Applying problem based learning to studying rural health care provision Dr Sarah Lovell Field trip to Hurunui District which is home to two large primary health care facilities, a disused mental health hospital, a small rural hospital and a popular thermal pool complex.

The Problem Neoliberal restructuring and urbanisation are among the process of change producing unique health pressures for rural regions Specifically: Populations are ageing more rapidly in rural areas Closure of rural hospitals Expectation the voluntary sector will ‘fill the gap’ left by the withdrawal of state funding Volunteers are also ageing Limited support for ageing in place

Learning Outcomes Identify the changing demographics and health care needs of rural populations Understand the implications of rural health service restructuring Demonstrate how theories of change may be applied to a rural case study

Pedagogical Inspiration Problem-Based Learning (PBL) an approach widely used in medical schools internationally Students work in groups to work through a process of setting goals and identifying ‘triggers’ Learning ‘triggers’ lead to further self-directed study; on returning to the group further discussion allows students to learn from each other Team work and problem solving are amongst the skills learned through PBL The approach is rated well by students who experience control over the learning process A level of competence in the subject area for problem solving to be an effective mode of learning

PBL Tutorial Process Step 1 Clarify terms and concepts not readily comprehensible Step 2 Define the problem Step 3 Analyse the problem Step 4 Review steps 2 and 3 and arrange explanations into tentative solutions Step 5 Formulate learning objectives Step 6 Private study (all students gather information related to each learning objective) Step 7 Group synthesises and tests newly acquired information

Field trip preparation Constraints: 40 students, one day field trip, group-based work. Preparation: background lecture, students provided with key readings on the following topics What are the implications of population ageing for rural health care provision? How has health care restructuring changed the landscape of care in rural places? How has the process of deinstitutionalisation impacted Hanmer Springs? Working in groups, students choose one of the above topics, carry out background readings, supplementary research and devise questions for key informants giving them insight into the case study

Discussion Student learning is evaluated through group presentations where they are asked to demonstrate linkages between theory and the case study Challenges: Group work, freeloaders and lack of community feedback Problem-based learning requires students set their own learning goals and instigate problem-solving themselves Challenges: the short time frame and lack of prior knowledge of the topic compromises this process The field trip is an effective solution for student demand to engage in real world problem solving and lecturers prioritising acquiring content knowledge