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

Adoption of Problem-Based Learning in Medical Schools in Non-Western Countries: A Systematic Review

Phenomenon: In recent decades, medical education practices developed in Western countries have been widely adopted in non-Western countries. Problem-based Learning (PBL) was first developed in North America and it relies on Western educational and cultural values, thereby raising concerns about its 'lift and shift' to non-Western settings. Approach: This review systematically identified and interpretively synthesized studies on students' and teachers' experiences of PBL in non-Western medical schools. Three databases (ERIC, PsycINFO, and MEDLINE) were searched. Forty-one articles were assessed for quality using the Critical Appraisal Skills Program (CASP) checklist and synthesized using meta-ethnography. The final synthesis represented over 5,400 participants from 18 countries. Findings: Findings were categorized into three different constructs: Student Engagement, Tutor Skills, and Organization and Planning. Our synthesis demonstrates that medical students and teachers in non-Western countries have varied experiences of PBL. Students engage variably with PBL, consider knowledge to be better acquired from authoritative figures, and deem PBL to be ineffective for assessment preparation. Student participation is limited by linguistic challenges when they are not native English speakers. Teachers are often unfamiliar with the underlying philosophical assumptions of PBL and struggle with the facilitation style needed. Both students and teachers have developed modifications to ensure that PBL better fits in their local settings. Insights: Given the significant adjustments and resource requirements needed to adopt PBL, medical school leaders and policy makers in non-Western countries should carefully consider possible consequences of its implementation for their students and teachers, and proactively consider ways to 'hybridize' it for local contexts.

Implementation of mind mapping with problem-based learning in prosthodontics course for Chinese dental students

BACKGROUND

The traditional Chinese dentistry classroom teaching model focuses on the instruction of knowledge details, but less on the frameworks and learners' motivation. Here, we introduced a combination of mind mapping and PBL instruction (MBL)into the prosthodontics course for Chinese dental students. This study aimed to evaluate the effectiveness and efficiency of MBL in prosthodontics and make observations from the students' perspectives, based on their response with the learning process.

METHODS

We prospectively enrolled 56 fourth-year undergraduates of stomatology, and these participants were randomly allocated into either the combined mind map teaching group (MBL) or the problem-based learning group (PBL) to attend the prosthodontics course. An anonymous questionnaire was also administered to both groups to evaluate the students' perceptions and experiences, using closed and open-ended items. Data were analyzed using descriptive statistics and thematic analysis.

RESULTS

The students' responses to closed items indicate their experience in PBL and MBL to be positive, including increased motivation, improved memory of knowledge, enhanced discipline connection and raised teamwork, with fairly higher ratings for the MBL group. However, the tutor-guided competence scores including the memory and framework part, were significantly higher for MBL group than PBL group (two-way ANOVA, p < 0.01, p < 0.001, respectively). Meanwhile, the self-perceived competence scores including the motivation, framework and teamwork part, were significantly higher for MBL group than PBL group (two-way ANOVA, p < 0.01, p < 0.001, p < 0.05, respectively).

CONCLUSION

Our findings suggest that MBL teaching approach can help in integration of knowledge structure and enhance clinical reasoning. MBL is an effective and well-organized method in prosthodontics course for dental students.

Simulation-based learning in nursing curriculum- time to prepare quality nurses: A systematic review and meta-analysis

Background

Simulation-based learning (SBL) emerged as an imperative pedagogical approach adaptable to situations involving widely varying clinical content without exposing patients to the risks inherent in trainee learning. The purpose of the present review was to assess the outcome of SBL on the domains of learning i.e cognitive, affective, and psychomotor.

Methods

We searched PubMed, Embase, Cochrane library, Clinical Trial database, and other sources to evaluate the effectiveness of SBL versus traditional teaching methods among nursing students till March 2021. Two authors individually extracted the data and identified the risk of bias and analyzed the data.

Results

The selected studies with a total of 364 nursing students were included for analysis. Overall, it was found that learning via simulation has beneficial effects. In combined subgroup analysis, use of simulation showed significant effects on students' understanding (SMD = 1.31, 95% CI [0.80, 1.82], P < 0.00001), Self-confidence (SMD = 1.93, 95% CI [1.01,2.84], P < 0.0001), (SMD = 1.83, 95% CI [0.91,2.74], P < 0.0001), Learning satisfaction [E:17.94, C-17.60] and Skill (SMD = 1.62, 95% CI [0.62,2.62], P = 0.002) and psychological care (SMD = 1.60, 95%CI [0.61,2.58], P = 0.001). Heterogeneity ranging from I2 = 54%-86% was found during the analysis.

Conclusion

The findings of the present study considered simulation as an effective teaching method to enhance cognitive, affective, and psychomotor skills.

Implementation of a Surgical Problem-Based Learning Curriculum: A One-Year Single-Center Experience

Background

Problem-Based Learning (PBL) has become an integral part of medical student education for preclinical curricula, but few studies have evaluated the benefits of a PBL curriculum for clinical education. This study aims to assess the 1-year experience after implementing a resident-led PBL program for the third-year (MS3) surgery clerkship and compare students’ self-reported preparedness following PBL sessions to traditional faculty-led lectures.

Methods

Surgical faculty and residents developed a PBL curriculum to address common topics in surgical education. Pandemic requirements necessitated a switch from in-person to virtual sessions during the experience. Students enrolled in the MS3 surgical clerkship were asked to participate in a survey. Demographics and clerkship data were obtained. Quality of PBL and faculty-led lectures were assessed using a ten-point Likert scale, and standard statistical analyses were performed.

Results

During the study period, 165 students rotated through surgery, of which 129 (78%) responded to the survey (53% female, 59% white). PBLs were held in-person (53%), exclusively virtual (32%) or hybrid (15%) platforms. In-person PBLs were preferred to faculty-led lectures for preparing students for NBME examinations (6.9 vs 6.0), oral examinations (7.8 vs 6.3), and surgical cases (6.3 vs 5.8), all P < .001. Virtual PBLs were also preferred to lectures for preparing students for NBME examinations (6.8 vs 5.8, P < .001) and surgical cases (5.6 vs 4.8, P = .05).

Conclusions

PBL is a valuable adjunct for medical student education. Resident-led PBLs were preferred to faculty-led lectures for preparing students for examinations and clerkship experiences and may be useful adjuncts to clinical education.

The impact of interprofessional task-based training on the prevention of surgical site infection in a low-income country

BACKGROUND

Training is considered instrumental in reducing surgical site infection. We developed training based on authentic tasks, interprofessional learning, and reflective learning for implementation in a low-income country where such training opportunities are rare. This study evaluated the results of training in terms of participants' acceptance, participants' knowledge acquisition, and their self-perceived behavior change.

METHODS

We included 145 participants in the voluntary training program, comprising 66 technologists (45.5%), 43 nurses (29.7%), and 36 doctors (24.8%) from Shifa International Hospital, Islamabad, Pakistan. We measured "satisfaction" using a questionnaire at the end of the training, "knowledge" through pre-and post-intervention assessments, and "self-perceived behavior change" using a questionnaire and interviews 8 weeks post-training.

RESULTS

Pre- and post-test scores showed a significant increase in knowledge. Participants were favorable to the training and eager to participate. They positively applied in practice what they had learned about preventing surgical site infection. Our qualitative data analysis revealed two categories of themes, representing the upsides of the training as it stood, and existing factors or downsides that hindered the effective transfer of learning to practice.

CONCLUSION

Participants were very enthusiastic about the training format. The knowledge test showed a gain in knowledge. Moreover, participants acknowledged that their behavior toward the prevention of surgical site infection in the operating rooms had changed. The use of authentic tasks from daily clinical practice, as well as the interprofessional approach and reflection, were considered to promote the transfer of learning. Although promising, our findings also pointed to obstacles limiting the application of evidence-based knowledge, such as a shortage of supplies and conventional practices.

Is it time for transition from the subject-based to the integrated preclinical medical curriculum?

In the 60s of the last century, a number of new universities in the world began to apply an integrated program of medical education, the cornerstone of which was problem-oriented education. Thus, the Flexner model of higher education adopted by that time in most countries of the world, with its characteristic segregation of teaching of the theoretical and clinical disciplines, which had ceased to satisfy the needs of modern healthcare, was gradually replaced by a new system that put the student in the center of the educational process and opened the way to active methods of teaching being focused on the end result – training of graduates whose qualifications most fully satisfy the needs of society. Over the half-century history of its existence, this system has been adopted by most medical universities in different countries of the world, in many of which it has undergone significant modifications in accordance with the needs of national educational standards. Many medical universities in Russia and other countries of the former Soviet Union showed interest in this system, some of the medical faculties of our country accepted certain elements of it. However, up to date no integrated preclinical medical education program has been applied in any of the Russian universities. Hereby we are undertaking an attempt to analyze the reasons and assess the possible perspectives for the transition of medical universities in Russia to teaching of fundamental and biomedical disciplines using the integrated curriculum.

Application of PRECEDE-PROCEED Planning Model in Transforming the Clinical Decision Making Behavior of Physical Therapists in Myanmar

Introduction: Physical therapists in Myanmar use a prescriptive model of Clinical Decision Making (CDM). Improving CDM effectiveness is one essential factor in professionalizing practice and enhancing patient outcomes. This study assesses the changes in CDM skills and behaviors using the PRECEDE-PROCEED planning Model (PPM). Methods: In the PRECEDE planning phases, we investigated the current clinical decision making knowledge, and process, clinical practice culture, and contributing factors of CDM among Myanmar physical therapists. A qualitative approach consisted of 18 in-depth interviews and one focus group discussion was used. In the PROCEED evaluation and implementation phases, we developed and presented the CDM educational book at CDM workshop, which was a 4-day intensive program in Yangon, Myanmar with 34 participants. The participant's CDM knowledge and processes were assessed before and after the educational program to explore the potential impact on implementing CDM which can ultimately improve patient care in the health settings of Myanmar. Results: In the PRECEDE phases, we explored the predisposing and reinforcing factors of Myanmar physical therapists' CDM. We found that CDM models and deliberative decision making process that is used internationally were not followed by Myanmar physical therapists who followed the physician's prescriptions. Teaching and learning emphasize a stimulus-response-repeat-outcome cycle without internal processing or application to clinical situations. Using the PROCEED model components, we developed a 14 chapters CDM workbook and a 4-day workshop as a behavioral change intervention. Participants' prior technical CDM behavior was transformed into professional CDM behavior that included an understanding of clinical practice models and improvement in the cognitive process of CDM processes. The workbook coupled with the intensive active-learning, hands-on workshop of examination and intervention procedures were effective in improving CDM. Discussion: The application of PPM provided a through understandings of current CDM process of Myanmar therapists and aided in the development of the tailored CDM educational program to improve participants' CDM. Using the PPM model for developing a set of Physical Therapy educational content and curriculum was new. The application of PPM was beneficial to use accepted clinical practice models, standardized tests and measures, set goals and clinical outcomes, reassessed to determine change and implement evidence-based practice.

Applying empathy-driven participatory research methods to higher education new degree development

Purpose

Innovation and entrepreneurship are economic drivers promoting competition and growth among organizations throughout the world, many of which would not exist without well-established new product development processes coupled with intentional and strategic focus on research and development. New product development processes, such as the lean start-up methodology and design thinking, are well-known and thriving as a result of empirically grounded research efforts. Unfortunately, educational institutions and educational researchers, alike, are lagging when it comes to new program/degree development processes. Although the quantity of new degree offerings has increased substantially over the past several decades (in particular for multidisciplinary, interdisciplinary and transdisciplinary programs), limited research has been conducted to document key procedures associated with the creation of new degree programs. The purpose of this study is to show one approach to how students can be involved within the new program development process.

Design/methodology/approach

This approach uses participatory research, wherein students act as researchers and actively participate in the data collection and analysis process. Under the umbrella of participatory research, the study uses photovoice, photoelicitation and focus groups for collecting qualitative data.

Findings

Results suggest that students in one transdisciplinary studies in technology program value the following key attributes: learning style (agency and choice, active hands-on learning and real-world applications) and learning context (technology and design-focused assignments, integration of humanities and self-selected disciplines of interest).

Originality/value

Recommendations are provided for various higher education benefactors of the user-generated data, including administration, faculty, marketing, recruitment, advisors and the students themselves.

What do we know about coaching in medical education? A literature review

CONTEXT

Coaching has been employed successfully in the competitive sports, professional music, and business and corporate worlds. It is now emerging as a training modality in medical education.

OBJECTIVES

This paper reviews the current evidence on coaching strategies for doctors and medical students.

METHODS

An applied literature search was conducted in PubMed, MEDLINE and Web of Science. Predetermined definitions of coaching interventions and their evaluations were used to narrow 993 papers down to 21, which were included in the final review. The 21 papers were critiqued with reference to validated scoring metrics.

RESULTS

There are many papers discussing the merits of coaching in the world of medicine, but few evaluations of coaching interventions. Existing coaching methodologies can be broadly summarised into three categories: coaching for doctor/student well-being and resilience; coaching for improved non-technical skills, and coaching for technical skills. Identification of suitable papers for inclusion is complicated by theoretical uncertainty regarding coaching: many papers use the term as a synonym for teaching or mentoring. The strongest evidence for coaching lies in the teaching of technical skills.

CONCLUSIONS

There is weak- to medium-strength evidence to support coaching as a method of improving doctor well-being and enhancing non-technical skills, although the evidence base is limited as a whole. This review identifies strong evidence to support coaching as a method to improve technical skills. There is great scope for further studies investigating the power of coaching in medical students and doctors.

From PBL tutoring to PBL coaching in undergraduate medical education: an interpretative phenomenological analysis study

BACKGROUND

Coaching psychology is of increasing interest to medical educators for its potential benefits as a facilitative method in problem-based learning (PBL). However, the field lacks empirical studies that explore the lived experiences of students and tutors in the PBL coaching process. This study aimed to elicit knowledge regarding medical students' and tutors' experiences and perceptions of PBL coaching in the context of Chinese undergraduate medical education.

METHODS

The qualitative methodology of interpretative phenomenological analysis (IPA) was employed. Participants comprised third year medical students (n=20) and PBL tutors (n=5) who have adopted a coaching approach in PBL for a semester. Semi-structured interviews were utilized to obtain a comprehensive understanding of their experiences of PBL coaching. Data analysis followed an iterative four-stage scheme of Biggerstaff and Thompson.

RESULTS

Six main themes emerged from diverse experiences and interpretations: 1) mindsets of coaching and learning, 2) the development of learning dispositions and capacities, 3) student group collaboration, 4) tutor-student relationships, 5) personal and professional development, and 6) challenges and difficulties in implementation.

CONCLUSIONS

It could be concluded that PBL coaching is a dynamic, facilitative process that makes a particular contribution to the learning process from psychological, emotional, and social perspectives, whilst it demonstrates significant overlaps with PBL tutoring in terms of supporting students' cognitive activities in PBL. Further research is needed to identify the barriers and challenges for medical educators to implement coaching in the PBL process.