Is there a problem with the problems in problem-based learning?

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.

Mapping health, social and health system issues and applying a social accountability inventory to a problem based learning medical curriculum

Social accountability is a powerful concept. It is applied to medical education to encourage future doctors to take action to address health inequalities and overlooked health needs of disadvantaged populations. Problem-based learning (PBL) provides an ideal setting to teach medical students about these topics. The objective of this study is to explore how well the components of social accountability are covered in a pre-clinical PBL medical curriculum and to determine the usefulness of an adapted validated social accountability framework. We identified Irish health needs and social issues through a literature review. The retrieved documents were aligned to four values (relevance, equity, cost-effectiveness and quality) from a validated social accountability inventory, to generate a map of social accountability values present in the Irish health system and population. We then used the adapted validated social accountability inventory to evaluate the content of the PBL medical curriculum at an Irish medical school. We identified 45 documents, which upon analysis lead to the identification of health and social issues related to social accountability. 66 pre-clinical PBL cases included demographic, health and psychosocial issues similar to the local population. Analysing along the four social accountability values, the PBL cases demonstrated room for improvement in the equity and relevance domains. Topics for expansion are Traveller health, LGBTI health, alcohol use, climate change and more. Medical educators can use the paper as an example of how to apply this methodology to evaluate PBL cases. Adapting and applying a validated framework is a useful pedagogical exercise to understand established societal values related to social accountability to inform a medical curriculum. We identified opportunities to improve the PBL cases to depict emerging global and social issues.

Planning a Collection of Virtual Patients to Train Clinical Reasoning: A Blueprint Representative of the European Population

Background: Virtual patients (VPs) are a suitable method for students to train their clinical reasoning abilities. We describe a process of developing a blueprint for a diverse and realistic VP collection (prior to VP creation) that facilitates deliberate practice of clinical reasoning and meets educational requirements of medical schools. Methods: An international and interdisciplinary partnership of five European countries developed a blueprint for a collection of 200 VPs in four steps: (1) Defining the criteria (e.g., key symptoms, age, sex) and categorizing them into disease-, patient-, encounter- and learner-related, (2) Identifying data sources for assessing the representativeness of the collection, (3) Populating the blueprint, and (4) Refining and reaching consensus. Results: The blueprint is publicly available and covers 29 key symptoms and 176 final diagnoses including the most prevalent medical conditions in Europe. Moreover, our analyses showed that the blueprint appears to be representative of the European population. Conclusions: The development of the blueprint required a stepwise approach, which can be replicated for the creation of other VP or case collections. We consider the blueprint an appropriate starting point for the actual creation of the VPs, but constant updating and refining is needed.

Do virtual patients prepare medical students for the real world? Development and application of a framework to compare a virtual patient collection with population data

BACKGROUND

An important aspect of virtual patients (VPs), which are interactive computer-based patient scenarios, is authenticity. This includes design aspects, but also how a VP collection represents a patient population and how a patient is presented in a VP scenario. Therefore, our aim was to analyze VP scenarios integrated into the combined internal medicine and surgery curriculum at the University of Munich (LMU) and compare the results with data from the population in Germany.

METHOD

We developed a coding framework with four main categories: patient data, patient representation, diagnoses, and setting. Based on the framework we analyzed 66 VP and compared the results with data from the German healthcare system.

RESULTS

Especially in the categories of patient data and patient representation, the VPs presented an unrealistic image of the real world; topics such as unemployment, disability, or migration background were almost non-existent. The diagnoses of the VPs and the onset of diseases were comparable with the healthcare data.

CONCLUSIONS

An explanation for the lack of representativeness of the patient data and representation might be a trend to create VPs based on fictional patient stories with VP authors trying to minimize complexity and cognitive load for the students. We suggest raising awareness among VP authors concerning personalized representations of patients without overwhelming their students. Our framework can support educators to assess the authenticity and diversity of a VP collection.

Exploring the Realities of Curriculum-by-Random-Opportunity: The Case of Geriatrics on the Internal Medicine Clerkship Rotation

BACKGROUND

While major clerkship blocks may have objectives related to specialized areas such as geriatrics, gay and lesbian bisexual transgender health, and palliative care, there is concern that teaching activities may not attend sufficiently to these objectives. Rather, these objectives are assumed to be met "by random opportunity".((1)) This study explored the case of geriatric learning opportunities on internal medicine clinical teaching units, to better understand the affordances and limitations of curriculum by random opportunity.

METHODS

Using audio-recordings of morning case review discussions of 13 patients > 65 years old and the Canadian geriatric core competencies for medical students, we conducted a content analysis of each case for potential geriatric and non-geriatric learning opportunities. These learning opportunities were compared with attendings' case review teaching discussions. The 13 cases contained 40 geriatric-related and 110 non-geriatric-related issues. While many of the geriatric issues (e.g., delirium, falls) were directly relevant to the presenting illness, attendings' teaching discussions focused almost exclusively on non-geriatric medical issues, such as management of diabetes and anemia, many of which were less directly relevant to the reason for presenting to hospital.

RESULTS

The authors found that the general medicine rotation provides opportunities to acquire geriatric competencies. However, the rare uptake of opportunities in this study suggests that, in curriculum-by-random-opportunity, presence of an opportunity does not justify the assumption that learning objectives will be met.

CONCLUSIONS

More studies are required to investigate whether these findings are transferrable to other vulnerable populations about which undergraduate students are expected to learn through curriculum by random opportunity.

Features for Suitable Problems

One cannot be a problem solver without deep understanding of what constitutes a problem. Failing to recognise and define problems presents obstacles in constructing and applying knowledge in problem solving. This has been the motivation for the authors to re-examine in the context of IT (Information Technology) the concept, nature and types of a problem. The most and least important features of a problem are scrutinized, considering the problem-based learning experts’ opinions and a collection of IT students’ viewpoints. The authors (i) identify and critically comment on the features of a problem that are still needed in problem-based learning, and (ii) provide insights and guidelines on the position and use of problems for IT curriculum designers and IT professionals in problem-focused higher education.

Are patient-centered care values as reflected in teaching scenarios really being taught when implemented by teaching faculty? A discourse analysis on an Indonesian medical school's curriculum

BACKGROUND

According to The Indonesian Medical Council, 2006, Indonesian competence-based medical curriculum should be oriented towards family medicine. We aimed to find out if the educational goal of patient-centered care within family medicine (comprehensive care and continuous care) were adequately transferred from the expected curriculum to implemented curriculum and teaching process.

METHODS

Discourse analysis was done by 3 general practitioners of scenarios and learning objectives of an Indonesian undergraduate medical curriculum. The coders categorized those sentences into two groups: met or unmet the educational goal of patient-centered care.

RESULTS

Text analysis showed gaps in patient-centered care training between the scenarios and the learning objectives which were developed by both curriculum committee and the block planning groups and the way in which the material was taught. Most sentences in the scenarios were more relevant to patient-centered care while most sentences in the learning objectives were more inclined towards disease-perspectives.

CONCLUSIONS

There is currently a discrepancy between expected patient-centered care values in the scenario and instructional materials that are being used.

Nursing Students' Perceptions of Self-Determination in Elderly People

The purpose of this study was to compare nursing students' perceptions of self-determination in elderly patients before and after clinical training in long term care institutions as a part of their course in gerontological nursing. A pre- post-test design was employed. The data were collected by questionnaires completed by students at one nurse education organization college in Finland (pre-test n ± 120, response rate 95%; post-test n ± 115, response rate 91%). The students' perceptions of elderly patients' self-determination were more positive after their clinical training period concerning to what extent elderly patients are able to control their treatment and what kind of support they received from nurses to exercise their self-determination. The students' perceptions remained stable concerning how important self-determination is to elderly patients, and how willing and knowledgeable they are about using their self-determination. Ethics teaching, together with high quality clinical training placements, should be assured early during nursing studies.

The patient as text: a challenge for problem-based learning

OBJECTIVES

To explore the values and assumptions underlying problem-based learning (PBL) cases through narrative analysis, in order to consider the ways by which paper cases may affect student attitudes and values.

METHODS

Randomly chosen PBL cases from the first year curriculum at Dalhousie University medical school (n = 10) were coded by 3 independent reviewers attending to narrative components.

RESULTS

The cases generally used spare, objective language, used the passive voice, eliminated agency, and employed linguistic markers to encode scepticism about patient reports. There was almost no sense of the presence of the patient as person in these cases in terms of their words, feelings, or their social and cultural context. The almost complete exclusion of the preferences and priorities of the patient was striking.

CONCLUSION

The sample is small, the results only suggestive. Yet it appears that the cases used in PBL may unnecessarily, even unintentionally, encourage student detachment from the messiness of real patients' lives and emotions. Positioning a particular way of seeing - the doctor's gaze - as normative renders less visible the choices that are being made whenever an account is constructed. Including multiple voices in a case would complicate that tidy reduction of choices. Ongoing attempts to enrich the case format should be encouraged. At the same time, students may benefit from being taught the skills for critical analysis of the case itself.

Social and behavioural science education in UK medical schools: current practice and future directions

INTRODUCTION

The increasing importance accorded the social and behavioural sciences in medical education presents opportunities for developing new and innovative forms of teaching and learning in this field. Yet social and behavioural scientists often feel isolated and marginalized. This research was designed to build a network of such practitioners to share and compare current practice, and to develop better models and resources.

METHODS

Questionnaire survey and workshop discussions describe current practice among social and behavioural scientists in UK medical education, and identify current and future issues.

RESULTS

Most UK medical curricula feature a significant social and behavioural science component, often in multidisciplinary contexts. Questions of core content, and how this relates to desired learning outcomes, particularly in the attitudinal sphere, remain unresolved. Identity problems result from differing perspectives of medics and social and behavioural scientists, staffing constraints, assessment regimes, and relationships with external examiners.

DISCUSSION

This project identified barriers and opportunities for providing adequate training in the social and behavioural sciences in medical schools. Some of the barriers are common to higher education generally. Through our network, a database of core cases and assessments can be developed that would be available to all for teaching purposes.

CONCLUSION

Social and behavioural scientists involved in medical education show commonality and difference in the extent and scope of their input. While they have made great progress, there remains much to achieve.

Reforming medical education to enhance the management of chronic disease

Medical education must adapt to change if it is to remain relevant to the needs of doctors, patients and society. Ideally, it should anticipate and lead change. Undergraduate education remains rooted in urban medical schools where the focus is on acute disease, while most graduates spend their working lives in the community, dealing mainly with chronic health problems. Medical graduates need to acquire specific knowledge, skills and attitudes if they are to effectively manage people with chronic disease. Strategies that create a better balance between education in acute and chronic disease are being developed. These include a transfer of clinical teaching to community and nursing home settings and the development of interdisciplinary teaching.

Introducing a problem-based unit into a lifespan nutrition class using a randomized design produces equivocal outcomes

Problem-based learning (PBL) is a tutorial, student-centered, problem-driven educational strategy adopted by medical and allied health educators to positively influence self-directed learning, critical thinking, and learning behavior. PBL was examined in dietetics education through random assignment of 32 undergraduate dietetics students for two weeks to either a problem-based or a lecture-based case format for the infant and elderly units of a 16-week lifespan nutrition course. Random assignment followed stratification for gender and earlier course examination performance. Expert validation of PBL curricular components and noted differences in discussion structure and information resources verified curriculum distinctiveness. Main outcome measures were pre- and post-Cognitive Behavior Survey scores for memorization, reflection, and positive learning experience scales, unit and course evaluations and unit examination scores. Students in problem-based modules demonstrated greater gains in reflective thinking with stable memorization, suggesting improved critical thinking skills. Tenets that problem-based learning promotes knowledge retention and provides a more positive learning experience were not upheld. Knowledge acquisition was not hindered by a problem-based approach. We conclude that gains in reflective thinking and evidence of increased self-directed learning argue for inclusion of PBL in dietetics curricula and that a problem-based education will help dietitians successfully respond to professional development needs.

Challenges of current geriatric education-inspired by the Nordic geriatric professors' meetings

Geriatric educators are faced with several different challenges. The rapid growth of aged population in the Western world has led to a growing need for health and social services and thus, an increased need for trained professionals in this field. In addition, new learning theories and activating learning methods have achieved wide acceptance in academic medicine. How has geriatric education applied these new learning methods? In this article we review the current status of academic geriatric education in Western countries in these respects. We especially review the literature of how geriatric training has been experimenting with the new learning methods.