Case design to emphasize population health concepts in problem-based learning

Progressive disclosure cases: The design and evaluation of use in multiple therapeutics courses

BACKGROUND AND PURPOSE

Case-based learning is used frequently throughout pharmacy education. Although beneficial, stand-alone cases may result in segmented learning that does not simulate realistic longitudinal patient care. We report the development, implementation, and evaluation of a longitudinal progressive disclosure case surrounding a single patient spanning two different therapeutics courses.

EDUCATIONAL ACTIVITY AND SETTING

A patient case was developed surrounding topics in two third professional year therapeutics courses occurring sequentially in the same semester. Changes to the patient's status were provided to students longitudinally via "disclosures." Students were assessed via quizzes and written assessment and plans. Students completed four perceptions of confidence surveys via a four-point Likert Scale. Surveys included questions surrounding confidence in areas of the pharmacists' patient care process (PPCP) before and after courses utilizing the progressive disclosure case. Case assessment grades were used to evaluate the impact on student performance on course examinations. Students also completed a survey on final perceptions of the activity.

FINDINGS

Seventy students were enrolled in the two courses participating in the progressive disclosure case and there were 50 (71.4%) matched, completed surveys completed for analysis. Significant improvements were seen in several questions surrounding confidence in the areas of the PPCP between the beginning and conclusion of courses that contained the progressive disclosure case. No correlation between case activity grades and examination performance was found.

DISCUSSION AND CONCLUSION

Overall, student confidence in patient care skills associated with information collection, assessment, plan design, and monitoring improved with the use of progressive disclosure cases within two sequential therapeutics courses.

Examining the effects of interprofessional problem-based clinical ethics: Findings from a mixed methods study

Understanding how interprofessional education (IPE) works in learning clinical ethics via problem-based learning (PBL) and how different professions' perspectives influence each other in this setting may inform future IPE. Eighty-nine students participated in a clinical ethics PBL and were assigned into three study groups, i.e., medical, nursing, and interprofessional groups. This study applied an explanatory sequential mixed methods design. The quantitative phase involved observation of the learning process in PBL tutorial with checklists to code students' performance of learning behaviour, ethics discussion skills, learning content explored, and analysis through comparison of accumulative percentage of the coded performance between groups. Content analysis of post-PBL homework self-reflections from interprofessional group was conducted as the following explanatory qualitative phase. Quantitative results indicated that nursing students performed favourably on course engagement, caring, and communication while medical students performed positively on issue identification and the life science aspect. Interprofessional group showed the strength of the both professions and performed best through the learning process. Content analysis revealed that students in the interprofessional group achieved interprofessional learning from recognizing the differences between to appreciating learning from each other and to sense the need of future collaboration. With early exposure to IPE, undergraduate students may learn to balance their socialized viewpoints by seeing ethical dilemmas from each other's standpoint.

Using a Web-based simulation as a problem-based learning experience: perceived and actual performance of undergraduate public health students

OBJECTIVES

This study investigated the use of a Web-based community health simulation as a problem-based learning (PBL) experience for undergraduate students majoring in public health. The study sought to determine whether students who participated in the online simulation achieved differences in academic and attitudinal outcomes compared with students who participated in a traditional PBL exercise.

METHODS

Using a nonexperimental comparative design, 21 undergraduate students enrolled in a health-behavior course were each randomly assigned to one of four workgroups. Each workgroup was randomly assigned the semester-long simulation project or the traditional PBL exercise. Survey instruments were used to measure students' attitudes toward the course, their perceptions of the learning community, and perceptions of their own cognitive learning. Content analysis of final essay exams and group reports was used to identify differences in academic outcomes and students' level of conceptual understanding of health-behavior theory.

RESULTS

Findings indicated that students participating in the simulation produced higher mean final exam scores compared with students participating in the traditional PBL (p=0.03). Students in the simulation group also outperformed students in the traditional group with respect to their understanding of health-behavior theory (p=0.04). Students in the simulation group, however, rated their own level of cognitive learning lower than did students in the traditional group (p=0.03).

CONCLUSIONS

By bridging time and distance constraints of the traditional classroom setting, an online simulation may be an effective PBL approach for public health students. Recommendations include further research using a larger sample to explore students' perceptions of learning when participating in simulated real-world activities. Additional research focusing on possible differences between actual and perceived learning relative to PBL methods and student workgroup dynamics is also recommended.

Using problem-based learning for pandemic preparedness

To test the hypothesis that PBL is an effective method for preparing multidisciplinary learner groups at community health centers (CHCs) for pandemics, quantitative and qualitative methods were utilized to evaluate the conduct of a PBL case of a hypothetical outbreak of severe acute respiratory syndrome (SARS) at two CHCs in Hawaii, with multidisciplinary health professional and student participants. It was found that: (1) there was an overall increase in knowledge of bioevent preparedness; (2) participants gave high ratings for the effectiveness of the PBL process; (3) participants found value in the multidisciplinary group process; and (4) participants strongly agreed that they preferred the PBL process to the traditional lecture format for learning about bioevent preparedness. The PBL approach is useful in educating community-based health professionals from different disciplines about issues related to pandemic preparedness.

Using problem-based learning in public health service based training

OBJECTIVES

This study explored the suitability and benefits of problem-based learning (PBL) in competency-based postgraduate public health training. The PBL was delivered within a rural retreat and included site visits.

METHODS

Qualitative semistructured interviews with trainee public health officers and key informants.

RESULTS

The learning approach (retreat-PBL combination with site visits) was valuable and relevant. Trainees reported a high learning impact with increased knowledge about the problems examined and rural public health practice. They also expressed an openness to work rurally.

CONCLUSION

Collaboratively developed and delivered, experiential rural public health PBL provides a positive learning experience for trainees undertaking competency-based training in public health and could play an important workforce role. PBL appears to be suitable in rural and non-rural public health training settings.

A conceptual framework for developing teaching cases: a review and synthesis of the literature across disciplines

Case-based teaching is regarded as a superior instructional method compared with lectures in promoting a learner's critical thinking skills. While much is known about the role a discussion facilitator plays in case-based teaching, the debate on the influence of the format and structure of cases on learning is controversial. We sought to identify strategies for constructing cases based on studies from multiple disciplines, which report the development and use of cases in teaching and learning. The purpose was to offer the medical and other educational communities a conceptual framework that can be examined in future research. Based on a review of 100 studies, we synthesised 17 strategies around 5 core attributes of cases: relevant (level of learner, goals and objectives, setting of case narrative); realistic (authenticity, distractors, gradual disclosure of content); engaging (rich content, multiple perspectives, branching of content); challenging (difficulty, unusual cases, case structure, multiple cases), and instructional (build upon prior knowledge, assessment, feedback, and teaching aids). Despite the wide use of cases in disparate disciplines, there has been no overarching study that synthesises strategies of case development or tests these strategies in research settings. The framework we developed can serve as a menu of case development options that educators and researchers can pilot and evaluate in their local settings.

Ethical decision making on truth telling in terminal cancer: medical students' choices between patient autonomy and family paternalism

INTRODUCTION

The effect of medical education is often hard to evaluate. We tried to assess whether a 2-hour, small-group discussion could alter student perspectives on truth telling. Currently, in Taiwan it is common practice to consult with the family of a terminally ill patient before telling the truth to the patient, which may be in conflict with patient autonomy.

METHODS

The study was based on content analysis of self-reflective written texts after a 2-hour group discussion on a clinical case describing a truth-telling situation. The changes in decision patterns regarding the emphasis placed on patient autonomy versus family paternalism and the connection to related moral reasoning were subjected to focus analysis.

RESULTS

The students' initial attitudes regarding the subject of truth telling were categorised into 4 patterns, namely, patient-centred (n = 46), family-centred (n = 20), simultaneous informing (n = 1), and situational informing (n = 5) modes. The discussion stimulated perspective changes in many of the students and their attitudes were then regrouped as patient-comprehensive (n = 35), family-centred (n = 1), and family-comprehensive (n = 36) modes. It was found that variations on 'common sense' and moral reasoning existed prior to the class and the students initially tended to overlook the complexity of truth telling in terminal cancer. Through the discussion and reflective learning, they were enabled to acknowledge the vulnerability of both the patient and his or her family, and to make decisions based on more comprehensive considerations.

CONCLUSION

Group discussion seemed to be able to enhance ethical consideration. Further research is required to determine whether the benefits of this approach can be translated into behavioural changes in practice.

Adding problem-based learning tutorials to a traditional lecture-based curriculum: a pilot study in a dental school

This article reports on the implementation of a problem-based learning (PBL) tutorial in our advanced program for second year students within an existing curriculum. The program was opened on the last 5 days of the summer vacation and students could volunteer to be part of the group. Students separated themselves into small groups by random sampling. The PBL tutorials were done during the first 3 days for medical problems according to our original scenarios (based on medical cases), and during the last 2 days, students made presentations of their learning outcomes, using information technology (IT) by themselves. Throughout this program, students were expected to engage in self-learning, except for a 1(1/2)-h group session with a tutor. Assessment was done by attendance at a group session and by portfolio analysis. Following the portfolio analysis, students identified the number of learning issues (group A, 26 +/- 7 issues; group B, 20 +/- 3 issues; group C, 21 +/- 7 issues). Research, by questionnaire, revealed that 84% of the students were strongly interested in each scenario and 95% of the students felt familiar with each scenario. The levels of satisfaction with the tutor were different in the three groups. All of the students were comfortable in the discussion room and IT center. These results suggested that PBL tutorials are supported by the scenario, the tutor, and the location of the group session, as well as by self-learning. Moreover, one of the most important factors for a PBL tutorial that the student is ready for the free discussions and has enough time for individual self-learning.