Problem-based learning in resource-poor settings: lessons from a medical school in Ghana

Employing students' evaluations and tutors' perceptions to evaluate a faculty development program on problem-based learning at the Faculty of Medicine, King Abdulaziz University

BACKGROUND

Faculty development programs are crucial for promoting continuous learning, enhancing teaching effectiveness, and encouraging professional growth among medical educators. Problem-based learning was introduced as a teaching strategy in our Faculty of Medicine in 2007. Thereafter, several rounds of a faculty development program were conducted to help teachers recognize their role as facilitators and assess areas for improvement.

METHODS

We conducted a mixed-methods study with a sample of 284 third-year medical students answering a questionnaire and 21 faculty members participating in focus groups. A validated 13-item questionnaire was used to investigate the students' evaluation of their tutors' performance in problem-based learning. Three sessions were then conducted with faculty members involved in problem-based learning to gain in-depth insights into their experiences and perspectives.

RESULTS

The mean performance ranking for tutors awarded by the students was above halfway. There was a significant positive correlation between tutors' performance ranking and all five of the learning approaches examined herein: constructive/active learning, self-directed learning, contextual learning, collaborative learning, and intra-personal behavior (p < 0.05). The data from the focus groups were analyzed under five broad themes: tutors' insights into their strengths and weaknesses, challenges in conducting problem-based learning, tutors' ways of preparing for problem-based learning, feedback, and suggestions for improving problem-based learning workshops.

CONCLUSIONS

This study recommends improvements and future directions for advanced program evaluation. Faculty development programs can be tailored to effectively address students and faculty members' goals and needs, which can benefit the teaching and learning process and foster a culture of continuous improvement and professional growth.

Problem-Based Learning in Medical Education: A Global Research Landscape of the Last Ten Years (2013-2022)

Background

Problem-based learning (PBL) constructs a curriculum that merges theory and practice by employing clinical scenarios or real-world problems. Originally designed for the pre-clinical phase of undergraduate medicine, PBL has since been integrated into diverse aspects of medical education. Therefore, this study aims to map the global scientific landscape related to PBL in medical education in the last ten years.

Methods

We combined bibliometrics and network analysis to analyze the metadata of related research articles published between 2013 and 2022 and indexed in the Web of Science Core Collection.

Results

Our results show an annual publication rate of 9.42%. The two main journals disseminating research on this subject are BMC Medical Education and Medical Teacher. Education & Educational Research and Health Care Sciences & Services are the two most frequent research areas, and also the two most central nodes of the related network. The USA and China are the most publishing countries, while the Netherlands and Canada are the most collaborative. The Maastricht University holds the position of most publishing and collaborative research organization. The University of California ranks second in publications, while the University of Toronto is the second most central research organization.

Conclusions

Our study provides an overview of the last ten years of publications related to PBL and medical education, and we hope it can be of interest to educators, researchers, and students involved with this subject.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40670-024-02003-1.

Barriers to implementing problem-based learning at the school of medicine of Debre Berhan University, Ethiopia

BACKGROUND

Implementing PBL in teaching and learning can be challenging due to a variety of complex barriers. Studies on barriers to the implementation of problem-based learning in Ethiopia are scarce. This study aimed to explore the barriers to the implementation of problem-based learning at the Debre Berhan University Medical School.

METHODS

A qualitative study was conducted among faculty and medical students at the medical school. Purposive sampling was used to select participants. Semi-structured interviews were conducted with tutors and academic leaders, including the problem-based learning coordinator, the biomedical sciences coordinator, and the school dean. Data was also collected from students through focus group discussions. All interviews and discussions were recorded. The four steps of data analysis of Spradley, including domain analysis, taxonomic analysis, componential analysis, and theme analysis, were employed.

RESULTS

The study identified student-related, tutor-related, case scenario-related, and assessment-related barriers as the most significant obstacles to implementing problem-based learning. These barriers included work overload for both students and tutors, lack of training and experience among tutors, student reluctance, absence of standardized case scenarios, subjectivity of assessment methods, and on-the-spot assessment of students.

CONCLUSIONS AND RECOMMENDATIONS

Lack of both tutor and student commitment, lack of standardized cases, absence of a recognition of staff input, gap in communication skills, work overload, lack of continuous training, and at-spot evaluation of students were identified as the main barriers to the implementation of PBL.

Sociocultural factors affecting first-year medical students' adjustment to a PBL program at an African medical school

BACKGROUND

Besides regulatory learning skills, learning also requires students to relate to their social context and negotiate it as they transition and adjust to medical training. As such, there is a need to consider and explore the role of social and cultural aspects in student learning, particularly in problem-based learning, where the learning paradigm differs from what most students have previously experienced. In this article, we report on the findings of a study exploring first-year medical students' experiences during the first semester of an undergraduate problem-based learning medical program at an African medical school.

METHOD

We employed a qualitative case study approach using in-depth interviews with 23 first-year medical students. Participants ranged in age from 18 to 25 years. All students were bi/multilingual (some spoke three to five languages), with English as the learning language. We conducted an inductive thematic analysis to systematically identify and analyze patterns in the data using the Braun and Clarke framework.

RESULTS

Before medical school, students worked hard to compete for admission to medical school, were primarily taught using a teacher-centered approach, and preferred working alone. At the beginning of medical school, students found it challenging to understand the problem-based learning process, the role of the case, speaking and working effectively in a group, managing a heavy workload, and taking increased responsibility for their learning. By the end of the first semester, most students were handling the workload better, were more comfortable with their peers and facilitators, and appreciated the value of the problem-based learning approach.

CONCLUSIONS

Our study highlights the importance of interrogating contextual sociocultural factors that could cause tension when implementing problem-based learning in non-western medical schools. Adjustment to problem-based learning requires a conceptual and pedagogic shift towards learner-centered practice, particularly concerning self-direction, the role of the case, and collaborative learning. As such, there is a need to develop and implement research-informed learning development programs that enable students to reflect on their sociocultural beliefs and practices, and enhance their regulatory learning competence to optimize meaningful and early engagement with the problem-based learning process.

Implementation of Problem-Based Learning in Undergraduate Medical Education in Ethiopia: An Exploratory Qualitative Study

Background

The poor quality of health professional education in Ethiopia, which was rooted in a traditional curriculum, has posed significant challenges for graduates in effectively addressing real-life health problems. In response, there has been curricular reform by adopting problem-based learning across Ethiopian medical schools. Given the dearth of literature on the topic and the significance of context in the effective implementation of problem-based learning, it is imperative to provide local institutional evidence to pinpoint critical intervention areas and support the effective implementation of problem-based learning.

Methods

A qualitative design based on in-depth, individual, semi-structured interviews was used to explore medical educators, program coordinators, and educational leader's experiences and perspectives on the problem-based learning implementation in health sciences education. A total of 24 participants recruited from five undergraduate health science programs participated in the study. All sessions were audio recorded and transcribed verbatim. Results were analyzed following a qualitative thematic analysis method.

Results

Analysis of the transcripts revealed three main themes, along with their corresponding subthemes. Within the first main theme, participants discussed the importance of integrating Problem-Based Learning into undergraduate medical programs and the educational benefits it brings to medical education. The second main theme explored issues related to challenges in implementing problem-based learning which include inadequate staff training, deficiencies in curricular design and governance, constraints in educational resources, and a lack of preparedness in the educational environment. The third theme deals with the strategic recommendations to address the challenges that contributed to the poor implementation of problem-based learning in undergraduate medical schools.

Conclusion

Our study has addressed several issues related to the implementation of Problem-Based Learning in Ethiopian Health Sciences Colleges. The study's findings have the potential to provide educational stakeholders and policymakers with essential information to strategize successful problem-based learning implementation in undergraduate medical schools.

Barriers and Solutions to Successful Problem-Based Learning Delivery in Developing Countries - A Literature Review

Problem-based learning (PBL) was introduced in the 1960s as an alternative to traditional teacher-centered and discipline-based preclinical medical education. A literature review was conducted to explore the barriers and solutions to successful PBL uptake and delivery in developing countries. The review involved the search of articles and scientific studies on PubMed, The Lancet, and Scielo. The review focused on the medical education literature, using as a primary search criterion "problem-based learning" in combination with "developing countries" and "education". The search was limited to articles in Spanish and English published between 2011 and November 2021, except for three articles due to their relevance to the subject. Faculty development programs are the cornerstone when implementing a new methodology in developing countries. Early career development, PBL methodology, and the available assessment options should be the primary learning objectives of these programs. Stakeholders will need to plan using available resources following the experience of other countries and institutions encouraging collaborative development. Evaluation and assessment will be crucial to understand the impact of PBL, and considerations should be taken to implement an integrated curriculum. Medical Education Research should be encouraged, appraised, and disseminated to improve evidence-based decision-making, creating a constant development cycle. PBL is innovative and represents many unanswered questions that will develop in the following decade as more schools implement new methodologies and Research on PBL.

From the Global North to the Global South: preparing students for away rotations

Makerere University College of Health Sciences, Kampala, Uganda, has established partnerships with several other institutions worldwide, including the University of Brescia and "Magna Græcia" University, which have agreed to collaborate for the primary purpose of student exchange. Our aim is to comment on students' preparation for away rotations based on the authors' own experiences and opinions alongside a review of selected papers on the preparation of students for global health and ethical collaboration. Medical electives represent a unique opportunity for all medical students, not merely for those who will work in resource-limited settings due to increasing globalization. The emergence of ethical international collaborations is of paramount importance to stimulate these projects and ensure that they are implemented safely and with adequate preparation even and especially during the COVID-19 pandemic.

Teaching Cellular Architecture: The Global Status of Histology Education

Histology or microanatomy is the science of the structure and function of tissues and organs in metazoic organisms at the cellular level. By definition, histology is dependent on a variety of microscope techniques, usually light or more recently virtual, as well as electron microscopy. Since its inception more than two centuries ago, histology has been an integral component of biomedical education, specifically for medical, dental, and veterinary students. Traditionally, histology has been taught in two sequential phases, first a didactic transfer of information to learners and secondly a laboratory segment in which students develop the skill of analyzing micrographic images. In this chapter, the authors provide an overview of how histology is currently taught in different global regions. This overview also outlines which educational strategies and technologies are used, and how the local and cultural environment influences the histology education of medical and other students in different countries and continents. Also discussed are current trends that change the teaching of this basic science subject.

Adolescents’ World: Know One Tell One against Unsafe Sexual Behaviours, Teenage Pregnancies and Sexually Transmitted Infections Including Chlamydia

Addressing adolescents’ sexual and reproductive health (SRH) matters using multidisciplinary pedagogical innovations may assure the proper development and well-being of adolescents so that they reach the adulthood stage healthy and strong enough to produce for their future investment. This is in response to sustainable development goal number 3, target 3.7, and SDG4, target 4.7 in particular emphasizes the universal availability and accessibility of sexual information and education among people and knowledge and skills for gender equality, human rights and sustainable lifestyles by 2030, respectively. Yet, the innovative strategies may respond to a call stated by SGD5 (gender equality), target 5.3 which advocates the elimination of child, early, and forced marriages, and target 5.6 which focuses on ensuring universal access to SRH and rights to all by 2030.

The Influence of COVID-19 on Medical Student Resource Preferences

Introduction

Over the past decade, pre-clerkship medical education has shifted from solely relying on didactic lectures to implementing more group learning and clinical experience to promote individualized, self-directed, and patient-centered education. COVID-19 required medical schools to examine their curricula and determine which portions were adaptable to virtual learning. This study compared first-year medical students’ (MS1) perceptions of an online curriculum, focusing on the students’ preferred resources before and after the transition to virtual courses.

Materials and methods

At one community-based allopathic medical school, a decision was made to move the entire pre-clerkship curriculum to a virtual format in the setting of the pandemic. An end-of-course survey evaluation was distributed via email to 64 first-year medical students at a community-based allopathic medical school. The participants were asked numerous questions about their overall perceptions of each course, including questions about the usefulness of lectures, small group activities, course administration, and faculty communication. Quantitative and qualitative data were collected during the standard program evaluation process for the two courses, and a third survey that focused on learning resources asked questions regarding virtual learning.

Results

Of the students, 29.7% reported being disappointed with the virtual curriculum, while the other 70.3% reported an unchanged or improved overall medical education. Regarding resource preferences, 56.5% of the students viewed most (76%-100%) course lectures, while 35.5% of the students viewed less than half of the course lectures. In contrast, 75.8% of the students said the majority (>50%) of their learning comes from outside resources. Furthermore, 31% reported that they are satisfied with the resources provided by the school, while 42% reported that they would like the school to provide additional resources. With that being said, 61% reported using more outside resources with the onset of a virtual curriculum, while 34% reported no change in outside resource use. Only 2% reported using fewer outside resources.

Conclusion

This study found that pre-clerkship medical students preferred some aspects of the in-person setting, such as social interaction and clinical exposure that is lacking in the virtual setting. However, students preferred many aspects of the virtual setting, such as having more independent study time and a more efficient learning process. Overall, before and after the transition, students were less satisfied with traditional curricular resources and more likely to choose external, board-specific resources with hopes of building strong residency applications, and these preferences were heightened in the online format.

Factors Affecting Knowledge and Attitude Towards Hybrid Problem-Based Learning Curriculum Among Academicians of the University of Gondar, Northwest Ethiopia

BACKGROUND

Adapting a tutor role in a hybrid problem-based learning (h-PBL) model is a challenge to novices. Therefore, this study aimed to assess the factors associated with the academicians' knowledge and attitude toward the h-PBL curriculum.

METHODS

An institution-based cross-sectional study was conducted from August 1st to 30th, 2021. A Simple random sampling was employed. Data were entered and analyzed with EpiData 4.6 and SPSS® version 25. Multivariable logistic regression analysis was fitted and adjusted odds ratio at a p-value of ≤0.05 and 95% confidence interval were used to declare significant association.

RESULTS

The study included 415 academicians with a response rate of 97.8%. Four-sixths (66.3%) of them have good knowledge (95% CI = 61.7-70.8). Being age 30-34 (AOR = 2.97; 95% = CI: 1.69-5.23), being age over 34 (AOR = 3.36; 95% CI = 1.6-6.66), currently teaching (AOR=1.84; 95 CI = 1.1-3.07) and having received PBL training (AOR = 1.9; 95% CI = 1.01-2.7) were significantly associated with good knowledge. More than half (51.1%) had a favorable attitude (95% CI = 46.3-55.9). Being age over 34 (AOR = 3.69; 95% CI: 1.98-6.89), having 5-9 (AOR = 2.21; 95% CI: 1.85-2.34) and above 9 years of experience (AOR = 1.53; 95% CI = 1.03-2.11), having received PBL training (AOR = 1.93; 95% CI = 1.17-2.8), ever-constructing PBL cases (AOR = 1.7; 95% CI = 1.08-2.68), and presence of rooms set aside for PBL sessions (AOR = 2.26; 95% CI = 1.2-4.16) were significantly associated with academicians' favorable attitude.

CONCLUSION

Academicians' knowledge and attitude towards the h-PBL curriculum can be improved with training, participation in PBL case construction, and setting rooms aside for PBL sessions.

Effectiveness of problem-based learning methodology in undergraduate medical education: a scoping review

BACKGROUND

Problem-based learning (PBL) is a pedagogical approach that shifts the role of the teacher to the student (student-centered) and is based on self-directed learning. Although PBL has been adopted in undergraduate and postgraduate medical education, the effectiveness of the method is still under discussion. The author's purpose was to appraise available international evidence concerning to the effectiveness and usefulness of PBL methodology in undergraduate medical teaching programs.

METHODS

The authors applied the Arksey and O'Malley framework to undertake a scoping review. The search was carried out in February 2021 in PubMed and Web of Science including all publications in English and Spanish with no limits on publication date, study design or country of origin.

RESULTS

The literature search identified one hundred and twenty-four publications eligible for this review. Despite the fact that this review included many studies, their design was heterogeneous and only a few provided a high scientific evidence methodology (randomized design and/or systematic reviews with meta-analysis). Furthermore, most were single-center experiences with small sample size and there were no large multi-center studies. PBL methodology obtained a high level of satisfaction, especially among students. It was more effective than other more traditional (or lecture-based methods) at improving social and communication skills, problem-solving and self-learning skills. Knowledge retention and academic performance weren't worse (and in many studies were better) than with traditional methods. PBL was not universally widespread, probably because requires greater human resources and continuous training for its implementation.

CONCLUSION

PBL is an effective and satisfactory methodology for medical education. It is likely that through PBL medical students will not only acquire knowledge but also other competencies that are needed in medical professionalism.

The COVID-19 pandemic: the benefits and challenges it presents for medical education in Africa

The coronavirus disease (COVID-19) has impacted many facets of everyday daily life, resulting in far-reaching consequences on social interaction, regional and global economies, and healthcare delivery systems. Numerous reports have commented on the impact of the COVID-19 pandemic on medical education in various world regions. However, we know little about the influence of the pandemic on medical education in Africa. Here, we discuss the potential impact of COVID-19 on teaching and learning in undergraduate medical education in sub-Saharan Africa, illustrating some of the unexpected benefits and challenges the pandemic presents for medical education in sub-Saharan Africa.

Exploring the effect of problem based facilitatory teaching approach on motivation to learn: a quasi-experimental study of nursing students in Tanzania

Background

Academic motivation is most important as a key determinant of competent and motivated nurses who are often considered as frontline healthcare providers who devote most of their time taking care of clients and patients. However, most of them demonstrate remarkable differences in their academic performances during their schooling that might be due to the differences in their academic motivation and achievement motivation. There appears a growing concern to rethink the approaches on how nurses are prepared, explore, and test novel approaches for delivering the nursing curricula. This study tested the effect of Problem Based Facilitatory Teaching pedagogy on academic motivation among nursing students in Tanzania, higher learning institutions.

Methods

A pre-post-test controlled quasi-experimental study of 401 purposively selected participants was conducted between February and June 2018. The study was not a clinical randomized controlled trial and thus it has not been identified in the title and no summary of trial design, its methods, results, and conclusion. The Auditing Inventory developed by the researcher measured the intervention and a Questionnaire titled “Academic Motivation Scale,” was adopted to measure academic motivation. Statistical Product for Service Solutions software program version 23 was used to perform descriptive analysis to establish participants’ sociodemographic profiles. Regression analysis was performed to determine the association between variables.

Results

Findings revealed that 65.8% of participants were males. Post-test findings showed 70.3% of participants demonstrated the motive to learn contrary to 34.9% at baseline. The odds of an intervention to influence academic motivation among participants was higher than the control (AOR = 1.720; p < 0.05; 95%CI: 1.122, 2.635). However, the intervention demonstrated little influence on the extrinsic motivation to learn (AOR = 0.676, p > 0.05, 95%CI: 0.405, 1.129) and Amotivation to learn (AOR = 0.538, p > 0.05; 95%CI: 0.283, 1.022) compared to the control.

Conclusion

The Problem Based Facilitatory Teaching pedagogy was a predictive factor to intrinsic academic motivation among nursing students. The approach demonstrated educational potentials to change the spectrum of nursing competency and quality of care to patients or clients. This study suggests problem-based facilitatory teaching pedagogy be integrated into the nursing curriculum in Tanzania as it is feasible.

Perceptions of education quality and influence of language barrier: graduation survey of international medical students at four universities in China

BACKGROUND

As the number of Asian and African students studying medicine in China increases, it is imperative to evaluate the educational experiences of these international medical students (IMSs). This study was intended to investigate opinions of China-educated IMSs towards the medical curriculum and the impact of Chinese language capability on their clinical studies.

METHODS

A self-administered questionnaire was circulated to the final-year IMSs during the graduation time from May 2019 to July 2019 in 4 universities in China. The questionnaire asked IMSs to assess the quality of medical education and provide a self-evaluation of their Chinese language capability. One-way Analysis of Variance (ANOVA) was used to determine whether IMSs' Chinese language capability was associated with their clinical experiences and clinical competence.

RESULTS

Overall, we received 209 valid responses, of which 76.1% were satisfied with the quality of medical education. Genetics, physics, and mathematics were perceived as the least relevant basic courses for medical practice, and 21.5% of student reported that community-oriented medicine was a neglected subject. Notably, 58.9% of students had positive views about discussions on ethical topics during their clerkships, and 71.3% believed they had acquired sufficient clinical skills to begin a residency program. Chinese speaking skills and communication initiatives were found to be critical factors in influencing students' clinical experiences and competence.

CONCLUSION

This study presents the perceptions of China-educated IMSs towards medical curriculum from various aspects. Results show that language influences the education experiences of IMSs. Collectively, these results indicate that the curriculum for IMSs in China should be more problem-based and community-engaged to improve IMSs' learning experiences and preparation for community deployment. Furthermore, training curriculum for the oral Chinese should be improved to equip IMSs with sufficient language competence to enable them to efficiently carry out clinical clerkship and rotations. Our findings provide evidence for benchmarking medical curricular codifications tailored for Asian and African students.

Effectiveness and Key Success Factors for Implementation of Problem-Based Learning in Debre Tabor University: A Mixed Methods Study

BACKGROUND

Problem-based learning has been adopted as a core educational strategy for education of health professionals in more than a dozen of higher education institutions in Ethiopia. Debre Tabor University College of Health Sciences (DTUCHS) is one of the adopters. However, its effectiveness has not been researched yet. Thus, the objective of this study is to assess the quality of PBL implementation, its effectiveness in developing desired student learning outcomes and factors that facilitate or impede PBL implementation.

METHODS

A cross-sectional study was conducted in DTUCHS from May to June 2018. We collected quantitative data from students and tutors using self-administered questionnaire. We complemented this with key informant interviews with academic leaders. We computed descriptive statistics from quantitative data while qualitative data were subjected to thematic analysis.

RESULTS

A total of 308 students, 42 tutors and 8 academic leaders were included in the study. Students, tutors and academic leaders perceived that PBL was effective in developing knowledge, problem-solving skills, self-directed learning skills and collaboration competencies. The implementation process showed the existence of clear objectives, appropriate cases, and reasonable workload. Students rated tutors' performance positively, and tutors also rated student learning affirmatively. However, unlike tutors, students thought that the assessment of student performance in PBL was not appropriate. The factors that facilitated PBL implementation were students' and tutors' buy-in, clear curriculum design, adequate infrastructure, commitment to hire more faculty and develop their teaching skills continuously and strong coordination and monitoring.

CONCLUSION

The findings of our study support the introduction of PBL in a resource-constrained setting. Students, tutors and academic leaders perceived PBL to be effective in achieving desired student learning outcomes. Its implementation was considered consistent with the principles of PBL. Respondents identified the presence of enabling factors to implement PBL in Debre Tabor University (DTU).

Training the next generation of Africa's doctors: why medical schools should embrace the team-based learning pedagogy

BACKGROUND

As far back as 1995, the Cape Town Declaration on training Africa's future doctor recognized the need for medical schools to adopt active-learning strategies in order to nurture holistic development of the doctor. However, medical education in Africa remains largely stuck with traditional pedagogies that emphasize the 'hard skills' such as knowledge and clinical acumen while doing little to develop 'soft skills' such as effective communication, teamwork, critical thinking or life-long learning skills. By reviewing literature on Africa's epidemiologic and demographic transitions, we establish the need for increasing the output of well-trained doctors in order to match the continent's complex current and future healthcare needs. Challenges that bedevil African medical education such as outdated curricula, limited educational infrastructure and chronic resource constraints are presented and discussed. Furthermore, increased student enrollments, a trend observed at many schools, coupled with chronic faculty shortages have inadvertently presented specific barriers against the success of small-group active-learning strategies such as Problem-Based and Case-Based Learning. We argue that Team-Based Learning (TBL) offers a robust alternative for delivering holistic medical education in the current setting. TBL is instructor-driven and embodies key attributes that foster development of both 'hard' and 'soft' skills. We elaborate on advantages that TBL is likely to bring to the African medical education landscape, including increased learner enthusiasm and creativity, accountability, peer mentorship, deep learning and better knowledge retention. As with all new pedagogical methods, challenges anticipated during initial implementation of TBL are discussed followed by the limited pilot experiences with TBL in Africa.

CONCLUSION

For its ability to enable a student-centered, active learning experience delivered at minimum cost, we encourage individual instructors and African medical schools at large, to adopt TBL as a complementary strategy towards realizing the goal of training Africa's fit-for-purpose doctor.

Delivering and evaluating a scalable training model for strengthening family medicine in resource-limited environments: the Gaza experience. A mixed-methods evaluation

Background

Since 2007, Gaza Palestine has been subject to blockade affecting over 1.9 million people. This denies health professionals access to continuing professional development (CPD). In Gaza, family physicians are scarce, and their level of training does not meet the needs of United Nations Relief and Works Agency’s (UNRWA) Family Health Team (FHT) model for better population health.

Aim

This study sought to develop a postgraduate training programme for Gazan doctors via a Diploma in Family Medicine (FM PG), and evaluate its impact on physicians and patients.

Design & setting

A mixed-methods evaluation of a postgraduate diploma in Gaza Palestine.

Method

The programme was delivered over 1 year, to 15 primary care doctors. The impact was evaluated through focus group discussions and patient feedback questionnaire survey comparing FM PG graduate doctors and doctors without the FM PG Diploma.

Results

All participating doctors graduated successfully and found the experience extremely positive. Trainees felt that the Diploma helped them take more individualised approach to patients; have a better understanding of psychosocial elements affecting patient health; feel more inclined towards team-working and collaborative approaches to health care; and more insight into non-verbal communication such as active listening and tactile gestures. Statistical analysis of patients’ feedback showed significantly improved patient-reported outcomes and satisfaction when treated by course diplomates compared to non-diplomates.

Conclusion

Where there are limited training opportunities, investment in a structured postgraduate diploma training programme can improve quality of health service delivery. UNRWA’s experience in Gaza demonstrates the value of a scalable model in resource-limited settings.

Problem-based, peer-to-peer global mental health e-learning between the UK and Somaliland: a pilot study

BACKGROUND

WHO's mental health gap action programme intervention guide (mhGAP-IG) is an evidence-based tool aimed at front-line health workers in low-income and middle-income countries (LMICs). Its potential to improve global mental health education, especially through digital technologies, has been little studied. Problem-based learning (PBL) is usually conducted face-to-face, but its remote application could facilitate cross-cultural education.

OBJECTIVE

To evaluate PBL, applied to peer-to-peer global mental health e-learning (Aqoon), using mhGAP-IG.

METHODS

Twelve pairs of UK and Somaliland medical students completed the full programme. Participants self-directedly met online, via the low-bandwidth Medicine Africa website, for PBL-style tutorials focused on modules of the mhGAP-IG, V.2.0. Preparticipation and postparticipation surveys used mixed methods to evaluate Aqoon, including the Attitudes Toward Psychiatry (ATP-30) instrument.

FINDINGS

Median ATP-30 scores for Somaliland (82.0 vs 95.0, p=0.003) and UK students (82.0 vs 95.0, p=0.011) improved significantly following Aqoon. Qualitative feedback showed that participants valued peer connectivity and learning about cultural and psychosocial differences in their partner's country. Somaliland students were motivated by clinical learning and UK students by global health education. Feedback on the PBL structure was positive.

CONCLUSIONS

Digital PBL represents an innovative method to extend the benefits of mhGAP-IG beyond front-line clinical staff, to healthcare students in LMICs.

CLINICAL IMPLICATIONS

Educational resource limitations in LMICs may be overcome using digital platforms and PBL. Replication with non-medical healthcare students is the next step for this model to explore Aqoon's relevance to pressing global mental health workforce challenges.

Evaluation of problem-based learning curriculum implementation in a clerkship rotation of a newly established African medical training institution: lessons from the University of Botswana

Introduction

Problem-based Learning (PBL) curricula, like all curricula, require systematic evaluation as there is a risk of implementing a dysfunctional PBL curriculum. The study intended to evaluate the PBL curriculum delivery from the perspective of the clerkship students at the University of Botswana-Faculty of Medicine.

Methods

A cross-sectional study was conducted among clerkship students in Family Medicine, Paediatrics, Internal Medicine and Surgery. During a 4-week period, each respondent completed weekly a questionnaire based survey tool. The three part questionnaire consisted of demographic data, 'seven-jumps' adapted from a 'typical' PBL tool to evaluate PBL process and 11 items 'adopted 'from the Short-Questionnaire-to-Evaluate-the-Effectiveness-of-Tutors in the PBL tool to evaluate the PBL facilitation with open ended questions at the end.

Results

Of the 81 eligible participants, 89% (n=72) responded. We collected back 141 (49%) forms out of the 288 expected (72 X 4 weeks). PBL first sessions took place all the time only in Family Medicine and in about 75% of the time in Pediatrics but none were conducted in the other disciplines. Overall, they evaluated the PBL process as 'good' (median= 8 /10) and the PBL facilitation as 'very good' (median=9 /10). Students appeared to have differing opinions on the preferred approach to the nature of patient problems that the PBL sessions should be structured around.

Conclusion

Despite students rating PBL process as 'good' and facilitation as 'very good', PBL first sessions were not consistently undertaken.

Does a PBL-based medical curriculum predispose training in specific career paths? A systematic review of the literature

BACKGROUND

North American medical schools have used problem-based learning (PBL) structured medical education for more than 60 years. However, it has only recently been introduced in other medical schools outside of North America. Since its inception, there has been the debate on whether the PBL learning process predisposes students to select certain career paths.

OBJECTIVES

To review available evidence to determine the predisposition of specific career paths when undertaking a PBL-based medical curriculum. The career path trajectory was determined as measured by official Matching Programs, self-reported questionnaires and surveys, and formally defined career development milestones.

METHODS

A systematic literature review was performed. PubMed, Medline, Cochrane and ERIC databases were analysed in addition to reference lists for appropriate inclusion.

RESULTS

Eleven studies fitting the inclusion criteria were identified. The majority of studies showed that PBL did not predispose a student to a career in a specific speciality (n = 7 out of 11 studies, 64%). However, three studies reported a significantly increased number of PBL graduates working in primary care compared to those from a non-PBL curriculum.

CONCLUSIONS

PBL has been shown not to predispose medical students to a career in General Practice or any other speciality. Furthermore, a greater number of similar studies are required before a definitive conclusion can be made in the future.