1. Oral pathology in a PBL course Dr Mary Toner School of Dental Science Trinity College, Dublin.

2. Previous course Oral pathology delivered in series of lectures Given in 4 th year of 5 + year course Not integrated with oral surgery or medicine, overlap in some lecture topics Practical classes held in one whole week at year end, with whole class together Examinations separate until finals

3. Change of learning style to PBL In context, immediacy of application Integrated Self directed Students must take responsibility for learning

4. Implementation for oral pathology Collaboration with oral surgery and oral medicine to agree areas/topics to be covered Development of blocks of associated areas Problems and guidelines were written with staff together to achieve “right” balance Practical classes changed to go with each block, small groups

5. Changes that were also made with change to PBL course Exams integrated, exams previews for quality Exam reviews attended by staff and students – feedback Evaluation of tutors, problems, course, feedback strongly encouraged Assessment of whole course for timing and content, course at a glance available A lot of work! But stimulated staff interest in teaching immensely

6. How did it go? Staff (and even some students) worried about gaps - self directed therefore learning goals varied – but students are still exam driven – sample questions/ labs / tutors /exam reviews/ grapevine helped Tutors worried about lack of ability to answer question outside their field – guidelines, tutor/planning meetings Problems in trying to include some small not very common topics – adjusting of problems

7. How did it go? Students and staff engaged in culture change (some slowly)! At start, motivation made up for lack of expertise at the process; later expertise of students and tutors evolved Integration of benefit in oral surg/ med/ path

8. Current status (7 years) Now reviews produce minor adjustments and fine tuning Some lectures, audiovisual aids Staff finally trust the process Students arrive with 3 years experience of PBL Commitment to student and tutor training and support Exams: changed to send strong message as to what we value eg 10% of finals mark on dissertation that requires critical evaluation of information in literature,

9. PBL tutors: expert vs non expert our experience Integration means that students may always look at areas outside expert’s area Some experts tended to give tutorial on their pet subject, excluding other areas, need to trust and value process Good guidelines and tutor training help a lot Best tutors seem to be recent graduates Allow tutors access to planners/ experts Options to request wrap up session if needed

10. Advantages (for oral pathology) Staff much more aware of content of other related areas Pathology learned in relevant clinical context e.g. OKC learnt in clinical situation along with ameloblastoma, not in “classification of cysts” Better distribution of exam questions

11. Drawbacks for pathology Possibility of disappearing as an entity? Integrated exams mean an area may be poorly covered while student passes Large class numbers may mean less impact in practical classes

12. Pathology disappearing from curricula ? Many papers and reports are concerned about invisibility “pathology becoming invisible” Herdson 1998 “concern need to list core concepts” Dick 1998 DOH Feb 2004 “need to address invisiblity to patients”

13. Pathology disappearing? – Royal College Pathologists of Australasia Pathologists must be active at all levels and planning of curriculum Pathologists must be tutors and expert resource personnel Pathology should be present throughout the course Images and path reports should be key in PBL cases

14. “Protecting” pathology as an entity – what we do Use of images in problems – clinical and histologic – examined in OSCE (practical exam) Indicate the need for students to use pathology sources in some problems Practical classes (given at end of block) geared towards relating clinical and pathologic with illustrations, conundrums Protecting pathology in exam structure including final exam

15. Protecting pathology – what we do Use opportunities for visibility – exam reviews, case reports for prizes Planning process – need to contribute Tutoring, even occasionally Reminding colleagues of need to prompt consideration of pathology questions in clinics

16. PBL -Would I do it again? Students acquire a lot of skills: sorting information, questioning, chairing a group, assertiveness Making them take responsibility for learning so they are prepared for life-long learning Interactive nature of tutorial means weakest students are better standard You have better idea of what has been and is being learnt (as opposed to what you lectured) Lots of evaluation done = lots of communication Fun!