Problem-based Learning

A model of clinical problem-based learning for clinical attachments in medicine

CONTEXT

Problem-based learning (PBL) has been widely adopted in medical curricula for early-years training, but its use during clinical attachments has not been extensively explored. Objectives This study aimed to develop and evaluate a new model, 'clinical problem-based learning' (CPBL), to promote learning skills, attitudes and knowledge during clinical attachments.

METHODS

The CPBL model takes the principles of PBL and applies them to learning during clinical attachments. Real patient encounters are guided by a list of broadly defined case types to ensure curriculum coverage. By discussing history taking and examination in the context of differential diagnosis and problem listing, students generate learning objectives relating to clinical skills, disease mechanisms and clinical management. These are explored through self-directed learning before the second tutorial, in which the tutor takes the role of 'expert', demonstrating how learned material translates into clinical practice. We evaluated which components contributed most to the success of the model using semi-structured questionnaires, focus groups and a consensus (Delphi process) method.

RESULTS

Students found CPBL a positive learning experience. Identification of suitable cases for discussion was readily achieved, although follow-up was sometimes difficult. The tutor's level of expertise and a non-threatening learning environment, conducive to student questioning, were highly rated contributors to successful CPBL. Comments reinforced the view that CPBL is a parallel teaching approach that helps structure the teaching week, but does not replace traditional bedside teaching.

CONCLUSIONS

Clinical problem-based learning was well received in clinical placements. Key elements were the learning interval, the involvement of expert tutors and a non-threatening learning environment.

Cognitive and learning sciences in biomedical and health instructional design: A review with lessons for biomedical informatics education

Theoretical and methodological advances in the cognitive and learning sciences can greatly inform curriculum and instruction in biomedicine and also educational programs in biomedical informatics. It does so by addressing issues such as the processes related to comprehension of medical information, clinical problem-solving and decision-making, and the role of technology. This paper reviews these theories and methods from the cognitive and learning sciences and their role in addressing current and future needs in designing curricula, largely using illustrative examples drawn from medical education. The lessons of this past work are also applicable, however, to biomedical and health professional curricula in general, and to biomedical informatics training, in particular. We summarize empirical studies conducted over two decades on the role of memory, knowledge organization and reasoning as well as studies of problem-solving and decision-making in medical areas that inform curricular design. The results of this research contribute to the design of more informed curricula based on empirical findings about how people learn and think, and more specifically, how expertise is developed. Similarly, the study of practice can also help to shape theories of human performance, technology-based learning, and scientific and professional collaboration that extend beyond the domain of medicine. Just as biomedical science has revolutionized health care practice, research in the cognitive and learning sciences provides a scientific foundation for education in biomedicine, the health professions, and biomedical informatics.

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

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