Indian medical students' perspectives on problem-based learning experiences in the undergraduate curriculum: One size does not fit all

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.

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.

"I really liked the chance to talk about it": Students' Reflections on the Process of Completing Paper Puzzles, a Novel Active Learning Activity

INTRODUCTION

Research shows active learning is an effective teaching method. However, few qualitative studies explore medical student perceptions of the active learning process. The present study explored what students thought about while completing paper puzzles, an active learning tool used at the University of Utah School of Medicine, to understand what and how medical students think while engaged in active learning.

MATERIALS AND METHODS

To investigate second-year medical students' attitudes toward these active learning exercises, three Zoom-based focused groups were held and recorded throughout the course. Recordings were transcribed and coded using thematic analysis.

RESULTS

Students reported that peer interactions were of high value, and that while some interactions and thought processes were action-oriented, others were more metacognitive. Other benefits of the activity included promotion of learning, provision of structure, and designation of high-yield concepts. Challenges included feelings of confusion, problems with timing or difficulty of the tasks, and low utility without adequate preparation.

DISCUSSION

These findings reflect student-acknowledged pros and cons of active learning described in education literature and add further insight into the thoughts and conversations students have during active learning activities. These include practicing metacognitive skills, triaging information, and learning from peers.

CONCLUSIONS

These data further elucidate student perceptions of active learning activities in medical education. Though focused on a specific activity, the data can help medical educators understand what students appreciate about active learning and what they think about while engaged in such activities.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s40670-022-01682-y.

Training and assessing undergraduate medical students' research: Learning, engagement and experiences of students and staff

Background

The development of research skills is an important aspect of undergraduate medical training that facilitates the practice of evidence-based medicine. The inclusion of research training into undergraduate medical curricula can take various formats and is compulsory for all students at the Nelson R. Mandela School of Medicine (NRMSM). The evaluation of this training is important, both to ensure that students obtain the required research skills and to improve the quality of the training.

Aim

The aim of this study was to evaluate undergraduate medical students’ and staff learning, engagement and experiences in the training and assessment of third-year research projects.

Setting

This research was conducted at NRMSM, South Africa.

Methods

Questionnaires were administered to third-year medical students after they completed their research project poster presentations and to the staff who assessed the presentations. Responses to the learning process, group work, alignment between module outcomes and assessment and the benefits of poster presentations were assessed.

Results

A total of 215 students and 10 staff completed the questionnaire. Many students reported having enjoyed learning about research (78%) and that the training activities facilitated their understanding of the research process (84%). The majority of students (86%) and staff (80%) perceived the posters as an effective way to demonstrate students’ ability to collect, analyse and interpret data.

Conclusion

Staff and students viewed the research process positively and reported that the poster presentations were an effective way to assess research.

The Effectiveness of Problem-based Learning in Acquisition of Knowledge, Soft Skills During Basic and Preclinical Sciences: Medical Students' Points of View

Background:

Students’ opinions about their medical curriculum is essential process for evaluating program strength and weakness. Aim: We aimed to assess the benefits and effectiveness of PBL in acquisition of knowledge and soft skills during basic (Phase I) and preclinical (Phase II) sciences.

Methods:

Across-sectional study was conducted at the University of Bisha, College of Medicine, Saudi Arabia. Students at Phase I and Phase II were involved. A validated self-administered questionnaire used for data collection. Responses to the questionnaire items regarding PBL benefits, preferences and effectiveness in acquisition of knowledge and soft skills were ordinal following a four-point Likert scale format. Independent and paired t tests were used to compare between the means and SD of each two variables. A p value ≤ 0.05 considered as statistically significant.

Results:

Most of students (86.3%) reported a positive perception on all the items assessing the benefits of PBL approach. Students’ responses on PBL relating to the acquisition of knowledge (3.27±0.46) and soft skill (3.32±0.45) were high. There were no significant differences determined in the mean score and SD of acquisition of knowledge (p=0.768) and soft skills (p=0.297) between second and third year students. PBL was preferred in Phase II comparable to Phase I modules (3.371±0.299 vs. 3.026±0.627; p=0.001).

Conclusion:

Effectiveness of PBL found to be high and increasing after taking a series of modules. Although PBL methodology has impact in acquisition of knowledge and skills, intended program outcome should be determined to assess the effects of PBL.

Development of an international comorbidity education framework

CONTEXT

The increasing number of people living with multiple chronic conditions in addition to an index condition has become an international healthcare priority. Health education curricula have been developed alongside single condition frameworks in health service policy and practice and need redesigning to incorporate optimal management of multiple conditions.

AIM

Our aims were to evaluate current teaching and learning about comorbidity care amongst the global population of healthcare students from different disciplines and to develop an International Comorbidity Education Framework (ICEF) for incorporating comorbidity concepts into health education.

METHODS

We surveyed nursing, medical and pharmacy students from England, India, Italy and Sweden to evaluate their understanding of comorbidity care. A list of core comorbidity content was constructed by an international group of higher education academics and clinicians from the same disciplines, by searching current curricula and analysing clinical frameworks and the student survey data. This list was used to develop the International Comorbidity Education Framework.

RESULTS

The survey sample consisted of 917 students from England (42%), India (48%), Italy (8%) and Sweden (2%). The majority of students across all disciplines said that they lacked knowledge, training and confidence in comorbidity care and were unable to identify specific teaching on comorbidities. All student groups wanted further comorbidity training. The health education institution representatives found no specific references to comorbidity in current health education curricula. Current clinical frameworks were used to develop an agreed list of core comorbidity content and hence an International Comorbidity Education Framework.

CONCLUSIONS

Based on consultation with academics and clinicians and on student feedback we developed an International Comorbidity Education Framework to promote the integration of comorbidity concepts into current healthcare curricula.

Students' perceptions and satisfaction level of hybrid problem-based learning for 16 years in Kyungpook National University School of Medicine, Korea

PURPOSE

Kyungpook National University School of Medicine has been implementing hybrid problem-based learning (PBL) since 1999. The aim of this study was to investigate the changes in the students' perceptions and satisfaction levels of hybrid PBL.

METHODS

The target period of our study was from 1999 to 2014, and target subjects were second-year medical students in Kyungpook National University School of Medicine. The survey was conducted at the end of semester. We had a focused interview with group leaders and some volunteer students.

RESULTS

As for the scores regarding students' overall satisfaction with PBL, there was significant improvement in 2005 compared to 2002, but the scores decreased and no differences between the survey years noted after 2005. The students' preference ratio for the once a week PBL sessions, tutor presence, synchronization of contents, and arrangement of PBL sessions and related lectures was 60%-80%, 50%-90%, 52%-96%, and 78%-93%, respectively.

CONCLUSION

In order to increase students' satisfaction with hybrid PBL and to improve the perception of it, firstly, it is necessary to arrange the date and the time of PBL sessions so that students can concentrate on PBL. Secondly, PBL cases should be selected and arranged to be well synchronized with the ongoing lectures. Finally, it is important to create a safe atmosphere so that students can engage actively in PBL sessions.

Problem-based learning: Dental student's perception of their education environments at Qassim University

Aims:

The objectives of this study were to assess perceptions of the Saudi dental students of the problem-based learning (PBL) curriculum and to compare their perceptions among different sex and academic years.

Subjects and Methods:

Data was collected through a questionnaire-based survey at Qassim College of dentistry. The questionnaire consisted of 19 questions regarding the perception of PBL curriculum and was distributed to 240 students. The chi-square test was used for statistical analysis of the data.

Results:

Out of the 240 students recruited for this study, 146 returned a complete questionnaire (the response rate was 60.8%). The majority of the students perceived that PBL enhances the ability to speak in front of people (91.1%); improved the ability to find the information using the internet/library (81.5%); enhances the problem-solving skills (71.3%); increases the practice of cooperative and collaborative learning (69.2%); improves the decision-making skills (66.4%). Sixty-five percent (n = 96) noted that some students dominate whereas others are passive during PBL discussion session. Statistically, significant differences were found in the following variables according to the academic year students assuming before responsibility for their own learning (P < 0.037) and the role of facilitator in the process (P < 0.034). Moreover, according to gender; there were statistically significant differences in the following variables, assuming responsibility for own learning (P < 0.003); activating prior knowledge and learning to elaborate and organize their knowledge (P < 0.009); enhancing the ability to find the information using the Internet/library (P < 0.014); PBL is effective without having lecture of the same topic (P < 0.025); helping in identifying the areas of weakness for improvement (P < 0.031); student understanding the objectives of the PBL session better than the conventional way (P < 0.040); and enhancing the ability to speak in front of people (P < 0.040).

Conclusions:

Perceptions of Saudi dental students regarding their education environments at Qassim College of dentistry using PBL hybrid curriculum were more positive than negative. However, improvements are still required to provide students with stimulating favorable learning environment and to take the students recommendations into consideration.

A Rapid Review of the Factors Affecting Healthcare Students' Satisfaction with Small-Group, Active Learning Methods

PHENOMENON: Problem-based learning (PBL) and other small-group, active learning methodologies have been widely adopted into undergraduate and postgraduate healthcare curricula across the world. Although much research has examined student perceptions of these innovative teaching pedagogies, there are still questions over which factors influence these views. This article aims to identify these key elements that affect healthcare student satisfaction with PBL and other small-group learning methods, including case-based and team-based learning.

APPROACH

A systematic rapid review method was used to identify high-quality original research papers from the healthcare education literature from between 2009 and 2014. All papers were critically appraised before inclusion in line with published guidelines. Narrative synthesis was achieved using an inductively developed, thematic framework approach.

FINDINGS

Fifty-four papers were included in the narrative synthesis. The evidence suggests that, despite an initial period of negative emotion and anxiety, the perspectives of healthcare students toward small-group, active learning methods are generally positive. The key factors influencing this satisfaction level include (a) the facilitator role, (b) tutorial structure, (c) individual student factors, (d) case authenticity, (e) increased feedback, (f) group harmony, and (g) resource availability. Insights: Student satisfaction is an important determinant of healthcare education quality, and the findings of this review may be of value in future curriculum design. The evidence described here suggests that an ideal curriculum may be based on an expert-led, hybrid PBL model.

Students' perception towards the problem based learning tutorial session in a system-based hybrid curriculum

Objectives:

To evaluate students’ perception towards the problem based learning (PBL) session in a system-based hybrid curriculum.

Methods:

We conducted a cross-sectional study in the College of Medicine, King Saud University, Saudi Arabia at the end of the 2012-2013 academic year. The survey questionnaire was self-administered, and examined perceptions of PBL session benefits, appropriate running of sessions, and tutor’s roles.

Results:

Out of 510 students, 275 (53.9%) completed the questionnaire. Most of the students reported that PBL sessions were helpful in understanding basic sciences concepts (p=0.04). In addition, they agreed that PBL sessions increased their knowledge of basic sciences (p=0.01). Most students reported that PBL sessions encouraged self-directed learning, collaborative learning, and improved decision making skills. However, 54.5% of students reported lack of proper training before starting the PBL sessions, and only 25.1% of students agreed that the teaching staff are well prepared to run the sessions. Most students used the internet (93.1%), lecture notes (76.7%), and books (64.4%) as learning resources. Most students reported repetition of topics between PBL sessions and lectures (p=0.07).

Conclusion:

The study highlighted the significant role of PBL in a system-based hybrid curriculum and helped students improve their knowledge and different learning skills. Students and staff training is required before the utilizing the PBL as an instructional method.