Problem‐based learning: a dissemination success story?

The impact of facilitation in a problem-based pedagogy on self-directed learning readiness among nursing students: a quasi-experimental study in Tanzania

Background

Self-directed learning is important in nursing as it is associated with improved clinical and moral competencies in providing quality and cost-effective care among people. However, unethical professional conduct demonstrated by some graduate nurses is linked with the way they are developed in schools alongside the content and pedagogies prescribed in nursing curricula. Pedagogical transformations appear to be inevitable to develop enthusiastic nursing students who can work independently in delivering quality and cost-effective nursing services to people. This study intended to examine the impact of facilitation in a problem-based pedagogy on self-directed learning readiness among undergraduate nursing students in Tanzania.

Methods

A controlled quasi-experimental design was conducted in Tanzanian higher training institutions from January to April 2019. A 40-item Self-directed learning Readiness scale for nursing education adopted from previous studies measured self-directed learning and the Student A descriptive analysis via a Statistical Package for Social Sciences software program (version 23) was performed to establish nursing students’ socio-demographic characteristics profiles. Independent samples t-test determined mean scores difference of self-directed learning readiness among nursing students between groups while regression analysis was performed to discriminate the effect of an intervention controlled with other co-related factors.

Results

The post-test results of self-directed learning readiness showed that nursing students scored significantly higher [(M = 33.01 ± 13.17; t (399) = 2.335; 95%CI: 0.486,5.668)] in the intervention group than their counterparts in the control. Findings of SDL readiness subscales were significantly higher among students in the intervention including self-management [(M = 10.11 ± 4.09; t (399) = 1.354; 95%CI: 0.173,4.026)], interest learning [(M = 9.21 ± 2.39; t (399) = 1.189; 95%CI: 0.166,4.323)] and self-control [(M = 13.63 ± 5.05; t (399) = 2.335; 95%CI: 0.486,5.668)]. The probability of nursing students to demonstrate self-directed learning readiness was 1.291 more times higher when exposed to the intervention (AOR = 1.291, p < 0.05, 95%CI: 0.767, 2.173) than in the control.

Conclusion

Facilitation in a problem-based pedagogy promises to change the spectrum of nursing learning habits potentially to their academic and professional achievements. Nurse tutors need to be empowered with it to prepare nursing students to meet their academic and professional potentials.

Knowledge, Attitudes, and Barriers Regarding Health Research among Medical Students in Saudi Arabia

BACKGROUND: Research is the basic component of health science curriculum. AIM: The objective of the study is to determine the knowledge, attitude, and barriers regarding health research among health science students. METHODS: It is a cross-sectional study and 294 study participants were selected through stratified random sampling from different health science colleges (medicine, dental, nursing, and applied science). A validated, structured, and pre-tested questionnaire was used. Knowledge and attitudes were determined through scales. Analysis of variance and t-test were applied to determine the mean scores of knowledge and attitude, and multiple regression analysis was used to determine the factors which affect on knowledge and attitude. RESULTS: Knowledge and attitude mean scores were 4.36 ± 2.44 and 2.74 ± 1.17, respectively. Knowledge and attitude were increase significantly with increasing academic year of study in all health science colleges (Regression coefficient 0.043 [p = 0.032] and 0.005 [p = 0.040] for knowledge and attitudes, respectively). Most common barriers for research were lack of proper mentoring from the faculty staff and lack of time due to over burden with educational activities CONCLUSION: Health science students had moderate level of knowledge and attitude toward health research with common barrier which was lack of proper mentoring from the faculty. There is need for address the barrier for research and more integration of curriculum with research which improved the knowledge and attitude level.

Impact of Mode of Curriculum on Knowledge and Attitudes of Medical Students towards Health Research

INTRODUCTION

Equipping students with skills in medical research should be an integral part of medical education systems. This study is designed to gauge the difference in knowledge and attitudes towards health research between two sets of undergraduate medical students; those enrolled in the new Problem Based Learning (PBL) education system versus those of the conventional Lecture Based Learning (LBL) curricula.

MATERIALS AND METHODS

From the 4(th) and 5(th) years of medical university students, 90 participants were recruited from the Aga Khan University (PBL group) and Dow University of Health Sciences (LBL group) and were presented with structured and pre-validated questionnaire. Responses obtained for knowledge and attitudes of each group were recorded on a scale and graduated in percentages to be compared statistically for differences to identify the effectiveness of each curriculum.

RESULTS

The score on the knowledge scale for the PBL group was found to be 44.77% against the 31.55% of the LBL students (p-value<0.001). Furthermore, the mean attitude score of AKU students was 72.22% as opposed to the 56.11% of the DUHS participants (p-value<0.001).

CONCLUSION

The PBL group achieved significantly higher scores in all aspects than the LBL group, showing healthier attitudes towards health science research along with better knowledge. Hence, the apparent positive influence of PBL curricula on attitudes towards research may be helpful in improving research output of medical students in Pakistan.

Using cognitive theory to facilitate medical education

BACKGROUND

Educators continue to search for better strategies for medical education. Although the unifying theme of reforms was "increasing interest in, attention to, and understanding of the knowledge base structures", it is difficult to achieve all these aspects via a single type of instruction.

METHODS

We used related key words to search in Google Scholar and Pubmed. Related search results on this topic were selected for discussion.

RESULTS

Despite the range of different methods used in medical education, students are still required to memorize much of what they are taught, especially for the basic sciences. Subjects like anatomy and pathology carry a high intrinsic cognitive load mainly because of the large volume of information that must be retained. For these subjects, decreasing cognitive load is not feasible and memorizing appears to be the only strategy, yet the cognitive load makes learning a challenge for many students. Cognitive load is further increased when inappropriate use of educational methods occurs, e.g., in problem based learning which demands clinical reasoning, a high level and complex cognitive skill. It is widely known that experts are more skilled at clinical reasoning than novices because of their accumulated experiences. These experiences are based on the formation of cognitive schemata. In this paper we describe the use of cognitive schemata, developed by experts as worked examples to facilitate medical students' learning and to promote their clinical reasoning.

CONCLUSION

We suggest that cognitive load theory can provide a useful framework for understanding the challenges and successes associated with education of medical professionals.

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

PURPOSE

Problem-based learning (PBL) is a well-established method for facilitating the learning of basic science concepts in the context of clinical cases. Relevant evidence is lacking regarding PBL's effectiveness and acceptability as perceived by students accustomed to classical traditional teaching in India. Hence, this study gathered students' opinions on PBL versus Traditional teaching methods to generate a foundation for institutional policymaking and ultimately, changes in the policy of regulatory bodies.

METHODS

A total of 773 first year medical students admitted from 2007-2010 in Kasturba Medical College Manipal, Manipal University, India were asked to respond to a 15-item questionnaire evaluating their preferences for PBL or traditional methods such as lectures after undergoing a systematically conducted PBL session in physiology. Their responses were analyzed with an unpaired t-test. Their comments were also collected.

RESULTS

PBL scored significantly higher for most items in the questionnaire for "learning efficiency" and "student-teacher relationship". The students' comments highlighted the importance of a trained tutor/facilitator to enhance the learning process.

CONCLUSION

Our students are willing to adapt to the PBL method, although they recognize certain benefits of traditional pedagogy. For learning efficiency and the student-teacher relationship, the students feel that neither method holds an advantage. We recommend that the future medical curriculum in India be a hybrid form of PBL and traditional methods with specific training on the unfamiliar PBL approach for both faculty and students.

Team-based learning increases active engagement and enhances development of teamwork and communication skills in a first-year course for veterinary and animal science undergraduates

Team-based learning (TBL) was implemented into a first-year course (Principles in Animal Behaviour, Welfare and Ethics) for BSc Veterinary Bioscience (VB) and Animal Science (AS) students. TBL is now used widely in teaching medical students, but has had more limited uptake in veterinary education. This study reports its use over 2 years with cohorts of 126 and 138 students in 2011 and 2012, respectively. Average individual marks for multiple-choice question (MCQ) tests in the Readiness Assurance component of TBL were higher for the teams than for individuals for each session, explicitly demonstrating the advantages of teamwork. Students reported that they felt actively involved and that TBL helped them both with their learning and in developing other important skills, such as teamwork and communication. Qualitative analysis of written feedback from the students revealed positive themes of discussion, application, revelation, socializing, engagement, clarification, and retention/revision. In 2011 negative comments included the need to shorten the TBL sessions, but in 2012 tightening of the timelines meant that this was no longer a major concern. Requests to provide better introductory and background materials and ambiguity in questions in the TBL activities were what students least liked about the TBL. However, most comments were positive rather than negative in nature, and many students preferred the TBL to lectures. With requirements for curricula to teach professional skills, such as communication and teamwork, and the positive results from TBL's implementation, it is hoped that this study will encourage others to trial the use of TBL in veterinary education.

Las imágenes diagnósticas para el enfoque de problemas clínicos con base en la evidencia

En 1960 Lawrence Weed, microbiólogo norteamericano, publicó un artículo acerca del diagnóstico médico orientado por problemas como una metodología, en la cual, partiendo del problema referido por el paciente y no por la enfermedad, se logra llegar al diagnóstico. Un problema médico es todo aquel suceso en el que se presenta ruptura equilibrio biopsicosocial del ser humano, que se manifiesta por signos, síntomas o hallazgos paraclínicos (imaginológicos o bioquímicos). En este mismo contexto existen los problemas activos que son el motivo de consulta, que requieren atención inmediata, y los pasivos, que son los que médicamente se conocen como antecedentes.

The therapeutic test: an ancient malady in the 21st century

The response to treatment was the diagnostic mainstay in ancient times when diseases were poorly understood. Now that the bases of most diseases are known, appropriate diagnostic means are available. However, many physicians still rely on therapeutic tests to establish diagnoses. Since most illnesses are self-limited and because of the placebo effect, many physicians and patients attribute the improvement to the medication and believe that the correct diagnosis was made. However, inappropriate therapeutic tests often lead to diagnostic delays, rapid emergence of antibiotic-resistant bacterial pathogens, increased risks of adverse drug reactions, and unnecessary expenses. To reduce the frequency of unwarranted therapeutic tests, health-care professionals and educators must take steps to rectify the problem.

ANÁLISE DA INSERÇÃO DOS TEMAS DE HUMANIDADES E ÉTICA, COM METODOLOGIA DE APRENDIZAGEM BASEADA EM PROBLEMAS, EM CURRICULO MÉDICO INTEGRADO EM ESCOLA PÚBLICA NO DISTRITO FEDERAL, BRASIL

OBJECTIVE: To establish a diagnosis of the insertion of bioethics, ethics and humanistic values and attitudes to the program of the Medical School of ESCS - Escola Superior em Ciências da Saúde, public school of medicine, Distrito Federal, Brazil, in order to contribute to the process of curricular management. METHODOLOGY: The study is cohorte and documental. Thirty-two indicators to the thematic on ethics and twenty-four related to humanization were utilized. The educational purpose and contents of activities in modules such as thematic, abilities, interaction and attitude towards the community for teaching and services, from first to senior years as well as in boarding schools programs were all analyzed in the Medical School curriculum of ESCS (2006) and about the pedagogic project of the Course (2001). RESULTS: It was observed a greater insertion of thematic related to ethics and bioethics in the initial levels of the course, Freshman and Sophomore including boarded students, when compared to the insertion in Junior and Senior clerkship years (IC95%-alpha=0,034, pvalue=0,007). The unit on abilities and attitudes was the axle which presented greater recurrence of the thematic on humanization in programs of 1 and 4 years (IC95%-alpha=0,026, pvalue=0,013). It was observed an increase in the recurrence of the thematic on humanization developed in thematic modules and interaction community-teaching/service in the 2 year and decline in the subsequent ones. The results were very low in the 3 and 4 years. When compared with the clerkship it was observed that the first four series had greater insertion of such thematic (IC95%-alpha=0,042, pvalue=0,029). CONCLUSION: The academic program developed in the year of 2006 at ESCS presented improvements when compared to the pedagogical project of the course.

Collaborative action learning: A professional development model for educational innovation in nursing

The paper describes the processes and outcomes of a major curriculum innovation which was conducted by a collaborative multi-disciplinary team (nurse academics, educational developers and software developers). The paper argues that collaborative professional development in pedagogical innovation in nursing can be successfully supported by action learning as a framework for practice. In presenting this argument the paper draws on the experience of the School of Nursing and Midwifery (SNM) at the University of Tasmania in integrating high-fidelity simulation-based learning into an existing undergraduate case-based learning curriculum in the three year Bachelor of Nursing (BN).

The effects of problem-based learning during medical school on physician competency: a systematic review

BACKGROUND

Systematic reviews on the effects of problem-based learning have been limited to knowledge competency either during medical school or postgraduate training. We conducted a systematic review of evidence of the effects that problem-based learning during medical school had on physician competencies after graduation.

METHODS

We searched MEDLINE, EMBASE, CINAHL, PsycINFO, Cochrane Databases, and the tables of contents of 5 major medical education journals from earliest available date through Oct. 31, 2006. We included studies in our review if they met the following criteria: problem-based learning was a teaching method in medical school, physician competencies were assessed after graduation and a control group of graduates of traditional curricula was used. We developed a scoring system to assess the quality of the studies, categorized competencies into 8 thematic dimensions and used a second system to determine the level of evidence for each competency assessed.

RESULTS

Our search yielded 102 articles, of which 15 met inclusion criteria after full text review. Only 13 studies entered final systematic analysis because 2 studies reported their findings in 2 articles. According to self-assessments, 8 of 37 competencies had strong evidence in support of problem-based learning. Observed assessments had 7 competencies with strong evidence. In both groups, most of these competencies were in the social and cognitive dimensions. Only 4 competencies had moderate to strong levels of evidence in support of problem-based learning for both self-and observed assessments: coping with uncertainty (strong), appreciation of legal and ethical aspects of health care (strong), communication skills (moderate and strong respectively) and self-directed continuing learning (moderate).

INTERPRETATION

Problem-based learning during medical school has positive effects on physician competency after graduation, mainly in social and cognitive dimensions.

Matching purpose with practice: revolutionising nurse education with mita

Multiple intelligences have only recently entered the teaching dialogue in nurse education and research. It is argued that despite the rhetoric of a student centred approach nurse education remains wedded to conventional teaching approaches that fail to engage with the individual and unwittingly silence the student's voice. This paper will examine the concept of multiple intelligences (MI) and outline Gardner's contention that the brain functions using eight intelligences which can be employed to improve learning at an individual level. It will then outline the use of MI using a five phase model, developed by Weber, known as a multiple intelligence teaching approach (MITA). It is contended that MITA has great potential in nurse education, particularly in terms of reinforcing learning beyond the educational domain and into the individual's professional development and clinical practice.

Problem-based versus conventional curricula: influence on knowledge and attitudes of medical students towards health research

Background

Medical education curricula in developing countries should emphasize training in health research. This study compares the knowledge and attitudes towards health research between undergraduate medical students undertaking Problem Based Learning (PBL) versus conventional Lecture Based Learning (LBL).

Methods

Two groups comprising 66 (LBL) and 84 (PBL) 4^th and 5^th year students from the medical college of Aga Khan University were administered a structured and validated questionnaire. Knowledge and attitudes of the two groups were recorded on a scale (graduated in percentages) and compared for statistical difference.

Results

PBL students scored 54.0% while LBL students scored 55.5% on the knowledge scale [p-value; 0.63]. On the attitudes scale, PBL students scored 75.5% against a 66.7% score of LBL students [p-value; 0.021]. A higher proportion of PBL students (89%) had participated in research activities compared to LBL students (74%) and thus felt more confident in conducting research and writing a scientific paper.

Conclusion

The PBL students showed slightly healthier attitudes towards health research compared to LBL students. Both groups demonstrated a similar level of knowledge about health research. The positive impact of the PBL curriculum on attitudes of medical students towards health research may help in improving research output from developing countries in future.

Knowledge and attitudes about health research amongst a group of Pakistani medical students

BACKGROUND

Health research training is an important part of medical education. This study was conducted to assess the level of knowledge and attitudes regarding health research in a group of Pakistani medical students at Aga Khan University, Karachi.

METHODS

It was a cross-sectional pilot study conducted among a group of Pakistani medical students. Through stratified random sampling, a pre-tested, structured and validated questionnaire was administered to 220 medical students. Knowledge and attitudes were recorded on a scale (graduated in percentages).

RESULTS

Mean scores of students were 49.0% on knowledge scale and 53.7% on attitude scale. Both knowledge and attitudes improved significantly with increasing years of study in medical college [Regression coefficient 4.10 (p-value; 0.019) and 6.67 (p-value; < 0.001) for knowledge and attitudes, respectively].

CONCLUSION

Medical students demonstrate moderate level of knowledge and attitude towards health research. Intensive training in this regard is associated with significant improvement in knowledge and attitudes of students towards health research.

[Evaluation of the pertinence of international courses on human African trypanosomiasis]

The goal of this study was to evaluate the adequacy and relevance of a training course on Human African Trypanosomiasis, targeted to reach support and coordination staff in charge of activities being carried out in related prevention and control programmes. A questionnaire was emailed to the four course organisers and the 65 participants. The response rate among the participants was 41%. The training needs expressed covered issues such as treatment, diagnostic and epidemiological techniques, improved knowledge of the disease, and control planning. The lectures given were adapted for participants' professional activities. At the time of the evaluation (one to three years after the course) 67% of the participants had begun implementing the knowledge they had acquired and applying it to their practice, particularly in the area of programme planning. The analysis of the questionnaire's results pointed to the sections of the course that would benefit from modifications, such as the need for the development of lessons and modules in the areas of patient management and planning for future training sessions.

Lack of integration of medical education in Australia: the need for change

The lack of cohesion across health and education sections and national and state jurisdictions is counterproductive to effective national policies in medical education and training. Existing systems in Australia for medical education and training lack coordination, and are under resourced and under pressure. There is a need for a coordinated national approach to assessment of international medical graduates, and for meeting their education and training needs. The links between prevocational and vocational training must be improved. Tensions between workforce planning, education and training can only be resolved if workforce and training agencies work collaboratively. All prevocational positions should be designed and structured to ensure that service, training, teaching and research are appropriately balanced. There is a need for more health education research in Australia.

Imperatives in medical education and training in response to demands for a sustainable workforce

Factors to be considered in planning our medical workforce to meet future needs include: Need for outcomes-based curricular designs in medical schools and postgraduate training. Shortening the length of medical training. Improving career flexibility to permit professional re-invention. Developing awareness within the profession about how innovation happens.