Using faculty and student perceptions of group dynamics to develop recommendations for PBL training

Crossword puzzles versus Student-Led Objective Tutorials (SLOT) as innovative pedagogies in undergraduate medical education

AIMS: Small group teaching in Pharmacology offers an effective platform to encourage interaction amongst peers and self-directed learning. The present study is an attempt to assess and compare the effectiveness and perception of students on two different pedagogical methods: Crossword puzzles and Student Led Objective Tutorials (SLOT).METHODS: Second year undergraduate students who gave their informed consent were divided randomly into two groups: one which received crossword puzzle as a teaching learning method and the other had SLOT during which the students conducted an interactive quiz with multiple choice questions prepared by themselves. The students’ perceptions were recorded using a self-administered questionnaire. One week later, a unit test was conducted for both the groups and the performance of the students was compared. Statistical analysis was done using independent Student’s T test with SPSS version 15.0.RESULTS: Analyses revealed a statistical significant difference (P<0.001) between the mean marks obtained in the SLOT group (n= 74; 6.5±3.8) and the marks obtained in the crossword group (n= 87; 4.2±2.9), with the students in the tutorial group performing better. The students opined that SLOT sessions helped them to understand Pharmacology better whereas crossword sessions enabled them to memorize the names of the drugs.CONCLUSION: The present study revealed that SLOT sessions fared better compared to the crossword puzzles in terms of improving the students’ test scores. It fostered teamwork, self-directed learning skills and critical thinking. Crossword puzzles make the session more student friendly as it is fun and engaging but a careful design is inevitable as it may fail to test in-depth learning in students.

What can we learn from problem-based learning tutors at a graduate entry medical school? A mixed method approach

Problem-based learning (PBL) has been adopted by many medical schools as an innovative method to deliver an integrated medical curriculum since its inception at McMaster University (Dornan et al., Med Educ 39(2):163-170, 2005; Finucane et al., Med Educ 35(1):56-61, 2001; Barrows, Tutorials in problem-based learning: A new direction in teaching the health professions, 1984). The student experience in PBL has been explored in detail (Merriam, New Directions for Adult and Continuing Education 89: 3-13, 2001; Azer, Kaohsiung J Med Sci 25(5): 240-249, 2009; Boelens et al., BMC Med Ed 15(1): 84, 2015; Dolmans et al., Med Teach 24(2):173-180, 2002; Lee et al., Med Teach 35(2): e935-e942, 2013) but the tutors who facilitate PBL have valuable insight into how PBL functions and this aspect has not been extensively researched. The integrated curriculum for years 1 and 2 at the Graduate Entry Medical School at the University of Limerick is delivered though problem-based learning (PBL). This programme requires collaborative teamwork between students and the tutors who facilitate small-group tutorial sessions. All PBL tutors at GEMS are medically qualified, with the majority (68%) currently working in clinical practice.

METHODS

A mixed-methods approach was adopted, utilising two surveys and follow-up focus groups to fully understand the tutor experience. Thirty-three tutors took part in two online surveys with a response rate of 89%. Thirteen tutors participated in two focus groups. Descriptive analysis was completed on survey data and thematic analysis on focus group discussions which highlighted five main themes.

RESULTS

Tutors reported challenges with managing group dynamics, development of confidence in tutoring with experience and a willingness to learn from peers to improve practice. Findings are in keeping with previously published work. Results also identified several less commonly discussed issues impacting student engagement in PBL including the use of mobile device technology, unauthorised access to learning objectives and PBL cases, and the importance and need for professional development amongst tutors, including the impact of tutoring on clinical practice. This study revealed that experienced tutors spend considerable time preparing for PBL tutorials in the basic sciences and that this input is rewarded by the benefits it brings to their clinical practice.

CONCLUSIONS

Understanding PBL from the tutor's perspective reveals valuable insights which can inform ongoing tutor development and support. Limited research exists in the area of PBL tutor's experiences which may be of interest to medical educators, clinicians and the wider medical community. Findings highlight the value of shared tutor experiences as a resource that can be capitalised on to benefit both novice and experienced tutors.

Update on research and application of problem-based learning in medical science education

Problem-based learning (PBL) is a unique form of pedagogy dedicated to developing students' self-learning and clinical practice skills. After several decades of development, although applications vary, PBL has been recognized all over the world and implemented by many medical schools. This review summarizes and updates the application and study of PBL in medical education through the literature published between 1993 and early 2017. It focuses on understanding real medical PBL courses and ways to improve PBL to achieve better learning outcomes. PBL aims to develop lifelong skills to solve practical problems rather than limiting learning to theoretical knowledge. To achieve this goal, strict and reasonable procedures need to be designed and implemented. Rigorous monitoring and timely feedback and evaluation are indispensable to constant improvements and perfecting of the process. © 2017 by The International Union of Biochemistry and Molecular Biology, 46(2):186-194, 2018.

Student-led objective tutorials in Pharmacology: An interventional study

OBJECTIVES

Students learn in a better way if they are involved in active learning. Hence, the study was designed to introduce student-led objective tutorials (SLOTs) as an alternative to conventional tutorials (CTs) in pharmacology and to compare SLOT and CT on outcomes such as improved score in tests, active involvement of students, and faculty requirement of each.

MATERIALS AND METHODS

Didactic lectures taken on a topic in pharmacology were followed by a preintervention test for a batch of the 2nd year medical undergraduates. They were allotted either in SLOT or CT group. For a SLOT session, students of Group A (interventional group) were divided into teams and each team prepared five multiple choice questions on the given topic in PowerPoint format, which were presented to other teams and audience. The proceedings were facilitated by two lecturers. Group B undertook CT (controls). A postintervention test was then taken for both groups. Feedback was sought from students and teachers on SLOT.

RESULTS

The total marks for the test were 20. The mean marks in Group A improved by 31% (from 5.1 to 11.2). In Group B, they improved by 11% (from 5 to 7.2). Academic performance following SLOT was better than CT. Students (63%) favored SLOT as it stimulated their interest in the topic, improved self-learning skills, and teamwork. The teachers also favored SLOT for similar reasons.

CONCLUSION

SLOT leads to greater satisfaction and better performance in tests. SLOT is an effective alternative to CT to promote active learning among students through group work. It helps overcome the logistic difficulties due to faculty shortage.

Differential impact of student behaviours on group interaction and collaborative learning: medical students' and tutors' perspectives

BACKGROUND

Collaboration is of increasing importance in medical education and medical practice. Students' and tutors' perceptions about small group learning are valuable to inform the development of strategies to promote group dynamics and collaborative learning. This study investigated medical students' and tutors' views on competencies and behaviours which promote effective learning and interaction in small group settings.

METHODS

This study was conducted at UNSW Australia. Five focus group discussions were conducted with first and second year medical students and eight small group tutors were interviewed. Data were transcribed verbatim and thematic analysis was conducted.

RESULTS

Students and tutors identified a range of behaviours that influenced collaborative learning. The main themes that emerged included: respectfulness; dominance, strong opinions and openness; constructiveness of feedback; active listening and contribution; goal orientation; acceptance of roles and responsibilities; engagement and enthusiasm; preparedness; self- awareness and positive personal attributes. An important finding was that some of these student behaviours were found to have a differential impact on group interaction compared with collaborative learning. This information could be used to promote higher quality learning in small groups.

CONCLUSION

This study has identified medical students' and tutors' perceptions regarding interactional behaviours in small groups, as well as behaviours which lead to more effective learning in those settings. This information could be used to promote learning in small groups.

What are the most important tasks of tutors during the tutorials in hybrid problem-based learning curricula?

BACKGROUND

In problem-based learning, a tutor, the quality of the problems and group functioning play a central role in stimulating student learning. This study is conducted in a hybrid medical curriculum where problem-based learning is one of the pedagogical approaches. The aim of this study was to examine which tutor tasks are the most important during the tutorial sessions and thus should be promoted in hybrid (and in maybe all) problem-based learning curricula in higher education.

METHODS

A student (N = 333) questionnaire was used to obtain data about the problem-based learning process, combined with the achievement score of the students on a multiple-choice exam. Structural equation modeling was used to test the fit of different models (two existing models and a new simplified model) representing the factors of interest and their relationships, in order to determine which tutor characteristics are the most important in the present study.

RESULTS

A new simplified model is presented, which demonstrates that stimulation of active and self-directed learning by tutors enhances the perceived case quality and the perceived group functioning. There was no significant effect between the stimulation of collaborative learning and perceived group functioning. In addition, group functioning was not a significant predictor for achievement.

CONCLUSIONS

We found that stimulating active and self-directed learning are perceived as tutors' most important tasks with regard to perceived case quality and group functioning. It is necessary to train and teach tutors how they can stimulate active and self-directed learning by students.

The perceived effects of faculty presence vs. absence on small-group learning and group dynamics: a quasi-experimental study

BACKGROUND

Medical education increasingly relies on small-group learning. Small group learning provides more active learning, better retention, higher satisfaction, and facilitates development of problem-solving and team-working abilities. However, less is known about student experience and preference for different small groups teaching models. We evaluated group educational dynamics and group learning process in medical school clerkship small group case-based settings, with a faculty member present versus absent.

METHODS

Students completed surveys after cases when the faculty was present ("in") or absent ("out") for the bulk of the discussion. 228 paired surveys (114 pairs) were available for paired analysis, assessing group dynamics, group learning process, student preference, and participation through self-report and self-rating of group behaviors tied to learning and discussion quality.

RESULTS

Ratings of group dynamics and group learning process were significantly higher with the faculty absent vs. present (p range <0.001 to 0.015). Students also reported higher levels of participation when the faculty member was absent (p = 0.03). Students were more likely to express a preference for having the faculty member present after "in" case vs. "out" case discussions. (p < 0.001). There was no difference in reported success of the case discussion after "in" vs. "out" cases (p = 0.67).

CONCLUSIONS

Student groups without faculty present reported better group dynamics, group learning processes, and participation with faculty absent. Students reported that they feel somewhat dependent on faculty, especially when the faculty is present, though there was no significant difference in students reporting that they obtained the most they could from the discussion of the case after both "in" and "out" cases.

Experiencing the role of PBL tutor

The tutor is important for student learning in the PBL group. The students expect the tutor to monitor and steer the group process and to support the learning process, helping students to become aware of their own learning. This study aimed at investigating the PBL tutor's role. Five PBL tutors at the Speech/Language Pathology program were interviewed regarding their view of the tutors' role and what support they need. The analysis of the transcribed interviews focused on finding patterns and variation regarding tutor-activity at different stages in the PBL work and in their views of their progress as tutors. The results indicate that being a tutor is a balancing act and that the tutor need continuous support and input from different sources. Tutors should be encouraged to reflect on their own reactions and interventions and to be explicit and confident in their thoughts about PBL.

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.

How experienced tutors facilitate tutorial dynamics in PBL groups

BACKGROUND

Problem-based learning (PBL) tutorial are conducted in small groups, and successful learning in such groups requires good group facilitating skills. There is a lack of research on actual skills employed by tutors in facilitating the group dynamics.

AIM

To explore the process of PBL tutorial small groups, focusing on the tutors' actual behavior in facilitating group dynamics.

METHODS

Eight experienced tutors from various departments in medical colleges participated in this research. Forty tutorial group sessions were videotaped. Among the 636 tutorial intervention episodes, 142 of them were associated with facilitating group dynamics. Tutors interventions as well as their recalls were transcribed verbatim. Qualitative research methods were utilized to analyze the data.

RESULTS

There were 10 tutorial group dynamic situations and 48 tutorial skills. Analysis of the tutors' intentions employing these skills in the 10 situations showed that tutors were trying to achieve the following aims: (1) iteration of PBL principles, (2) delegation of responsibility to the students, (3) creation of a good discussion forum, and (4) the generation of a good learning atmosphere.

CONCLUSION

Results from this study provide PBL tutors with a practical frame of reference on group dynamic facilitating skills and stimulate further research on this topic.

Interactive seminars or small group tutorials in preclinical medical education: results of a randomized controlled trial

BACKGROUND

Learning in small group tutorials is appreciated by students and effective in the acquisition of clinical problem-solving skills but poses financial and resource challenges. Interactive seminars, which accommodate large groups, might be an alternative. This study examines the educational effectiveness of small group tutorials and interactive seminars and students' preferences for and satisfaction with these formats.

METHODS

Students in year three of the Leiden undergraduate medical curriculum, who agreed to participate in a randomized controlled trial (RCT, n = 107), were randomly allocated to small group tutorials (n = 53) or interactive seminars (n = 54). Students who did not agree were free to choose either format (n = 105). Educational effectiveness was measured by comparing the participants' results on the end-of-block test. Data on students' reasons and satisfaction were collected by means of questionnaires. Data was analyzed using student unpaired t test or chi-square test where appropriate.

RESULTS

There were no significant differences between the two educational formats in students' test grades. Retention of knowledge through active participation was the most frequently cited reason for preferring small group tutorials, while a dislike of compulsory course components was mentioned more frequently by students preferring interactive seminars. Small group tutorials led to greater satisfaction.

CONCLUSIONS

We found that small group tutorials leads to greater satisfaction but not to better learning results. Interactive learning in large groups might be might be an effective alternative to small group tutorials in some cases and be offered as an option.

Self- and peer assessment may not be an accurate measure of PBL tutorial process

BACKGROUND

Universidade Cidade de São Paulo adopted a problem-based learning (PBL) strategy as the predominant method for teaching and learning medicine. Self-, peer- and tutor marks of the educational process are taken into account as part of the final grade, which also includes assessment of content. This study compared the different perspectives (and grades) of evaluators during tutorials with first year medical students, from 2004 to 2007 (n = 349), from seven semesters.

METHODS

The tutorial evaluation method was comprised of the students' self assessment (SA) (10%), tutor assessment (TA) (80%) and peer assessment (PA) (10%) to calculate a final educational process grade for each tutorial. We compared these three grades from each tutorial for seven semesters using ANOVA and a post hoc test.

RESULTS

A total of 349 students participated with 199 (57%) women and 150 (42%) men. The SA and PA scores were consistently greater than the TA scores. Moreover, the SA and PA groups did not show statistical difference in any semester evaluated, while both differed from tutor assessment in all semesters (Kruskal-Wallis, Dunn's test). The Spearman rank order showed significant (p < 0.0001) and positive correlation for the SA and PA groups (r = 0.806); this was not observed when we compared TA with PA (r = 0.456) or TA with SA (r = 0.376).

CONCLUSION

Peer- and self-assessment marks might be reliable but not valid for PBL tutorial process, especially if these assessments are used for summative assessment, composing the final grade. This article suggests reconsideration of the use of summative assessment for self-evaluation in PBL tutorials.

Problem-based learning at the receiving end: a 'mixed methods' study of junior medical students' perspectives

Qualitative insights about students' personal experience of inconsistencies in implementation of problem-based learning (PBL) might help refocus expert discourse about good practice.

AIM

This study explored how junior medical students conceptualize: PBL; good tutoring; and less effective sessions.

METHODS

Participants comprised junior medical students in Liverpool 5-year problem-based, community-orientated curriculum. Data collection and analysis were mostly cross-sectional, using inductive analysis of qualitative data from four brief questionnaires and a 'mixed' qualitative/quantitative approach to data handling. The 1999 cohort (end-Year 1) explored PBL, generated 'good tutor' themes, and identified PBL (dis)advantages (end-Year 1 then mid-Year 3). The 2001 cohort (start-Year 1) described critical incidents, and subsequently (end-Year 1) factors in less effective sessions. These factors were coded using coding-frames generated from the answers about critical incidents and 'good tutoring'.

RESULTS

Overall, 61.2% (137), 77.9% (159), 71.0% (201), and 71.0% (198) responded to the four surveys, respectively. Responders perceived PBL as essentially process-orientated, focused on small-groupwork/dynamics and testing understanding through discussion. They described 'good tutors' as knowing when and how to intervene without dominating (51.1%). In longitudinal data (end-Year 1 to mid-Year 3), the main perceived disadvantage remained lack of 'syllabus' (and related uncertainty). For less effective sessions (end-Year 1), tutor transgressions reflected unfulfilled expectations of good tutors, mostly intervening poorly (42.6% of responders). Student transgressions reflected the critical incident themes, mostly students' own lack of work/preparation (54.8%) and other students participating poorly (33.7%) or dominating/being self-centred (31.6%).

CONCLUSION

Compelling individual accounts of uncomfortable PBL experiences should inform improvements in implementation.

Going interactive: six strategies to meet the challenge of teaching electrosurgery to general dental practitioners

Mandatory continuing professional development has resulted in a recent expansion in postgraduate dental teaching. One popular type of teaching is the practical 'hands-on' course that combines the explanation of theory with the acquisition of practical skills in small groups. The challenge to dental teachers is to provide the best level of teaching on these courses where the course participants bring varied expectations and different levels of knowledge, skill or interest. This paper presents a new teaching model that has been developed for the postgraduate teaching of Electrosurgery. The key components of this course include an interactive theory lecture using multimedia, followed by hands-on practical teaching. The emphasis throughout is on the use of facilitation and group learning rather than traditional didactic teaching. A series of strategies for the effective delivery of such a hands-on course together with evaluation of findings from 31 courses are considered.

Factors inhibiting assessment of students' professional behaviour in the tutorial group during problem-based learning

CONTEXT

We addressed the assessment of professional behaviour in tutorial groups by investigating students' perceptions of the frequency and impact of critical incidents that impede this assessment and 5 factors underlying these critical incidents.

METHODS

A questionnaire asking students to rate the frequency and impact of 40 critical incidents relating to effective assessment of professional behaviour on a 5-point Likert scale was developed and sent to all undergraduate medical students in Years 2-4 of a 6-year undergraduate curriculum.

RESULTS

The response rate was 70% (n = 393). Important factors underlying critical incidents are: lack of effective interaction; lack of thoroughness; tutors' failure to confront students with unprofessional behaviour; lack of effort to find solutions, and lack of student motivation. Confirmatory factor analysis showed a good model fit. Because the relationship between frequency of occurrence and degree of impediment varies, the best information about the true impact of critical incidents and the underlying factors is provided by the product of frequency and degree of impediment. Frequency of occurrence remains stable and degree of impediment increases in Years 2-4.

CONCLUSIONS

The results of this study can be used to design and improve faculty development programmes aimed at improving assessment of professional behaviour. Training programmes should motivate tutors by providing background information as to why and how sound assessment of professional behaviour is to be performed and encourage tutors to confront students with and discuss all aspects of professional behaviour, as well as provide appropriate feedback.

Development of an instrument to assess individual student performance in small group tutorials

Recognizing the need for a valid and reliable method to assess individual tutorial performance in a problem-based learning curriculum, we developed a 31-item instrument from theoretical frameworks and items used elsewhere. A scale was developed for each of three broad learning domains: self-directed learning (SDL), critical thinking (CT), and group process (GP). The instrument demonstrated high internal consistency (SDL = .88, CT = .90, GP = .83) on a sample of 18 tutors and 167 students. Tutor-student interrater reliability coefficients were estimated to be low (SDL = .16, CT = .18, GP = .14) due to lack of variance on the response scale. The instrument showed high correlation (r = .82) with other forms of summative evaluation. In its current form, this standardized and validated instrument is unreliable in differentiating strong from weak tutorial performance but can have a steering effect on student tutorial behaviors. The process of instrument development has general application to other educational programs.

Problem-Based Learning at the Faculty of Medicine of the Université de Montréal: A Situated Cognition Perspective

PURPOSE

This study describes the typical case of problem-based learning (PBL) application at the Faculty of Medicine of the Université de Montréal and its analysis from the perspective of situated cognition.

METHOD

I used a typical case study to determine the general model of PBL application and performed my analysis by a global processing of information, against to the conceptual model of situated cognition.

RESULTS

A typical PBL tutorial case consists of a meeting of a group of about 8 students with a tutor to discuss a medical problem. Learning objectives are predetermined by faculty and recorded in the tutor's handbook. Broadly speaking, the analysis revealed a certain kind of scaffolding within a "zone of proximal development" (ZPD).

CONCLUSION

The adaptation of PBL at the Faculty of Medicine of the University of Montreal is hybrid, original, and can be related to the model of cognitive apprenticeship, but the tutor's role, however, does not fit the model of cognitive apprenticeship completely.

What do we know about cognitive and motivational effects of small group tutorials in problem-based learning?

Students collaborating in small groups is a characteristic of problem-based learning (PBL) that is receiving increased consideration in the literature. In this paper findings from studies in this area are synthesized and discussed. A distinction is made between studies focusing on cognitive effects of group learning and studies focusing on motivational effects of group learning. Studies concentrating on the cognitive effects of small-group PBL seem to demonstrate that activation of prior knowledge, recall of information, causal reasoning or theory building, cognitive conflicts leading to conceptual change and collaborative learning construction take place in the tutorial group. Studies focusing on the motivational effects of PBL demonstrate that group discussion positively influences students' intrinsic interest in the subject matter under discussion. The studies also demonstrate that a haphazard discussion in the tutorial group or a discussion that just scratches the surface, probably caused by students being less motivated, inhibits student learning. Several studies are reported providing suggestions on how to optimize group work in PBL. Although the studies demonstrate that group learning in PBL may have positive effects, much more research is needed to obtain more evidence and deeper insight in the cognitive and emotional effects of small group learning in PBL.

Effect of teaching context and tutor workshop on tutorial skills

Effective faculty development workshops are essential to develop and sustain the quality of faculty's teaching. In an integrated problem-based curriculum, tutors expressed the needs to further develop their skills in facilitating students' content learning and small-group functioning. Based on the authors' prior observations that tutors' performance depends on their teaching context, a workshop was designed not only tailored to the tutors' needs but also organized within their respective teaching unit. The purposes of this study are (1) to evaluate whether this workshop is effective and improves tutors' teaching skills, and (2) to assess whether workshop effectiveness depends on tutors' performance before the workshop and on their teaching unit environment. Workshop effectiveness was assessed using (a) tutors' perception of workshop usefulness and of their improvement in tutorial skills, and (b) students' ratings of tutor performance before and after the workshop. In addition, an analysis of variance model was designed to analyse how tutors' performance before the workshop and their teaching unit influence workshop effectiveness. Tutors judged the workshop as helpful in providing them with new teaching strategies and reported having improved their tutorial skills. Workshop attendance enhanced students' ratings of tutors' knowledge of problem content and ability to guide their learning. This improvement was also long-lasting. The workshop effect on tutor performance was relative: it varied across teaching units and was higher for tutors with low scores before the workshop. A workshop tailored to tutors' needs and adapted to their teaching unit improves their tutorial skills. Its effectiveness is, however, influenced by tutors' level of performance before the workshop and by the environment of their teaching unit. Thus, to be efficient, the design of a workshop should consider not only individual tutors' needs, but also the background of their teaching units, with special attention to their internal organization and tutor group functioning.

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

BACKGROUND AND OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Emotional responses of tutors and students in problem-based learning: lessons for staff development

CONTEXT

Problem-based learning (PBL) is a method of teaching and learning that is used increasingly in medical and health care curricula worldwide. The literature on PBL is considerable and continues to develop. One important aspect of PBL is that students and tutors spend a lot of time together and this fosters an informal atmosphere that may encourage intimacy. The existing literature on PBL has not considered the emotional and psychological aspects of PBL nor the concomitant need for staff support and development.

PURPOSE

We present a discussion paper considering the ways in which educationalists using or considering using PBL could be informed by the psychological and psychotherapeutic literature on groups and group dynamics, in particular the work of Wilfred Bion. We discuss how PBL tutorials may arouse emotional responses that could result in unconsidered behaviours that impede student learning. We argue that faculty and PBL tutors need to agree and remain alert to the primary task of the group. Faculty should develop professional standards for tutors to use as reference points to ensure the group stays on course and achieves its intended outcomes.

CONCLUSION

We conclude that greater attention should be paid by educationalists and faculty to identifying possible tutor emotional responses as part of initial PBL tutor training and ongoing staff development. We offer vignettes that have been successfully used in training and staff development at a UK medical school to demonstrate the practical application of our theoretical discussion.

Faculty development for problem-based learning

Changing to a problem-based learning (PBL) curriculum represents a substantial challenge because many faculty members are unfamiliar with the process. Faculty development is a crucial component of successful curriculum change to PBL. This paper describes a logical process for designing and implementing a comprehensive faculty development programme at three main stages of change: curriculum transition, curriculum implementation and curriculum advancement. The components of each stage are discussed with reference to the literature and practice. Future advances in faculty development include harnessing the potential of complex adaptive systems theory in understanding and facilitating the change process, and incorporating the results of research, which illuminates the relationships of the PBL tutorial process to student achievement. There is a continuing need for rigorous outcome-based research and programme evaluation to define the best components and strategies for faculty development.

Student perceptions of effective small group teaching

PURPOSE

The goal of this study was to assess student perceptions of effective small group teaching during preclinical training in a medical school that promotes an integrated, systems-based undergraduate curriculum. In particular, students were asked to comment on small group goals, effective tutor behaviours, pedagogical materials and methods of evaluation.

METHODS

Six focus groups were held with 46 Year 1 and 2 medical students to assess their perceptions of effective small group teaching in the 'Basis of Medicine' component of the undergraduate curriculum. Ethnographic content analysis guided the interpretation of the focus group data.

RESULTS

Students identified tutor characteristics, a non-threatening group atmosphere, clinical relevance and integration, and pedagogical materials that encourage independent thinking and problem solving as the most important characteristics of effective small groups. Tutor characteristics included personal attributes and the ability to promote group interaction and problem solving. Small group teaching goals providing included opportunities to ask questions, to work as a team, and to learn to problem solve.

CONCLUSION

This study highlighted the benefits of soliciting student impressions of effective small group teaching. The students' emphasis on group atmosphere and facilitation skills underscored the value of the tutor as a 'guide' to student learning. Similarly, their comments on effective cases emphasised the importance of clinical relevance, critical thinking and the integration of basic and clinical sciences. This study also suggested future avenues for research, such as a comparison of student and teacher perceptions of small group teaching as well as an analysis of perceptions of effective small group learning across the educational continuum, including undergraduate, postgraduate and continuing professional education.

What can we learn from facilitator and student perceptions of facilitation skills and roles in the first year of a problem-based learning curriculum?

BACKGROUND

The small group tutorial is a cornerstone of problem-based learning. By implication, the role of the facilitator is of pivotal importance. The present investigation canvassed perceptions of facilitators with differing levels of experience regarding their roles and duties in the tutorial.

METHODS

In January 2002, one year after problem-based learning implementation at the Nelson R. Mandela School of Medicine, facilitators with the following experience were canvassed: trained and about to facilitate, facilitated once only and facilitated more than one six-week theme. Student comments regarding facilitator skills were obtained from a 2001 course survey.

RESULTS

While facilitators generally agreed that the three-day training workshop provided sufficient insight into the facilitation process, they become more comfortable with increasing experience. Many facilitators experienced difficulty not providing content expertise. Again, this improved with increasing experience. Most facilitators saw students as colleagues. They agreed that they should be role models, but were less enthusiastic about being mentors. Students were critical of facilitators who were not up to date with curriculum implementation or who appeared disinterested. While facilitator responses suggest that there was considerable intrinsic motivation, this might in fact not be the case.

CONCLUSIONS

Even if they had facilitated on all six themes, facilitators could still be considered as novices. Faculty support is therefore critical for the first few years of problem-based learning, particularly for those who had facilitated once only. Since student and facilitator expectations in the small group tutorial may differ, roles and duties of facilitators must be explicit for both parties from the outset.

Development of a teaching style inventory for tutor evaluation in problem-based learning

OBJECTIVE

To develop and validate a self-rating instrument to assess teaching styles among tutors in problem-based learning (PBL).

METHODS

The development of the teaching style inventory (TSI) was based theoretically on four types of teaching behaviours: the assertive, suggestive, collaborative and facilitative styles, as proposed by Bibace et al. A 35-item questionnaire was generated and evaluated for content validity by a group of experienced tutors. The questionnaire was mailed to 196 tutors at the National Taiwan University College of Medicine. The results were submitted for item analysis, internal consistency testing and exploratory factor analysis. Longterm test-retest reliability was assessed by a sample of 50 tutors after a 6-month interval.

RESULTS

Finally, 118 tutors returned the questionnaires. In the item reduction process, seven items were excluded due to low interscale correlation. Principle component factoring yielded a three-factor solution that accounted for 48.5% of the total variance. Internal consistency coefficients of the four hypothetical domains ranged from 0.73 to 0.83. All domains correlated to each other as expected. Assertive and facilitative styles, which are theoretically opposite teaching styles, showed a negative correlation with each other. Most of the items of each hypothetical domain correlated better with their own domain than with other domains. Longterm test-retest correlations of the four domains ranged from 0.54 to 0.81.

CONCLUSION

The TSI demonstrated high internal consistency reliability, acceptable longterm test-retest reliability, and construct validity. Further psychometric testing should focus on applicability to other populations, predictive validity and short-term test-retest reliability. This instrument can be used by programme directors for the recruitment of tutors and can also be used to increase the self-awareness of tutors.

Providing support for problem-based learning in dentistry: the Manchester experience

The introduction of problem-based learning (PBL) into any programme demands a period of adjustment on the part of faculty. Similarly, students new to PBL take time to adapt to what is, for the majority of them, an unfamiliar mode of learning. At Manchester, closed loop PBL is used throughout the first and second years of the dental programme; the method is interdisciplinary; there are no subject boundaries. Dental students work in groups of between 10 and 15, facilitated by a tutor from the Department of Biological Sciences, to research topics and share information in a mutually supportive environment. Each week a different problem forms the focus for learning. In this paper, we seek to describe the measures introduced in response to student feedback collected via routine meetings with the senior tutor, after meetings with their academic or personal tutors and through discussion at the staff students' committee, which we at Manchester have taken to facilitate the process of adaptation to PBL. Changes have been made in the areas of recruitment, pre-admission interviewing, induction (development of an induction booklet and communication skills module) and tutorial support (overhaul of personal tutor system and introduction of peer-assisted study (PAS) and personal and academic development programmes (PADPs)). Feedback on these changes, gathered via the routes described above, has been positive and continues to be central to our processes of development in these areas. Although the various ways in which PBL has been implemented worldwide may place limits on the transferability of our methods, this paper serves to illustrate some of the means available to support students in the transition to self-directed learning. The latter is not only an essential component of PBL but also something we should be seeking to foster in all students, no matter what philosophy and method of course delivery are utilized.

Design and feasibility of PASSIST, a passive instrument positioner

BACKGROUND AND PURPOSE

During minimally invasive procedures, an assistant controls the camera and often a laparoscopic grasper. Ideally, the surgeon should be able to manipulate the instruments because the indirect way of control complicates the surgeon's observation and actions and disturbs eye-hand coordination. Reported replacements for the assistant are active positioners, "robots," such as the Aesop and the EndoAssist. Because positioning instruments is often a static task, the Academic Medical Center has developed a passive assistant for instrument positioning (PASSIST) to allow solo surgery.

METHODS

The PASSIST was designed to be simple, fully autoclavable, slender, and stiff. The joints have adjustable friction and spring compensation for stabilizing the instrument in a fixed position, enabling intuitive single-hand repositioning.

RESULTS

The PASSIST has been tested in three laparoscopic procedures: cholecystectomy, laparoscopically assisted vaginal hysterectomy, and spondylodesis. In all of these procedures, the assistant could be replaced satisfactorily, and the surgeon was able to manipulate all of the instruments on his own.

CONCLUSION

Solo surgery using the PASSIST is feasible. The positioner enables the surgeon to manipulate the viewpoint, to have a stable image, and therefore to improve observation and manipulating actions.

Group process: the black box of studies on problem-based learning

A considerable number of medical schools worldwide have implemented, at least in part, a problem-based learning (PBL) approach in their curricula. Research to date has largely neglected the issue of the actual activities and learning processes that mediate and moderate the relationship between these programs and their cognitive outcomes. In this essay the authors discuss the few studies that have empirically investigated what students actually do in PBL tutorials, which arguably is the pivotal mediating process. These studies demonstrate that it is possible to observe, identify, and describe group activities (such as brainstorming and the joint identification of learning issues) that promote interactionally shared and achieved cognition. However, such studies have been confined to case studies in which isolated fragments of tutorials have been analyzed and described. Future studies need to provide a broader description and analysis of actually performed cognitive activities in all relevant phases of the entire PBL process.

Evaluating problem-based learning in a multilingual student population

OBJECTIVES

The University of Natal Medical School in South Africa provides training for a student body composed of two groups: one with English as a first language and the other with an African language as a first language and English as the second. A new methodology was developed to evaluate an innovative course using modified problem-based learning techniques in this heterogeneous environment.

DESIGN

The learning model proposed required achieving a balance of three components: content, enquiry/learning process and social interaction/group process. A multidimensional system, felt to be consistent with this educational philosophy, was developed using seven different quantitative and qualitative techniques.

SETTING

The University of Natal Medical School.

SUBJECTS

First-year multilingual medical students.

RESULTS

The results revealed that social interaction was highly successful in reducing barriers between the student groups and between students and facilitators. However, the emphasis on group participation may have overshadowed the enquiry process, leading to superficial discussions of problems and feelings of repetitiveness. During the course students and facilitators expressed concern that the innovative assessments used did not assess the course content adequately. While the group presentations and projects were useful exercises for consolidation and group interaction, they did not enable facilitators to identify struggling students.

CONCLUSIONS

The outcome of the evaluation stressed the need of achieving an appropriate balance both in the curriculum and assessments of the three components of the learning model, particularly in a setting where student backgrounds and language ability differ. Multidimensional methodology is needed for effective evaluation that promotes critical reflection.