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

Engaging medical physics students in active and authentic learning through the use of monte-carlo simulation and inverse treatment planning

PURPOSE

Engagement and participation of students with the learning process has been recognised as a growing problem across the higher education sector. The aim of this study was to investigate the value and impact of introducing Problem-based Learning (PBL) activities into a radiotherapy physics unit of a postgraduate medical physics course.

METHODS

Computer-based problem solving activities on 1) monte-carlo modelling of a linear accelerator and 2) inverse radiotherapy treatment planning were designed and implemented into a one-semester unit on radiotherapy physics. The value and impact of the activities on the student learning were evaluated through student surveys, a focus group, and peer observation of the sessions by members of the learning design team. Student attendance and grade profile data are also reported.

RESULTS

Overall the results indicated that students had a positive experience with the new problem solving activities that were implemented. Survey responses from a number of students indicated a desire for increased theoretical and technical support prior to and during activities. Another underlying theme that emerged from survey and focus group response was the perceived lack of reward in terms of marks for their efforts working on the learning activities. This may have influenced students' choices around attendance and participation. No significant changes were noted in the overall grades achieved in the unit.

CONCLUSIONS

Students appreciated the more hands-on approach to learning in the form of more authentic activities that they could directly relate to clinical radiotherapy. Further work is required to update and integrate assessment into the new learning delivery model more directly.

Problem-based learning as an effective method for teaching theoretical surgery courses to medical students

BACKGROUND

This study was designed to assess the clinical judgment of medical students in surgery clinical decision-making by a standard examination after lecture-based learning (LBL) or problem-based learning (PBL).

MATERIALS AND METHODS

A prospective randomized trial study on 175 medical students whom were randomly allocated to three groups was performed during November 2017 and January 2018. LBL group (n = 103), PBL group led by an attending (n = 39), and PBL group (n = 33) led by an intern. Chi-squared test and independent student t-test were used to compare between the two groups. All the analyses were performed by the two-sided method using the Statistical Package for the Social Sciences software (SPSS version 22; SPSS, Inc., Chicago, IL, USA), and a P < 0.05 set as statistically significant.

RESULTS

The students in the PBL group scored significantly higher on the posttraining multiple-choice examination, compared to the LBL group (P = 0.048). However, there was no significant difference between the PBL group led by an attending and the PBL group led by an intern (P = 0.892).

CONCLUSION

We concluded that PBL remarkably increased the students' scores in the problem-solving examination, as compared to the conventional method. We found no significant differences in PBL facilitated by an attending or an intern.

Effect of constant versus variable small-group facilitators on students' basic science knowledge in an enquiry-based dental curriculum

INTRODUCTION

The role of small-group facilitators is of pivotal importance for the success of curricula based on active learning. Disorganised tutorial processes and superficial study of the problem have been identified as main hindering factors for students' learning. The aim of this study was to evaluate the influence of consistency of facilitation on students' performance in knowledge-based basic science assessments in a hybrid, enquiry-based (EBL) undergraduate dental curriculum.

MATERIALS AND METHODS

This was a retrospective study of 519 first- and second-year undergraduate dental students, enrolled at Peninsula Dental School between 2013 and 2018. Twice in each academic year, students sat a 60-item single-best-answer, multiple-choice examination. Percentage and Z-scores were compared between students whose EBL groups had the same facilitator throughout the academic year, and those whose EBL group was facilitated by different members of staff. All EBL facilitators were dentally qualified but with different levels of expertise in basic dental sciences, prior EBL facilitation, involvement in the curriculum design and university affiliation.

RESULTS

No statistically significant difference was observed in the percentage or Z-scores of students whose EBL sessions were supported by consistent or variable facilitators in any of the 18 MCQ tests. Z-scores of first-year students were more variable than for second-year students. In addition, pairwise comparisons revealed no statistically significant differences in students' Z-scores between any of the permanent facilitators' groups.

CONCLUSIONS

The results of our study may influence the design and delivery of enquiry-based curricula as well as human resources management by shifting the focus from maintaining facilitator consistency to ensuring comparable training and approaches across facilitators.

Evaluating differently tutored groups in problem-based learning in a German dental curriculum: a mixed methods study

BACKGROUND

It is still unclear to what extent the PBL tutor affects learning in PBL-sessions. This mixed-methods study (Part 1 and 2) evaluated the effects of facilitative (f) versus non-facilitative (nf) tutoring roles on knowledge-gain and group functioning in the field of endodontics.

METHODS

Part 1 was a quantitative assessment of tutor effectiveness within a prospective, experimental, single-blind, stratified, randomized, two-group intervention study. Participants attended PBL in the context of a hybrid curriculum. A validated questionnaire was used and knowledge assessments were conducted before and after the intervention. External observers rated tutor performance. Part 2 was a qualitative assessment of tutor effectiveness and consisted of semi-structured expert interviews with tutors and focus group discussions with students.

RESULTS

Part 1: f tutors obtained significantly higher scores than nf tutors with respect to learning motivation and tutor effectiveness (p ≤ 0.05). nf tuition resulted in a slightly larger knowledge gain (p = 0.08). External observers documented a significantly higher activity among facilitative tutors compared to non-facilitative tutors. Part 2: Tutors found the f role easier although this led to a less autonomous working climate. The students rated f tutoring as positive in all cases.

CONCLUSIONS

With respect to PBL-group performance, students felt that groups guided in a non-facilitative fashion exhibited a higher level of independence and autonomy, especially with increasing PBL experience. In addition, students reported that more preparation was necessary for sessions guided by a non-facilitative tutor. Tutors were able to modify their role and influence group processes in a controlled manner. Results are useful for future "Train-the-Teacher" sessions.

Lecturing skills as predictors of tutoring skills in a problem-based medical curriculum

PURPOSE

Recruitment of tutors to work in problem-based learning (PBL) programs is challenging, especially in that most of them are graduated from discipline-based programs. Therefore, this study aims at examining whether lecturing skills of faculty could predict their PBL tutoring skills.

METHODS

This study included evaluation of faculty (n=69) who participated in both tutoring and lecturing within particular PBL units at the College of Medicine and Medical Sciences (CMMS), Arabian Gulf University, Bahrain. Each faculty was evaluated by medical students (n=45±8 for lecturing and 8±2 for PBL tutoring) using structured evaluation forms based on a Likert-type scale (poor to excellent). The prediction of tutoring skills using lecturing skills was statistically analyzed using stepwise linear regression.

RESULTS

Among the parameters used to judge lecturing skills, the most important predictor for tutoring skills was subject matter mastery in the lecture by explaining difficult concepts and responding effectively to students' questions. Subject matter mastery in the lecture positively predicted five tutoring skills and accounted for 25% of the variance in overall effectiveness of the PBL tutors (F=22.39, P=0.000). Other important predictors for tutoring skills were providing a relaxed class atmosphere and effective use of audiovisual aids in the lecture.

CONCLUSION

Predicting the tutoring skills based on lecturing skills could have implications for recruiting tutors in PBL medical programs and for tutor training initiatives.

Developing an integrated framework of problem-based learning and coaching psychology for medical education: a participatory research

BACKGROUND

Medical schools have been making efforts to develop their own problem-based learning (PBL) approaches based on their educational conditions, human resources and existing curriculum structures. This study aimed to explore a new framework by integrating the essential features of PBL and coaching psychology applicable to the undergraduate medical education context.

METHODS

A participatory research design was employed. Four educational psychology researchers, eight undergraduate medical school students and two accredited PBL tutors participated in a four-month research programme. Data were collected through participatory observation, focus groups, semi-structured interviews, workshop documents and feedback surveys and then subjected to thematic content analysis. The triangulation of sources and member checking were used to ensure the credibility and trustworthiness of the research process.

RESULTS

Five themes emerged from the analysis: current experience of PBL curriculum; the roles of and relationships between tutors and students; student group dynamics; development of self-directed learning; and coaching in PBL facilitation. On the basis of this empirical data, a systematic model of PBL and coaching psychology was developed.

CONCLUSIONS

The findings highlighted that coaching psychology could be incorporated into the facilitation system in PBL. The integrated framework of PBL and coaching psychology in undergraduate medical education has the potential to promote the development of the learning goals of cultivating clinical reasoning ability, lifelong learning capacities and medical humanity. Challenges, benefits and future directions for implementing the framework are discussed in this paper.

Brazilian medical students' perceptions of expert versus non-expert facilitators in a (non) problem-based learning environment

BACKGROUND

In problem-based learning (PBL), the facilitator plays an important role in guiding the student learning process. However, although content expertise is generally regarded as a useful but non-essential prerequisite for effective PBL facilitation, the perceived importance of content knowledge may be subject to cultural, contextual, and/or experiential influences.

AIM

We sought to examine medical students' perceptions of subject-matter expertise among PBL facilitators in a region of the world (Brazil) where such active learning pedagogies are not widely used in university or pre-university settings.

RESULTS

Of the 252 Brazilian medical students surveyed, significantly (p≤0.001) greater proportions viewed content expert facilitators to be more effective than their non-expert counterparts at building knowledge (95% vs. 6%), guiding the learning process (93% vs. 7%), achieving cognitive learning (92% vs. 18%), generating learning goals (87% vs. 15%), and motivating self-study (80% vs. 15%).

DISCUSSION/CONCLUSION

According to Brazilian medical students, subject-matter expertise among PBL facilitators is essential to the learning process. We believe this widespread perception is due, in large part, to the relative lack of prior educational exposure to such pedagogies.

High-fidelity simulation in pediatric emergency medicine: a national survey of facilitator comfort and practice

OBJECTIVES

High-fidelity simulation (HFS) is widely used in pediatric emergency medicine (PEM) training and a competent facilitator is vital for effective learning. This survey describes the characteristics, comfort, practices, and need of PEM physicians as HFS facilitators.

METHODS

A descriptive cross-sectional survey was electronically distributed to Pediatric Emergency Research Canada physician members, representing 14 academic pediatric emergency departments nationally.

RESULTS

The response rate was 66.6% (92/138); 63% (56/89) of PEM physicians taught HFS. Junior attending physicians (P = 0.011) and those with an education focus (P = 0.005) were more comfortable in using HFS. Sixty-eight percent (38/56) described their facilitator training as formal. Generally, facilitators felt comfortable in running simulations (weighted mean scale, 1.53 [<2 = comfortable] on a 5-point rating scale). Facilitators with formal training used verbal confidentiality agreements more frequently (P = 0.008), spent less time running the scenario (P < 0.05) and spent more time in debriefing (P < 0.05) than those without formal training. Sixty-three percent (n = 56) of facilitators identified debriefing as the most stressful aspect of HFS. Their main barrier to HFS teaching was lack of protected teaching time (mean scale, 2.02 [>2 = barrier]). Seventy-six percent (35/46) of respondents desired online and printable facilitator information. Seventy percent (35/51) thought the ideal time for formal facilitator training was during fellowship.

CONCLUSIONS

High-fidelity simulation is a widely used educational modality, and more attention must be paid to the needs of the facilitator in order to optimize the educational experience. Standardized facilitator training, focused particularly on effective debriefing techniques, would help improve facilitator comfort with HFS.

Students' perceptions of using Problem-Based Learning (PBL) in teaching cognitive communicative disorders

Problem-Based Learning (PBL) is an educational model that is characterized by student-centered learning and classroom discussion using clinically based problems. This study examines students' perceptions of PBL as an alternative approach of learning in speech-language pathology and investigates if these perceptions change over time as a function of students' learning experience with PBL. Written reflections by 96 graduate-students in a graduate elective course on cognitive-communicative disorders were analyzed using content analysis. Common words or phrases in each reflection paper were identified, grouped and coded into consistent themes. Percentage changes of these themes across a semester were also followed. A total number of 883 positive and 165 negative comments were identified. Thirteen positive and seven negative themes relative to students' perception of the inclusion of PBL were yielded. The advantages of PBL were found to outweigh its disadvantages. Moreover, accumulated experience with this approach was found to eliminate some initial perceived drawbacks about PBL. The extra efforts to engage students in interactive discussion as well as higher order critical thinking and knowledge application were acknowledged through student feedback. Future studies should investigate how PBL can be of greater use in other areas in communication sciences and disorders.

Cracks in problem-based learning: what is your action plan?

BACKGROUND

Problem-based learning (PBL) as an educational approach has been adopted by medical and health sciences faculties worldwide. Successful implementation of these curricula may, however, end a few years later with several problems reflecting cracks in curriculum maintenance.

AIMS

The aim of this article is to discuss these problems, their possible causes and what action can be taken to maintain effective curriculum delivery.

METHODS

We reviewed the current literature, recent Association for Medical Education in Europe conferences' sessions on PBL, explored curriculum design approaches and problems (cracks) identified in PBL programs that may occur a few years after successful implementation. We have also reflected on our collective experience in a number of universities to develop these tips.

RESULTS

Incorporating the methods described, we have developed the following 12 tips: (1) Pay attention to training new staff for PBL, (2) Maintain the briefing/debriefing sessions, (3) Review the PBL material and program in light of the previous year's feedback, (4) Monitor the delivery of the program, (5) Review management of the PBL program, (6) Encourage research and publications in PBL, (7) Ensure that assessment reflects PBL principles, (8) Refrain from adding new lectures to the timetable, (9) Reward contributions to on-going curriculum maintenance, (10) Provide on-going and advanced professional development tutor training, (11) Make explicit (and develop) students' skills required for PBL and (12) Attend to conflict and group dysfunction.

CONCLUSIONS

Being vigilant of possible cracks (erosion) in the PBL curriculum that may occur a few years after successful implementation is mandatory. Erosion of PBL can be minimized or avoided if these tips can be applied.

Objective structured brainstorming questions (OSBQs) in PBL tutorial sessions: Evidence based pilot study

The fact that faculty tutors do have different backgrounds and specialty has been a concern as a factor that contributes to disparity in the delivery of brainstorming session outcomes. This paper aims to introduce a road map in the form of a set of focused objective structured questions (OSBQs) for tutors to follow in brainstorming.

METHODS

Objectively structured questions were generated by the block planning committees. A pilot study was conducted from February 2008 - March 2009 and included groups (44 students) of second and third year undergraduate students of the Faculty of Medicine, King Fahad Medical City. Four indicators were considered to check the validity of the proposed OSBQs; (i) feed back on the perception of medical students experiencing different types of tutorial sessions, (ii) learning objectives achieved under both systems, (iii) student's performance under the OSBQs and the unguided tutorials and (iv) proper utilization of the time allocated to brainstorming sessions.

RESULTS

The student's perception of their satisfaction of implementation of OSBQs was unanimous. Student's performances were much better in blocks implementing OSBQs. The time allocated for brainstorming sessions was efficiently utilized with the introduction of OSBQs.

CONCLUSION

Implementation of OSBQs leads to standardization of tutorial sessions and allows more interaction between students to achieve their learning objectives and score better in their exams. Concern over the role of tutors will diminish.

What makes the learning of physiology in a PBL medical curriculum challenging? Student perceptions

Physiology is an integral component of any medical curriculum. Traditionally, the learning of physiology has relied heavily on systems-based didactic lectures. In 2001, the Nelson R. Mandela School of Medicine (NRMSM; Durban, South Africa) embarked on a problem-based curriculum in which the learning of physiology was integrated with relevant clinical scenarios. Students are expected to gain an understanding of physiology through self-directed research with only certain aspects being covered in large-group resource sessions (LGRSs). It has gradually become evident that this approach has resulted in significant gaps in students' understanding of basic physiological concepts. A survey of student perceptions of needs for physiology was undertaken to gain a better understanding of their perceived problems and also to inform them of proposed curricular changes. Students were asked to what extent they thought physiology was essential for their understanding of pathology, interpretation of patients' clinical signs and presentation of symptoms, and analysis of laboratory results. Students were also invited to detail the difficulties they experienced in understanding in LGRSs on clinical and physiological topics. The results of the survey indicate that greater interaction of students with experts is needed. In particular, students felt that they lacked the basic conceptual foundations essential for the learning and understanding of physiology, since the difficulties that the students identified are mainly terminological and conceptual in nature.

Teacher perceptions of desired qualities, competencies and strategies for clinical skills teachers

INTRODUCTION

Clinical skills centres (or Skillslabs) prepare students for patient-encounters. Evidence on teaching skills in these centres is lacking. What teaching skills do teachers view as effective in supporting the acquisition of physical examination skills in undergraduate medical training?

METHOD

Structured interviews of 10 teachers (1/3 of staff of Maastricht University, Skillslab) were conducted. Selection was based on even representation of age, years teaching experience, gender and previous experience at Maastricht University. A topic grid was used to ensure comparability. Interviews (average 70 min, range 33-95 min) were recorded and transcripts were analyzed independently by two researchers.

RESULTS

Teaching skills identified include the ability to adapt content of the training, level of depth and teaching method according to the needs of any particular group. Thorough comprehension of students' context (level of knowledge,prior experience and insight in the curriculum) is considered helpful. Explicitly inviting students to ask questions and providing relevant literature is seen to stimulate learning. Providing constructive feedback is essential, as is linking physical examination skills training to clinical situations. The ideal attitude includes appropriate dress and behaviour, as well as the use of humour. Affinity for teaching is regarded as the most important reason to work as a teacher.

CONCLUSION

Desired characteristics for undergraduate skills teachers resemble findings in other teaching roles. Affinity for teaching and flexibility in teaching methods are novel findings.

Problem-based learning and larger student groups: mutually exclusive or compatible concepts - a pilot study

BACKGROUND

Problem-based learning is recognised as promoting integration of knowledge and fostering a deeper approach to life-long learning, but is associated with significant resource implications. In order to encourage second year undergraduate medical students to integrate their pharmacological knowledge in a professionally relevant clinical context, with limited staff resources, we developed a novel clustered PBL approach. This paper utilises preliminary data from both the facilitator and student viewpoint to determine whether the use of this novel methodology is feasible with large groups of students.

METHODS

Students were divided into 16 groups (20-21 students/group) and were allocated a PBL facilitator. Each group was then divided into seven subgroups, or clusters, of 2 or 3 students wh each cluster being allocated a specific case. Each cluster was then provided with more detailed clinical information and studied an individual and distinct case-study. An electronic questionnaire was used to evaluate both student and facilitator perception of this clustered PBL format, with each being asked to rate the content, structure, facilitator effectiveness, and their personal view of the wider learning experience.

RESULTS

Despite initial misgivings, facilitators managed this more complex clustered PBL methodology effectively within the time restraints and reported that they enjoyed the process. They felt that the cases effectively illustrated medical concepts and fitted and reinforced the students' pharmacological knowledge, but were less convinced that the scenario motivated students to use additional resources or stimulated their interest in pharmacology. Student feedback was broadly similar to that of the facilitators; although they were more positive about the scenario stimulating the use of additional resources and an interest in pharmacology.

CONCLUSION

This clustered PBL methodology can be successfully used with larger groups of students. The key to success lies with challenging and well situated clinically relevant cases together with enthusiastic facilitators. Facilitator enjoyment of the PBL process may be related to adequate training and previous PBL experience, rather than academic background. The smaller number of facilitators required using this clustered PBL approach allows for facilitators with 'a belief in the philosophy of PBL' to volunteer which would again impact on the success of the process.

Applying problem-based learning to the teaching of anatomy: the example of Harvard Medical School

The introduction of problem-based learning techniques into the teaching of anatomy has been subject to great controversies. This paper debates the rationale behind this concept using the example of the curriculum of Harvard Medical School in which problem-based learning techniques have been used during the past 20 years. The anatomy curriculum is covered during the eight first weeks of the medical studies, and is an original combination of discussions of clinical cases in small groups, and work in gross anatomy, histology and radiology laboratories. The lectures are reduced to the minimum and emphasize general concepts. In this setting, the learning of anatomy is mostly led by students who have prepared for the different laboratory sessions and tutorials. The implementation of problem-based learning to the teaching of anatomy requires a close follow-up of each student with regular feedbacks on his work. Tutorials must be considered as a cornerstone between lectures and work in laboratories. Traditional aspects of the teaching of anatomy, such as work in dissection laboratories, are given an important role as they are aimed to clear-up misunderstood points. Further studies are required to compare at the long term the level of medical students who learned anatomy in a problem based versus traditional learning setting.