of teaching is to facilitate learning and to encourage the learners to learn more effectively. The learning style is an individual's consistent way of perceiving, processing and retaining new information. Educational researchers have shown an increasing interest in the learning styles, the related instructional methods and the andrgogical teaching techniques. This interest is spurred by a desire to help the students to become capable and successful learners.

AIM

The aim of this study was to determine the preferred learning styles of medical students as well as their preferences of specific teaching-learning methods.

METHOD

A cross sectional study was conducted on 100 first semester medical students who were enrolled at SMS & R, Sharda University, India. The VARK questionnaire, version 7.1 was used to categorize the learning preferences/modes as visual (V), auditory (A), read and write (R) and kinaesthetic (K). The students were also asked to rank the various teaching methodologies viz. lectures, tutorials, demonstrations and practicals/dissections from the most preferred choice to the least preferred one.

RESULTS

The majority (61%) of the students had multimodal VARK preferences. Among them, 41%, 14% and 6% preferred the bimodal, trimodal and the quadrimodal ways of information presentation. 39% of the respondents had one strong (unimodal) learning preference. The most common unimodal preference was kinaesthetic, followed by visual, auditory and read and write. The most preferred teaching methodology was practical/dissection (39%) and tutorial was the least preferred one (12%).

CONCLUSION

One single approach to teaching does not work for every student or even for most of the students. The educators' awareness of the various learning styles of the students and their efforts towards matching the teaching and learning styles may help in creating an effective learning environment for all the students.

Geriatric pharmacology and pharmacotherapy education for health professionals and students: a systematic review

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT

The rate of medication errors is high, and these errors can cause adverse drug reactions. Elderly individuals are most vulnerable to adverse drug reactions. One cause of medication errors is the lack of drug knowledge on the part of different health professionals. Medical curricula have changed in recent years, resulting in less education in the basic sciences, such as pharmacology.

WHAT THIS STUDY ADDS

Our study shows that little curricular time is devoted to geriatric pharmacology and that educational programmes in geriatric pharmacology have not been thoroughly evaluated. While interest in pharmacology education has increased recently, this is not the case for geriatric pharmacology education. Education on geriatric pharmacology should have more attention in the curricula of health professionals, given the often complex pharmacotherapy in elderly patients. Educational topics should be related to the known risk factors of medication errors, such as polypharmacy, dose adjustments in organ dysfunction and psychopharmacotherapeutics.

AIMS

Given the reported high rates of medication errors, especially in elderly patients, we hypothesized that current curricula do not devote enough time to the teaching of geriatric pharmacology. This review explores the quantity and nature of geriatric pharmacology education in undergraduate and postgraduate curricula for health professionals.

METHODS

Pubmed, Embase and PsycINFO databases were searched (from 1 January 2000 to 11 January 2011), using the terms 'pharmacology' and 'education' in combination. Articles describing content or evaluation of pharmacology education for health professionals were included. Education in general and geriatric pharmacology was compared.

RESULTS

Articles on general pharmacology education (252) and geriatric pharmacology education (39) were included. The number of publications on education in general pharmacology, but not geriatric pharmacology, has increased over the last 10 years. Articles on undergraduate and postgraduate education for 12 different health disciplines were identified. A median of 24 h (from 15 min to 4956 h) devoted to pharmacology education and 2 h (1-935 h) devoted to geriatric pharmacology were reported. Of the articles on education in geriatric pharmacology, 61.5% evaluated the teaching provided, mostly student satisfaction with the course. The strength of findings was low. Similar educational interventions were not identified, and evaluation studies were not replicated.

CONCLUSIONS

Recently, interest in pharmacology education has increased, possibly because of the high rate of medication errors and the recognized importance of evidence-based medical education. Nevertheless, courses on geriatric pharmacology have not been evaluated thoroughly and none can be recommended for use in training programmes. Suggestions for improvements in education in general and geriatric pharmacology are given.

Comparing the long-term retention of a physiology course for medical students with the traditional and problem-based learning

The rapid improvements in medical sciences and the ever-increasing related data, however, require novel methods of instruction. One such method, which has been given less than due attention in Iran, is problem-based learning (PBL). In this study, we aimed to evaluate the impact of study skills and the PBL methods on short and long-term retention of information provided for medical students in the course of respiratory physiology and compare it with traditional learning method. In this study, 39 medical students from Medical School of Kerman University of Medical Sciences, Kerman, Iran (2006-2010) were enrolled in the study and allocated randomly in three equal groups (13 in each group). All groups underwent a pre-test to be assessed for their basic information regarding respiratory physiology. Two groups were instructed using the traditional method, and one group used PBL. Among the two groups of the traditional method, one was instructed about study skills and the other was not. Once the PBL group took the study skill workshop, they were aided by tutors for their education. In the final term test, those students who had learned study skills and were instructed with the traditional method scored higher compared to other groups (p < 0.05). However, in the 1 year (p < 0.05) and 4 year (p < 0.01) interval examinations, the PBL group achieved significantly higher scores. Despite the fact that PBL had no positive effect on the final term exam of our students, it yielded a more profound and retained understanding of the subject course. Moreover, considering the positive effect of study skills on long-term student scores, we recommend students to receive instructions regarding the appropriate study skills when initiated into universities.

Comparison of three problem-based learning conditions (real patients, digital and paper) with lecture-based learning in a dermatology course: a prospective randomized study from China

BACKGROUND

The precise effect and the quality of different cases used in dermatology problem-based learning (PBL) curricula are yet unclear.

AIM

To prospectively compare the impact of real patients, digital, paper PBL (PPBL) and traditional lecture-based learning (LBL) on academic results and student perceptions.

METHODS

A total of 120 students were randomly allocated into either real-patients PBL (RPBL) group studied via real-patient cases, digital PBL (DPBL) group studied via digital-form cases, PPBL group studied via paper-form cases, or conventional group who received didactic lectures. Academic results were assessed through review of written examination, objective structured clinical examination and student performance scores. A five-point Likert scale questionnaire was used to evaluate student perceptions.

RESULTS

Compared to those receiving lectures only, all PBL participants had better results for written examination, clinical examination and overall performance. Students in RPBL group exhibited better overall performance than those in the other two PBL groups. Real-patient cases were more effective in helping develop students' self-directed learning skills, improving their confidence in future patient encounters and encouraging them to learn more about the discussed condition, compared to digital and paper cases.

CONCLUSION

Both real patient and digital triggers are helpful in improving students' clinical problem-handling skills. However, real patients provide greater benefits to students.

Improved performance of students instructed in a hybrid PBL format

As a result of enrollment expansion, increasing numbers of students are entering into medical school in China. This combined with a shortage of teachers, means that the learning environment typically consists of a large classroom setting with traditional lecture-based learning (LBL) as the major mode to teaching and learning. In this article, we investigate the preferences for hybrid problem-based learning (hybrid-PBL) or LBL in a large classroom setting. Two hundred five second-year undergraduate students in Third Military Medical University were randomly divided to two groups. The hybrid-PBL group contained 101 students and was taught by hybrid LBL (60%) and tutor-less PBL(40%) in a large classroom. The LBL group consisted of 104 students and was taught by LBL in a large classroom too. Post-teaching performance was assessed by multiple choice questions, short-essay questions, and case-analysis questions, while the students' teaching preferences and satisfaction were assessed by questionnaires. Analysis of the results of both groups in the examination of biochemistry revealed significantly higher scores on short-essay questions and case-analysis questions in the hybrid-PBL group. Students considered hybrid-PBL to be an effective learning method and favored it over the lecture format. Furthermore, students reported positive effects of hybrid-PBL in terms of additional learning resources, critical thinking, and fun learning experiences. These results suggest that hybrid-PBL is better than the traditional LBL method at improving students' basic knowledge and problem-solving skills. Students preferred hybrid-PBL and were satisfied with it. The tutor-less PBL pattern in a large classroom setting may be feasible in Chinese medical schools.

Differential student attrition and differential exposure mask effects of problem-based learning in curriculum comparison studies

PURPOSE

Studies that compare the effects of problem-based and conventional medical curricula on student performance generally show no significant differences. However, curriculum comparison studies are at best quasi-experimental, so they are prone to forms of selection bias. The purpose of this study was to reanalyze data from such comparisons by controlling for two potential biases: differential student attrition and differential exposure.

METHOD

The authors reanalyzed 104 previously published comparisons involving a single, problem-based medical school in the Netherlands (Maastricht University's medical school), using student attrition and study duration data from this school and the schools with which it was compared. The authors removed bias by reequalizing the comparison groups in terms of attrition and study duration.

RESULTS

The uncorrected data showed no differences between problem-based and conventional curricula: Mean effect sizes as expressed by Cohen d were 0.02 for medical knowledge and 0.07 for diagnostic reasoning. However, the reanalysis demonstrated medium-level effect sizes favoring the problem-based curriculum. After corrections for attrition and study duration, the mean effect size for knowledge acquisition was 0.31 and for diagnostic reasoning was 0.51.

CONCLUSIONS

Effects of the Maastricht problem-based curriculum were masked by differential attrition and differential exposure in the original studies. Because this school has been involved in many studies included in influential literature reviews published in the past 20 years, the authors' findings have implications for the assessment of the value of problem-based learning put forward by these reviews.

Impact of problem-based learning in a large classroom setting: student perception and problem-solving skills

Problem-based learning (PBL) can be described as a learning environment where the problem drives the learning. This technique usually involves learning in small groups, which are supervised by tutors. It is becoming evident that PBL in a small-group setting has a robust positive effect on student learning and skills, including better problem-solving skills and an increase in overall motivation. However, very little research has been done on the educational benefits of PBL in a large classroom setting. Here, we describe a PBL approach (using tutorless groups) that was introduced as a supplement to standard didactic lectures in University of British Columbia Okanagan undergraduate biochemistry classes consisting of 45-85 students. PBL was chosen as an effective method to assist students in learning biochemical and physiological processes. By monitoring student attendance and using informal and formal surveys, we demonstrated that PBL has a significant positive impact on student motivation to attend and participate in the course work. Student responses indicated that PBL is superior to traditional lecture format with regard to the understanding of course content and retention of information. We also demonstrated that student problem-solving skills are significantly improved, but additional controlled studies are needed to determine how much PBL exercises contribute to this improvement. These preliminary data indicated several positive outcomes of using PBL in a large classroom setting, although further studies aimed at assessing student learning are needed to further justify implementation of this technique in courses delivered to large undergraduate classes.

Enhanced podcasts for teaching biochemistry to veterinary students

The teaching of biochemistry within medical disciplines presents certain challenges; firstly to relay a large body of complex facts and abstract concepts, and secondly to motivate students that this relatively difficult topic is worth their time to study. Here, nutrient biochemistry was taught within a multidisciplinary module as part of an undergraduate veterinary curriculum. The teaching approach was initially focussed on a mixture of didactic lectures and student-centred activities such as directed group/self learning. In subsequent years the core didactic lectures were replaced with enhanced podcasts covering the same material, along with the introduction of student presentations delivered within groups with both peer and facilitator assessment. These changes were accompanied by an increase in the time dedicated to this topic to allow sufficient time for students to work through podcasts and prepare presentations. The combination of these changes resulted in significant improvements in student performance within an in-course biochemistry long essay. These changes in the teaching approach, and particularly the introduction of extensive podcasts, was well received by students who perceived the process of going through the podcasts as time consuming but allowing them flexibility in both the pace that they studied this topic as well as the location and times that they studied it.

Six ways problem-based learning cases can sabotage patient-centered medical education

PURPOSE

Problem-based learning (PBL) cases tell a story of a medical encounter; however, the version of the story is typically very biomedical in focus. The patient and her or his experience of the situation are rarely the focus of the case despite a prevalent discourse of patient-centeredness in contemporary medical education. This report describes a qualitative study that explored the question, "How does PBL teach medical students about what matters in medicine?"

METHOD

The qualitative study, culminating in 2008, involved three data collection strategies: (1) a discourse analysis of a set of PBL cases from 2005 to 2006, (2) observation of a PBL tutorial group, and (3) semistructured, in-depth, open-ended interviews with medical educators and medical students.

RESULTS

In this report, using data gathered from 67 PBL cases, 26 hours of observation, and 14 interviews, the author describes six specific ways in which PBL cases-if not thoughtfully conceptualized and authored-can serve to overlook social considerations, thereby undermining a patient-centered approach. These comprise the detective case, the shape-shifting patient, the voiceless PBL person, the joke name, the disembodied PBL person, and the stereotypical PBL person.

CONCLUSIONS

PBL cases constitute an important component of undergraduate medical education. Thoughtful authoring of PBL cases has the potential to reinforce, rather than undermine, principles of patient-centeredness.

A comparison of competencies between problem-based learning and non-problem-based graduate nurses

Competence is essential to ensuring safe, ethical and legal nursing practice. Various teaching strategies are used in nursing education in an effort to enhance graduate competence by bridging the gap between theory learned in the classroom and professional practice as a nurse. The objective of this comparative descriptive research was to determine if there was a difference in self reported competence between graduates from PBL and non PBL (NPBL) nursing programs. A convenience sample of 121 graduate nurses in one Canadian province, who had been practicing for at least 6 months took part in the study. The researcher designed questionnaire included both forced choice and open ended questions. There was no statistical significance difference between the PBL and NPBL graduates on self reported entry-to-practice competence. However, several significant themes did emerge from the answers to open ended questions which asked graduates how their nursing programs prepared them to meet the entry-to-practice competencies and what program improvements they might suggest. Unlike the NPBL graduates, the PBL graduates identified the structure and process of their programs as instrumental in their preparation to meet the entry-to-practice competencies. PBL graduates associated their abilities to think critically and engage in self-directed evidence-based practice as key to enabling them to meet the competencies. A common theme for program improvement for both PBL and NPBL graduates was a request for more clinical time.

Education strategies to foster health professional students' clinical reasoning skills

Clinical reasoning is an important skill for health professionals that should be developed to achieve high levels of expertise. Several education strategies have been suggested for implementation by health professional educators to foster their students' clinical reasoning skills. The strategies have included the following: problem-based learning, the integrative curriculum, reflection, and concept mapping. This review assesses which is the most effective education strategy for developing the clinical reasoning skills of health professional students. Four publications, from a total of 692 identified records, were included. Overall, this review was not able to make a final conclusion to answer the question. Therefore, there is a need to conduct more studies with larger samples and to undertake research that evaluates the following aspects: more alternate education interventions, variations in the delivery of education interventions, and the cost-effectiveness of implementing education strategies.

Problem-based learning in academic health education. A systematic literature review

Problem based learning (PBL) arguably represents the most significant development in education over the past five decades. It has been promoted as the curriculum of choice, and since its introduction in the 1960's, has been widely adopted by many medical and dental schools. PBL has been the subject of much published literature but ironically, very little high quality evidence exists to advocate its efficacy and subsequently justify the widespread curriculum change. The purpose of this review is to classify and interpret the available evidence and extract relevant conclusions. In addition, it is the intent to propose recommendations regarding the relative benefits of PBL compared with conventional teaching. The literature was searched using PubMed, ERIC and PsycLIT. Further articles were retrieved from the reference lists of selected papers. Articles were chosen and included according to specific selection criteria. Studies were further classified as randomised controlled trials (RCTs) or comparative studies. These studies were then analysed according to intervention type: whole curricula comparisons and single educational interventions of shorter duration. At the level of RCTs and comparative studies (whole curricula), no clear difference was observed between PBL and conventional teaching. Paradoxically, it was only comparative studies of single PBL intervention in a traditional curriculum that yielded results that were consistently in favour of PBL. Further research is needed to investigate the possibility that multiple PBL interventions in a traditional curriculum could be more effective than an exclusively PBL programme. In addition, it is important to address the potential benefits of PBL in relation to life-long learning of health care professionals.

Problem-based learning in pre-clinical medical education: 22 years of outcome research

PURPOSE

To conduct a systematic review of problem-based learning (PBL) in undergraduate, pre-clinical medical education.

METHODS

A research librarian developed comprehensive search strategies for MEDLINE, PSYCINFO, and ERIC (1985-2007). Two reviewers independently screened search results and applied inclusion criteria. Studies were included if they had a comparison group and reported primary data for evaluative outcomes. One reviewer extracted data and a second reviewer checked data for accuracy. Two reviewers independently assessed methodological quality. Quantitative synthesis was not performed due to heterogeneity. A qualitative review with detailed evidence tables is provided.

RESULTS

Thirty unique studies were included. Knowledge acquisition measured by exam scores was the most frequent outcome reported; 12 of 15 studies found no significant differences. Individual studies demonstrated either improved clerkship (N = 3) or residency (N = 1) performance, or benefits on some clinical competencies during internships for PBL (N = 1). Three of four studies found some benefits for PBL when evaluating diagnostic accuracy. Three studies found few differences of clinical (or practical) importance on the impact of PBL on practicing physicians.

CONCLUSIONS

Twenty-two years of research shows that PBL does not impact knowledge acquisition; evidence for other outcomes does not provide unequivocal support for enhanced learning. Work is needed to determine the most appropriate outcome measures to capture and quantify the effects of PBL. General conclusions are limited by methodological weaknesses and heterogeneity across studies. The critical appraisal of previous studies, conducted as part of this review, provides direction for future research in this area.

A formação médica ancorada na aprendizagem baseada em problema: uma avaliação qualitativa

Pretendeu-se avaliar os resultados de um curso de medicina ancorado na aprendizagem baseada em problema. A metodologia do estudo baseou-se no desenho de pesquisa de avaliação com abordagem qualitativa, envolvendo entrevistas, elaboração de um plano de cuidados e atividade com paciente simulado. Os dados obtidos foram analisados a partir da perspectiva hermenêutica-dialética. Apesar de ter tido limites, o curso foi avaliado de forma positiva porque, segundo os egressos, proporcionou uma formação humanista, promoveu o aprender a aprender, valorizou a convivência com outros profissionais e integrou teoria com a prática. Os egressos articularam as dimensões biológica, psicológica e social tanto em suas falas quanto em suas ações. Os pacientes consideraram que os egressos eram cuidadosos, respeitando-os e escutando-os, enquanto os gestores dos serviços de saúde reconheceram que a atuação do egresso ia para além do foco da doença.