A complete guide to PBL Problem Based Learning Ramesh Mehay

Aims of this Session What is It? What Is it For? What do you need Adv vs Disadv Have a go What do you think? Further information

Sophie could remember times when the teachers or her mother had tried to teach her things she hadn’t been receptive to. Ask if anyone has read the book? Synopsis Sophie finds two questions in her mailbox: "Who are you?" and "Where does the world come from?" This is the start of her journey through the history of philosophy, guided by a mysterious mentor. To find the truth, we must understand the questions, but the truth is stranger than Sophie can imagine.

And whenever she had really learned something, it was when she had somehow contributed to it herself. Jostein Gaarder. Sophie’s World Question What does this tell you? Then go on to say why lectures are crap

Lecture (lec’char;n.) Process by which the notes of a speaker become the notes of a student without passing through the minds of either. Academic period set aside for rest and recovery There are some who say : The problem with a lecture is that it yields information which is not tailored to your need.

The most important phrase in education is “I don’t know .” At the end of this slide….ask Question What do you think PBL is? Draw a flow diagram or something. Then present the next slide.

“uses problems or cases to identify learning issues.” PBL What is it? “uses problems or cases to identify learning issues.” Question : What do you think PBL is? Draw a rough flow diagram of what you think it is. Then ask them for their views.

PBL. The process The Case / problem Discussion Identify learning issues Reflection Individual study Group study Review Discussion/mini-presentations ?More learning issues Take a problem and develop it Take a group who work well together Take a facilitator who understands the process Discuss the problem Identify areas of knowledge gaps or where further understanding is needed (Learning Issues) Address the learning issues as individuals or as groups Feedback to the group Question at the end of this slide: “ We have all seen a traditional case meeting where the case is dissected in detail and eventually a diagnosis is reached. Is this PBL? Show of hands please.” Answer NO….. Ask why of those who say NO. Reason – all to do with the outcome. Reaching the diagnosis is not the aim, identifying the learning issues is!

Dolomans 1997, Effective Case Design, Medical Teacher The Problem/Case Dolomans 1997, Effective Case Design, Medical Teacher Trainee’s prior knowledge Contain cues Relevant context Integrate basic science concepts Interest, Discussion Self-directed learning. Learning objectives. The contents of the case should: Adapt to the trainee’s prior knowledge Contain several cues which allow the registrar to elaborate Be presented in a context which is relevant to the profession Relevant basic science concepts should be presented in the context of a clinical problem to encourage integration of learning Enhance interest in the subject matter by sustaining discussion about possible solutions and facilitating students to explore alternatives Should encourage self directed learning by encouraging students to generate learning issues and conduct literature searches Each case should meet overall learning objectives

So What DO You Need? 3 things A Facilitator A Problem A Group Facilitator – he or she is the key to the process. A knowledge needed of small groups and their dynamics is needed. What does he do? Organise the group Identify a reader and a scribe initiates the process – distribute materials as appropriate maintains the group focus Monitor discussion - encourage participation from all members, monitor the pace of discussion , gives further information as necessary Evaluate the session Debrief Knowing the topic in great detail is not important. The process is what matters. In fact, many say it is better not to know too much about the subject as then, the temptation to teach or take on the role of the expert is reduced. With a really good group, you may find the facilitator taking on the “on looker” role. Don’t worry, sit back, relax, watch aand enjoy. The PROBLEM Any problem can be considered. Most will generate a variety of issues that delve in to the realms of the profession itself, clinical issues, managerial/organisational issues, ethical and even interpersonal issues The whole point is that PBL accurately reflects what happens in the PHCT setting. The whole scenario is not stated all in one go. Chunks or statements are given and the registrars asked to respond. As the scene builds up, more issues will be raised. Different groups doing the same exercises may produced different learning issues list, but that reflects the needs of the group…..and is not a bad thing! They are issues particularly important for them at this particular stage in their professional and personal development. The process is very learner centred. Some Issues may be knowledge based and easy to rectify eg literature search. Others will be more attitudinal and require reflection. Debriefing – very important. Usually occurs a few days or a fortnight after depending on the organisational set up….don’t worry, they’ll still remember the cases. During this session : individuals feedback to the group on the learning issues – they way this is done is up to them eg minipresentations. New learning issues may even be identified in the debriefing session!….pathognomic of a really good PBL session.

The group Should understand principles of PBL Appoint a reader Appoint a scribe R.O.P.E.S. Learning issues THE GROUP Groups need to function well if PBL is to work. Undergraduate teaching has typically been pedagogic (child like) and one must therefore explain the PBL process and what it is about. Reader – to read the questions Scribe – to jot down the learning points R RISK - members must be prepared to take risks and make mistakes O OPENESS – members must be open with each other, willing to admit deficiencies, share ideas, express feelings about the group or any of its members (good or bad) P PARTICIPATION – everyone! E EXPERIENCE – NOT the experience the member brings to the group BUT RATHER the process of reasoning ones way through the case. Each member of the group must partake in the homework. S SENSITIVITY – each member to be sensitive to the needs & feeling of the others. IN ESSENCE, IT IS ALL ABOUT WORKING WELL IN A TEAM….SOMETHING THAT REFLECTS THE TEAM WORK NEEDED TO FUNCTION IN A PHCT.

Benefits to the Individual Thomas 1997, Medical Education 4 areas of benefits 1. Motivates learning 2. Develops clinical reasoning skills 3. Helps structure knowledge in the clinical context 4. Helps develop self learning skills By the way, the gunshot noise is to waken everyone up! I’ve included individual to emphasise that the tool is beneficial to anyone interested in it…not just registrars. 3. Helps structure knowledge in the clinical context – PBL promotes learning in a structured way which has led to practice based needs being addressed as suggested in the Calman report (1998)

What else is so good about PBL? Better understanding of groups & gp dynamics Problem solving Negotiating Reflection Presentation & Research Skills Learning from each other Learner centred It promotes a better understanding of groups and group dynamics to the registrars. It promotes adult type (what we call deep ) learning through problem solving, negotiation and Reflection. In fact many doctors used to the didactic approach have for the first time been allowed to air their own ideas and opinions within the safe environment of a group of peers. Other skills it harvests is that of presentation skills and research skills through the homework that is set. It encourages us to learning from each other and to appreciate the different skills different people bring to the group, which in itself promotes respect. Finally, it is learner centred - addressing the learning needs of different people with different experience and different skills and who are at different stages of their career development

Misconceptions about PBL PBL teaches less therefore there is less to remember anyway (Morgan 1995 BMJ Letter) Does not meet everybody’s needs “chatty” and unstructured Question: What do you make of it so far? If no negative responses…..”Some of you may be sceptical about the tool. Colleagues have often said…..(display the slide)’ Teaches Less ? - Rubbish! Chatty and unstructured – not true. Each case raises around 20 learning issues. These are then tackled in detail – promoting deep learning through reflection & thought. Promotes attitudes and other aspects of personal development – something which is of life long value compared to facts read from a book. Does not meet everyone’s needs? Nonsense – 20 learning issues in each case. Each will cater for a different set of people. Not structured – Nonsense again! Very structured – a lot of thought goes into a case and can not just be made up in 5 minutes.

PBL enhances learning – the evidence Caplow et al, 1997, Medical Education “enhances retention and thinking, rather than just memorising it” Norman & Schmidt, 1987, Acad. Med. Little difference in exam results BUT What is learnt is both deeper and retention of knowledge is greater in PBL PBL is evidence Based…like everything else in life these days! Caplow Study – on medical students, published in Medical Education PBL fosters self directed learning (SDL) Students liked it because It expanded their knowledge base and It encouraged them to fulfil their responsibilities to the group by providing teaching material

Add PBL to your repertoire of educational tools Use it IN ADDITION to the other educational tools we use because it is… fun relevant Promotes group discussion Helps learners identify their own educational needs It is fun to participate in It’s relevant Allows group discussion Enables registrar’s to identify their own educational needs within a case setting

The Sorts of thing PBL can be used for in GP training Role-play Consultation skills Clinical examination Clinical/managerial/ethical and business topics Group skills Presentational skills

Using PBL in Primary care Develops teamwork People learn about each other and their role Identifies issues in all areas Fosters better relations Clinical governance Risk management Audit Calman has proposed the development of Practice Development Plans. Hereford has produced a PBL for the PHCT too…..something you might want to consider Both the cases and learning issues often apply to many members of the PHCT – not just the registrars. PBL is all about focusing on the common issues in a particular group.

Why should I get involved with it? For your learners’ sake For your practice’s sake (good for team problem-solving) It’s a pleasurable thing to do Another new LIFELONG skill for YOU. Educational tool for your registrars Educational tool for your practice (PDP’s) Pleasure from the Fun & Interaction….okay, perhaps im bullshitting here, but you got to hand it to me for trying! It is popular – well rated Another new LIFELONG skill for YOU – join others in their quest for enlightenment

Further Information HEREFORD FACILITATORS PACKS (Dec O’Brien & Pat Downey) PBL – fpr GP Vocational Training PBL – for PHCT education PBL – for Practice Staff Training 120 page folder/CD ROM “How to do it” Eight “themed”cases for VTS or PHCT Each case worth 4 hours education. Facilitator skills guide ANY QUESTIONS? CLOSE www.problembasedlearning.co.uk

Adult Learning: how does PBL fit in? Brookfields Principles of Adult Learning Participation is voluntary Mutual respect between teachers & learners Collaboration is impt (learners & teachers) Action & reflection should be a continuous process Critical reflection brings invokes further exploration Nurturing of self directed adults is impt. I just want to leave you with Brookfields Principles of Adult learning. Have a read through and I hope it shows how perfectly PBL obeys these criteria…..making it an effective tool for adult learning. Further explanations Participation is voluntary ie the decision to learn is the decision of the learner Mutual respect – between learners, between learners and teachers Collaboration – between learners, between learners and teachers Action and reflection form a continuous process of Ix, Exploration, Action, Reflection and further action Critical reflection – brings awareness that alternatives can be presented as challenges to the learner to gather evidence, ask questions and develop a critically aware frame of mind As stated above – self explanatory