M1 Orientation Small Group Learning Problem Based Learning We cannot teach people anything. We can only help them to discover it within themselves. Galileo Galilei To know that you know what you know, and that you do not know what you do not know, that is true wisdom. Confucius I hear and I forget. I see and I remember. I do and I understand. Structure Function Medical Decision Making Physician Patient Society

Principles of Adult Learning

I hear and I forget. I see and I remember. I do and I understand. Confucious Studies reveal that over a period of 3 days, the retention of learning is 10% of what we read, 20% of what we hear, 30% of what we see (demonstration), 50% of what we see and hear (discussion), 70% of what we say (practice), and 90% of what we say as we do (teach others, immediate use). It follows that an effective learning protocol is to watch one (demonstration), do one (practice), and teach one (use new learning).

Confucious

PATIENT-CENTERED MEDICAL CARE COMMUNITY ENGAGEMENT AND SERVICE

M1 Orientation Small Group Learning Problem Based Learning We cannot teach people anything. We can only help them to discover it within themselves. Galileo Galilei To know that you know what you know, and that you do not know what you do not know, that is true wisdom. Confucius I hear and I forget. I see and I remember. I do and I understand. Structure Function Medical Decision Making Physician Patient Society

PBL Goals and Objectives Overview of PBL Process Student Role in PBL (Active, Collaborative Learner) Evaluating Students in PBL Concept-Mapping Information Literacy

What is Problem-Based Learning? What is Problem-Based Learning? “ A learning method based on the principle of using problems as a starting point for the acquisition and integration of new knowledge.” H.S. Barrows 1982

Principles of Adult Learning

PBL Goals  Knowledge – understand and apply the science basic to medicine  Skills - scientific reasoning, critical thinking, problem- solving, information literacy, effective communication (the skills of self-directed, life-long learning)  Attitudes - value of teamwork and importance of feedback to personal and professional development

PBL Learning Objectives Acquire, synthesize and apply basic science knowledge in a clinical context Engage in analysis, critical thinking and problem-solving Develop the ability to evaluate learning/gaps in knowledge and collaborate with peers Effectively utilize information technology and identify the most appropriate resources for knowledge acquisition and hypothesis testing Contextualize and communicate knowledge to others Ask for, provide and incorporate feedback

Acquire, synthesize and apply basic science knowledge in a clinical context Engage in analysis, critical thinking and problem-solving collaborate with peers Contextualize and communicate knowledge to others Develop the ability to evaluate learning / gaps in knowledge Effectively utilize information technology and identify the most appropriate resources Ask for, provide and incorporate feedback PBL Learning Objectives

Characteristics of the PBL Process Groups are small (7-9 students) and collaborative Cases provide a relevant clinical context for inquiry, learning, and integration of basic sciences Cases are characterized by “progressive disclosure” of clinical information (history, physical findings, test results, clinical condition) Students are active participants in the learning process identifying gaps in knowledge, proposing/testing hypotheses and constructing/pursuing/reporting learning issues Tutors are custodians of the group process and guides to collaborative learning and discovery rather than content experts dispensing information.

The PBL process Roles: Student: leader, reader, scribe, discussant Tutor: facilitator, guide, monitor Student tasks: Analyze the case Identify learning issues Pursue learning issues Present learning issues Critically analyze essential elements of the case and apply basic science learning to them

PBL Process – iterative and open- ended Data (e.g., temp of 101°F) An example of a less-productive strategy

The PBL Process Data (e.g., 4 year old, temp of 101°F, listless) Information (fever)

The PBL Process Data (e.g., temp of 101°F) Information (fever) Hypothesis (infection ?)

The PBL Process Data (e.g., temp of 101°F) Information (fever) Hypothesis (infection?) Learning Issue (causes of fever in a 4 year old )

The PBL Process Data (e.g., temp of 101°F) Information (fever) Hypothesis (infection) Learning Issue (causes of infection) Information resources Knowledge (most common causes of fever in a 4 year old is otitis media)

The PBL Process Data (e.g., temp of 101°F) Information (fever) Hypothesis (infection) Learning Issue (causes of fever) Information resources Knowledge (there are many causes of fever) The problem is “solved” (4 year old has otitis media)

The PBL Process – iterative and open-ended Data (e.g., temp of 101°F)

The PBL Process – iterative and open-ended Data (e.g., temp of 101°F) Information (fever)

The PBL Process – iterative and open-ended Data (e.g., temp of 101°F) Information (fever) Hypothesis (infection)

The PBL Process – iterative and open-ended Data (e.g., temp of 101°F) Information (fever) Hypothesis (infection) Learning Issue (how does an infection produce an elevation in Body temperature)

The PBL Process – iterative and open-ended Data (e.g., temp of 101°F) Information (fever) Hypothesis (infection) Learning Issue (how does an infection produce an elevation in Body temperature) Information resources Knowledge (cytokines and the thermoregulatory center In the hypothalamus)

The PBL Process – iterative and open-ended Data (e.g., temp of 101°F) Information (fever) Hypothesis (infection) Learning Issue (how does an infection produce an elevation in Body temperature) Information resources Knowledge (cytokines and the thermoregulatory center In the hypothalamus) The problem is “solved” (the patient has a fever due to infection)

Anatomy of a PBL block 2 hours Case 1 Read and discuss“A” Case 1 present LI “A” Case 3 2 nd week 1 st week Day1Day2Day3Day4Day5 Case 3 Intro, Review Process 1:2:11:1 Case 2 Present LI “A” Case 1 Read and discuss“B” Case 1 present LI “B” Case 2 Read and discuss“A”

PBL Skills Analyze case and generate LI Research and Prepare LI Present LI Use LI Information to critically re- analyze the case and “solve” the problem (problem= gaps in knowledge not the diagnosis)

Relevant to the case. Learning issues should clearly arise from prioritized hypotheses and must be both relevant and fundamental to addressing the concepts that arise in the case. “Owned” by the students. Identifying learning issues is an important part of developing life-long learning skills. Learning issues that are student generated are usually more meaningful and motivating. Specific, rather than too big or broad. However, sometimes a broad overview of a topic is indicated and relevant. When used excessively, LI presentations become redundant, over-bearing and boring. Clearly stated, using appropriate terminology, so that the tutor and students understand them. Framed so that they direct the student’s independent learning and guide their report during the next session. Most often, learning issues should consist of a specific, answerable question that is generated by the case. Organized so that they represent a logical sequence of learning about the case at hand. Good learning issues should….

Benchmarks for LI Identification

PBL Skills Analyze case and generate LI Research and Prepare LI Present LI Use LI Information to critically re- analyze the case and “solve” the problem (problem= gaps in knowledge not the diagnosis)

Benchmarks for Information Literacy

PBL Skills Analyze case and generate LI Research and Prepare LI Present LI Use LI Information to critically re- analyze the case and “solve” the problem (problem= gaps in knowledge not the diagnosis)

Presenting a Learning Issue Restate the Learning Issue (Why is it important to the case? How will it help us make sense of the case elements?) Present information concisely and clearly (Be organized. What is the best format? Use different techniques. Consider using diagrams/pictures/images/etc) Summarize the main learning points (Does it warrant a handout – archived on BlackBoard or a link? Check for understanding. Ask and answer questions) How does your LI help us understand the case in a new way? (Be analytical and synthetic. Reinterpret your information in the context of another student’s presentation.) Critique and cite sources

Benchmarks for LI Presentations

PBL Skills Analyze case and generate LI Research and Prepare LI Present LI Use LI Information to critically re-analyze the case and “solve” the problem (problem= gaps in knowledge that will explain the underlying pathophysiologic processes not necessarily the diagnosis)

Benchmarks for Integration/Synthesis

PBL Skills- Group Process Students are expected to play a variety of roles in their group, i.e.,  Leader  Reader  Scribe All students are expected to participate in organizing and analyzing data, generating and evaluating hypotheses, problem solving, and decision making They must identify deficiencies in personal/group knowledge needed to resolve issues in the case and explain the clinical phenomena

Benchmarks for Group Process

PBL Demo Case: House

PBL Goals and Objectives Overview of PBL Process Student Role in PBL (Active, Collaborative Learner) Evaluating Students in PBL Concept-Mapping Information Literacy

Assessment and Evaluation Formative Summative “Do not fear feedback, loathe its absence”

Assessment Students:  Evaluate other students and the group  Evaluate themselves  Evaluate tutor/course Faculty:  Evaluate themselves  Evaluate the group  Evaluate students

PBL Be present, Be prepared, Be engaged Use BlackBoard Post Learning Issues Embrace Feedback

Organizing Information Traditionally, we have used the following table to help students organize data and begin the PBL analytical process : Facts/Observations HypothesesLearning Issues

Organizing Information Hypothesis generation Diagnostic Grid Concept-mapping

PBL and Concept Mapping

In PBL, students analyze cases, develop hypotheses and pursue and report on student-defined learning issues. Keeping track of group learning and documenting group progress in understanding basic principles of the case is inherently difficult. Traditionally, students are taught to think and document in a very linear and hierarchical manner (i.e., “lists” of symptoms or differential diagnoses are generated) rather than focusing on the relationships between concepts or case elements. Organizing Information – Concept Mapping

In contrast, concept maps allow the learner to “create an understanding of information by making connections, creating links as well as exploring and testing links” (Brussow, 2005) which promote the basic processes of problem solving, reflection and creative thinking. Concept maps have the potential for providing a “scaffold” for learning that promotes more effective and deeper understanding of knowledge domains (Novak, 2004). As such, concept mapping may offer a superb vehicle with which to record, track and promote group learning in PBL. As well, concept mapping may be a valid and reliable measure of what a learner understands (Rye & Rubba 2002). Organizing Information – Concept Mapping

Concept-Mapping

PBL and Concept Mapping “concept maps are graphical tools for organizing and representing knowledge” A good way to define the context for a concept map is to construct a “focus question”, this is question that clearly specifies the problem or issue the concept map should have to resolve. Most often, this will be “How do we explain Anthony’s signs and symptoms?......How are they related?....What is the underlying pathophysiologic process that explains what is happening to him?” Concept maps are merely a means to an end….not the end itself. Concept maps emphasize relationships. In order to draw a line between to concepts, a student must be able to explain how they are related. The inability to draw a line (or link concepts) = a learning issue.

PBL and Concept Mapping Keeping track of group understanding / progress Generating learning issues Presenting learning issues Summarizing group knowledge at end of case Assessing learning outcomes