PROBLEM-BASED LEARNING

1. PROBLEM-BASED LEARNING Professor Sabri KEMAHLI, M.D.

3. Principles of adult learning Adults are motivated by learning that: • Is perceived as relevant • Is based on, and builds on, their previous experiences • Is participatory and actively involves them • Is focused on problems • Is designed so that they can take responsibility for their own learning • Can be immediately applied in practice • Involves cycles of action and reflection • Is based on mutual trust and respect

4. Self directed learning(or Directed self-learning) The learner takes the initiative for: • Diagnosing learning needs • Formulating goals • Identifying resources • Implementing appropriate activities • Evaluating outcomes

5. Change in Education: What kind of education? (1) • Student-centred and based on active learning • Developing problem solving skills and critical thinking • Acquiring scientific thinking and research approaches

6. Change in Education: What kind of education? (2) • Making competent in professional skills • Developing communication skills • Acquiring professional values and ethical viewpoint • Discussing humanitarian and environmental problems

7. “Traditional Education” • Do lectures provide this? • Example: A lecture you have listened to tens-hundreds of times……

8. Boeing 727-200

9. Boeing 727 Test • How many emergency exits are there?

10. Cannot be used during the whole flight • Computers • Radios • Mobile phones • Walkie-talkies • Remote control devices • Palm computers

11. Where are the life jackets? How are they retrieved?

12. You are travelling with your wife and6 yar-old daughter. Cabin pressure falls. What do you expect? What should you do?

13. Oxygen masks open and fall from the top of the cabin. To whom should you attend first? Your wife Your daughter Yourself The cabin crew

14. Cannot be used during the whole flight • Computers • Radio • Mobile phones • Walkie-talkies • Remote control devices • Palm computers

15. Where are the life jackets? How are they retrieved? • Under your seat • Can be retrieved when you take the cushion off.

16. Where are the oxygen masks?How are they retrieved? Who should wear them first? Yourself/your wife/your friend/your child? • Above your seat. • Opens automatically when cabin pressure falls. • First to yourself- then to your children.

17. Student-Centred Problem-based Integrated Community-based Electives Systematic Teacher-centred Information gathering Discipline-based Hospital based Standard programme Apprenticeship-based and opportunistic Educational Strategies S P I C E S Harden RM (1984) Med Educ 18: 284-297

18. What is Problem-Based Learning? “ A learning method based on the principle of using problems as the starting point of acquiring and structuring knowledge” Howard.S. Barrows 1982

19. WHAT IS PBL? • PBL is a learning method where students perceive their knowledge gaps, decide on learning issues and achieve these, while working in small groups on a case to solve a patient’s problems

20. The principal idea behind PBL is A. PBL challenges students to learn to learn. B. Learning is initiated by a problem. C. Student-centered work in permanent groups.

21. WHERE AND WHEN PBL STARTED • 1960’s: Howard Barrows- Mc Master University • 1970s: Toronto, Southern Illinois,Limburg, Maastricht, Dundee,...........................

22. Properties of PBL Process-I • Triggered by clinical cases valid in real life. • Students come to the first session without a prior knowledge on the subject. • Students identify, find and use the relevant sources of information. • Students identify and determine the learning objectives, starting from the case they discuss.

23. Properties of PBL Process-II • Sessions are open-ended. • Tutors play a role of facilitating the knowledge acquisition process for students- not as a source of knowledge!- • Students work with the same group and tutor throughout the whole process/module (3-8 cases). • Learning is active, integrated, cumulative and associating.

24. Problems presented through patient problems are multidisciplinary, and knowledge acquired by each case is a building stone to be used in following cases.

25. Medical knowledge cannot be passively learned but rather involves the mental process of observation, sorting, combining, inferring, and trying. • Men are self-taught. • Medicine cannot be taught but can be learned…. Abraham Flexner, 1925

26. PBL METHOD OR SYSTEM ?

33. Reading resources Lecture Problem based learning Role modelling Demonstration Humanistic training (use of mannequins) Discussion Programmed learning Project work Role playing Standardised patients Clinical experience Learning in groups EDUCATION METHODS

34. Medicine Pharmacy Dentistry Veterinary med. Nursing Engineering Architecture Political sciences Divinity Law Natural sciences Forestry Social work Educatioan sciences Military schools Police schools Primary and secondary education AREAS WHERE PBL IS USED

35. PRINCIPLES OF PBL • SOLVING A PROBLEM IS NOT THE GOAL- IT IS AN INSTRUMENT TO LEARN; • THE AIM IS THAT THE STUDENT RECOGNIZES AND ACHIEVES THE KNOWLEDGE, SKILLS AND ATTITUDES TO SOLVE THE PROBLEM.

36. PRINCIPLES OF PBL PROBLEM BASED LEARNING PROCESS STARTS WITH A PROBLEM (PREPARED BY THE EDUCATIONAL INSTITUTION IN ACCORDANCE WITH THE LEARNING AIM AND OBJECTIVES) THAT THE STUDENT WANTS TO SOLVE

37. PRINCIPLES OF PBL IN TRADITIONAL APPROACH, IT IS DESIRED THAT THE STUDENT SHOULD HAVE A PRIOR KNOWLEDGE IN ORDER TO SOLVE A PROBLEM. IN PBL APPROACH, HOWEVER, KNOWLEDGE IS ACQUIRED WHILE SOLVING THE PROBLEM.

38. Problem Solving / Problem-based learning Different Approaches Knowledge (gap) needed to solve the problem is recognized upon encountering the problem and learned during the process. Knowledge necessary to solve the problem is previously learned. Pattern recognition Hypothetico-deductive model

39. THE MAIN OBJECTIVE IS LEARNING THE CONTENT OTHER USES • Increase in motivation to learn • Developing oral communication skills • Understanding differences • Critical reading of the literature • Getting more self-confident as student • Co-operation skills with peers • Closer relationships with the faculty

40. EDUCATION “ENVIRONMENT” WB TV/Video Faci Scr FC

42. Traditional Small Group Lecture

43. PBL Session

44. FLOW OF SESSIONS • INTRODUCTION-KNOWING EACH OTHER- WARM UP • SETTING GROUP RULES • (S)ELECTING THE SCRIPT • STARTING THE CASE (READING) • DISCUSSION • EVALUATING THE SESSION • FEEDBACK

45. Maastricht “seven jump” sequence forproblem based learning 1. Clarify and agree working definitions and unclear terms and concepts 2. Define the problems; agree which phenomena need explanation 3. Analyse the problem (brainstorm) 4. Arrange possible explanations and working hypotheses 5. Generate and prioritise learning objectives 6. Research the learning objectives 7. Report back, synthesise explanations, and apply newly acquired information to the problem

46. WORKING METHOD I. Defining (patient) problems II. Hypothesis generation and listing III. Listing additional information IV. Learning issues V. Re-organizing the hypotheses 4

47. 78 year old Mrs. Nurgül Alkan, is admitted with shortness of breath and chest pain. The patient had no complaints until 3 weeks ago…. Read problem Pass to the next page Brainstorm Hypotheses generation Evaluate Discuss- Re-read- Summarize Define learning issues Search-Study 2-7 days

48. USING THE FLIPCHART/WHITE BOARD ADDITIONAL INFORMATION LEARNING ISSUES (PATIENT’S) PROBLEMS HYPOTHESES Pallor Fever Fatigue Anemia Iron def.? Hemolytic? Infection Physical exam CBC Throat culture Anemia classification Iron metabolism Coombs test Fever pathogenesis Role of cytokines

49. The most important step of PBL process is studying the determined learning issues and learning them.

50. CASE EXAMPLE-1 • Case Summary: 37 year old woman.Admitted with abnormal vaginal bleeding. Diagnosed as cervix Ca. Surgery and radiotherapy performed. Radiation enteritis develops.Nutritional complications of intestinal disorders emphasised.