Problem-based Learning (PBL) An introduction to the Concept, its Rationale and Process

1. Problem-based Learning (PBL) An introduction to the Concept, its Rationale and Process Gene A. Kallenberg, M.D. Suraj Achar, M.D. MEDS – 11/2/06

2. Goal:To generate interest in further development of PBL curricular offerings at UCSD Objectives: By the end of the presentation participants will: • understand the rationale and be familiar with the process of conducting PBL session • develop an interest in developing an/or participating in a PBL pilot– and in developing a PBL strand at UCSD

3. Background of PBL in US Medical Schools: • Started at McMaster University in 1969 • 70% use PBL in some way (03-04 data) • 45% use it for <10% of their curricular time; 6% use it for > half of their time • Of the 30% not using, 22% had used it in the past and 2% planning to use it in the future • Widespread experimentation/adoption in many countries around the world (Canada, Australia, NZ, Europe, Asian nations, SA nations, India, Africa)

4. Background of PBL in US Medical Schools: con’t. • Results: • Has not demonstrated any decrease in objective KB testing and in a number of situations demonstrates an associated improvement in performance • Most reports of attitudes of faculty and students are positive (though there are some negative reports) • Concerns include: • Resource-intense to mount (faculty facilitators) • Lack of demonstrated measured superiority over the long haul • Less “efficient” than traditional methods • Tutor/facilitator background and training

5. General Pedagogical Rationale for PBL: • Actively involves students in the process of defining the learning objectives • Exposes students to meta-cognition through the act of assessing what s/he does and does not know • Allows students to function in the future as their learned KB changes with the advance of science • Allows students to adjust to the variations in cases they will see in practice from the “classic case” they learned on

6. General Pedagogical Rationale for PBL: con’t. • Promotes problem-solving and reflection on material as it applies clinically • Promotes clinical judgment in distinguishing important/relevant facts from those which are often present as background context/”noise” • Promotes group process skills including peer evaluation skills • Models the way clinicians work in real practice settings

7. How to Conduct a PBL Session: • Identification of roles of tutor/facilitator; student leader (if present), group • Case presentation in appropriate dosing • Use of general structure: • Problems [or Problem List] • Hypotheses [or Differential Diagnosis] • “To Do” List • Learning Issues – importance of defining these properly

8. How to Conduct a PBL Session: con’t. • Division of Learning Issues and “Homework” • Nature of homework • Relevance to answering questions about managing this case • Inclusion of process of finding/gathering information (e.g. choice of resources, search strategies used, etc.) • Sharing of homework with group members prior to f/u session

9. How to Conduct a PBL Session: con’t. • Follow-up session: • Review case to present • Discuss managing case and order topics along a progression from etiology, diagnosis, therapy • Calling on the “experts” rather than mini-lectures • Identify additional issues for resolution • distribute additional data if present and continue process or wrap up

10. PBL at George Washington University School of Medicine • Overall objectives span 3 content areas: • biomedical – chosen by BS faculty but adhering to the principle of being “epidemiologically correct” • psychosocial – developed by PC faculty • clinical decision-making – developed by PC faculty • Case teams of basic science, specialist and primary care faculty developed the cases with central oversight for uniformity • Library/information systems searching skills taught early in program

11. PBL at George Washington University School of Medicine con’t. • Cases spanned the life cycle twice through the 2 years as normal growth and development was a standard component of the psychosocial objectives • Approximately 8-10 objectives for each case which spans a 4 week period • One continuity faculty “tutor” who can be either a clinician or a basic scientist • 3 2-hour sessions a week apart followed by an all-class wrap up session with a real patient and his/her PCP • Cases in year two second semester become 2 weeks long to parallel the Introduction to Clinical Medicine/Pathology system-based units • PBL triple-jump exam

12. PBL Pilot Efforts at UCSD: • Conversion of “clinical correlation” sessions to PBL • 2-week cases in ERM at the end of MSI year: • Atherosclerosis (CAD/PVD) and hyperlipidemia • Polycystic Ovary Syndrome (PCOS) [see handout] • Calcium metabolism and osteoporosis case (to be done spring 07) • Planning for an asthma case in CBB with Joe Ramsdell • 2-session case in Anatomy in MSII: • Sports Medicine case [see handout] • Primary Care Clerkship: • Fatigue case • SOM 410 - Principles to Practice–MSIV–Renate Pilz, M.D.

13. Vision for the Future at UCSD: • a continuous thread of PBL cases throughout MSI-II-(III) • a continuity tutor/facilitator + a collaborating content expert from each course [during the contemporaneous time of each course] • cases that include a complete span of objectives represented by the biopsychosocial model of care • cases would be developed with full input from select basic science and clinical [specialty, primary care and psychiatry/psychology] faculty with oversight by the Associate Dean for Undergraduate Medical Education • a unique UCSD component could be a sub-thread on how the management of each disease entity will evolve in the next 10-15 years – which would take advantage of the outstanding science that is being carried out at UCSD