New trends in methods ofNew trends in methods ofmedical education: Problem medical education: Problem

Based LearningBased LearningProf. Victor VovcProf. Victor Vovc

State University of Medicine and State University of Medicine and Pharmacy “Nicolae Testemitanu” of the Pharmacy “Nicolae Testemitanu” of the

Republic of Moldova Republic of Moldova

Reasons for changeReasons for change Medical knowledge expands too rapid and too Medical knowledge expands too rapid and too

much to be covered in education much to be covered in education Health care becomes multidisciplinary, education Health care becomes multidisciplinary, education

should followshould follow Changing health care circumstances for education: Changing health care circumstances for education:

patient mix and restricted labour timepatient mix and restricted labour time Educational theory has progressedEducational theory has progressed New technologies enter health care and educationNew technologies enter health care and education Communication, collaboration and professionalism Communication, collaboration and professionalism

emerge as increasingly important in health careemerge as increasingly important in health care

Innovation in medical education Innovation in medical education worldwide: Th. Ten Cate, 2006worldwide: Th. Ten Cate, 2006

Innovations in medical education from traditional (1) to innovative (5)

0

1

2

3

4

5

1950 1960 1970 1980 1990 2000

USA CANADA UK AUSTR NL OTHER

Major trends in medical Major trends in medical educationeducation

Fore-front countries in medical education:Fore-front countries in medical education:

CanadaCanadaUKUKUSA USA Australia Australia The NetherlandsThe Netherlands

Major trends in medical Major trends in medical educationeducation

From input-based to From input-based to outcome-basedoutcome-based trainingtraining

From passive to From passive to active learningactive learning From tradition to From tradition to educational theoryeducational theory

based methods of teachingbased methods of teaching From departmentalized to From departmentalized to centralized,centralized,

integrated integrated curriculum coordination curriculum coordination Incorporation of Incorporation of technology and the technology and the

internetinternet Skills labsSkills labs and and simulation simulation techniquestechniques New New assessmentassessment methodologies methodologies Staff development and Staff development and teacher trainingteacher training

Teacher-centeredStudent-centered

New-Innovative Curricula

Traditional Medical Curricula

Information gatheringProblem-based

Discipline-basedIntegrated

Hospital basedCommunity-based

StandardElective

Apprenticeship-basedSystematic

Continuum

S

P

I

C

E

S

SPICES

From From inputinput to to outcomeoutcome

Don’t start with asking: Don’t start with asking: How much How much should we teachshould we teach? (input)? (input)

But ask first: But ask first: What competencies What competencies should graduates haveshould graduates have? (outcome)? (outcome)

Objectives of medical training should Objectives of medical training should reflect the reflect the needs of societyneeds of society in Moldovain Moldova

Objectives of medical training should meet Objectives of medical training should meet international standardsinternational standards

From From Passive listeningPassive listening to to Active learningActive learning

BMJ 2003;326:438

From From Passive listeningPassive listening to to Active learningActive learning

lecture

reading

audiovisual

demonstration

discussion group

practicing by doing

teaching others

5

10

20

30

50

75

80

average long termretention rate (%)

“Learning pyramid”,adapted from: Bales, National Training Laboratories, Bethel, Maine, USA, 1996

What helps to stimulate activity?What helps to stimulate activity?- Lectures with dialogueLectures with dialogue- Small group teachingSmall group teaching- Problems to be solvedProblems to be solved- Application of knowledge, not only Application of knowledge, not only

reproduction in examinationsreproduction in examinations- Peer-presentations and other active Peer-presentations and other active

rolesroles

From From Passive listeningPassive listening to to Active learningActive learning

Vertical integration: from H to Z modelVertical integration: from H to Z model

clinical

application

theory

basis

clinical

application

theory

basis

Tomorrow’s Doctors, Tomorrow’s Doctors, 19931993

• Reduction in factual factual overloadoverload

• Increase in learninglearning through curiosity (PBL)(PBL)

• Emphasis on clinical clinical skills /communication skillsskills /communication skills

• Understanding of Research Research technologytechnology

Development of the skills Development of the skills and attitudes that befit a and attitudes that befit a doctordoctor

Definition of PBLDefinition of PBL

An instructional student-centered approach An instructional student-centered approach which uses which uses carefully constructed clinical carefully constructed clinical problemsproblems as a context for students to: as a context for students to: define their learning needsdefine their learning needs, , conduct self-conduct self-directed enquirydirected enquiry, , integrate theory and integrate theory and practicepractice, and , and apply knowledge and skills apply knowledge and skills to develop a solution to a defined to develop a solution to a defined problem.problem.

The problems (clinical cases) serves as The problems (clinical cases) serves as a stimulus for learninga stimulus for learning

Problem-solving Problem-solving vs. vs. problem-based problem-based learninglearning

- different but inter-related -- different but inter-related -

Problem-solving:Problem-solving: arriving at arriving at decisions based on prior decisions based on prior knowledge and reasoningknowledge and reasoning

Problem-based learning:Problem-based learning: the process the process of acquiring new knowledge based of acquiring new knowledge based on recognition of a need to learnon recognition of a need to learn

Rationale for introducing PBL into the Rationale for introducing PBL into the undergraduate curriculaundergraduate curricula

The rationale for PBL lies in The rationale for PBL lies in its comparability with its comparability with modern educational modern educational principles. Its approach is principles. Its approach is based on principles of based on principles of adult education and self-adult education and self-directed learning.directed learning.

Principles of adult learning

Adults are motivated by learning that:

• Is perceived as relevant• Is based on, and builds on, their previous experiences• Is participatory and actively involves them• Is focused on problems• Is designed so that they can take responsibility for their own learning• Can be immediately applied in practice• Involves cycles of action and reflection• Is based on mutual trust and respect

Example: Example: PBL tutorial processPBL tutorial process

1. Case presentation: 1. Case presentation: The tutor provides the group The tutor provides the group with some introductory clinical information about a with some introductory clinical information about a hypothetical patient.hypothetical patient.

Mary Smith, a 28-year-old office worker and part-time swimming instructor, comes to see her GP because of pain in her chest and shortness of breath. This has been a recurring problem in recent months and seems to be gradually worse. On the previous evening, while participating in a swimming gala, she became so short of breath that she found it difficult to walk.difficult to walk.

2.2. Identifying key informationIdentifying key information

3.3. Generating and ranking Generating and ranking hypotheses:hypotheses:

e.g., Infection, cardiac problem, e.g., Infection, cardiac problem, allergy, asthma, broken rib.allergy, asthma, broken rib.

Allergy ˃ cardiac problemAllergy ˃ cardiac problem

4.4. Generate an enquiry strategy:Generate an enquiry strategy: What additional information is What additional information is

required?required? e.g., Previous medical problems e.g., Previous medical problems

and relevant drug, family & and relevant drug, family & psychosocial histories, physical psychosocial histories, physical exam, lab. tests. exam, lab. tests.

Hybrid curriculaHybrid curricula

In preclinical phase, PBL can be In preclinical phase, PBL can be designed and timetabled so as to designed and timetabled so as to complementcomplement other teaching methods other teaching methods such as:such as:– LecturesLectures– Practicals, other laboratory workPracticals, other laboratory work– Computer-assisted learningComputer-assisted learning

PROBMEDFORM PROBMEDFORM

TEMPUS Project CD_JEP-TEMPUS Project CD_JEP-25195-200425195-2004

PROBLEM BASED MEDICAL EDUCATION FOR MOLDOVA

CONSORTIUMCONSORTIUM

Università Cattolica del Sacro Cuore Università Cattolica del Sacro Cuore Utrecht University Utrecht University - - School of School of

Medical Sciences Medical Sciences State University of Medicine and State University of Medicine and

Pharmacy "Nicolae Testemitanu"Pharmacy "Nicolae Testemitanu"

WIDER OBJECTIVEWIDER OBJECTIVE

Improving the quality of medical Improving the quality of medical education at SUMPh through the education at SUMPh through the introduction of problem based introduction of problem based

learning (PBL) medical education learning (PBL) medical education and participative students and participative students evaluation of the teaching evaluation of the teaching

process.process.

SPECIFIC PROJECT SPECIFIC PROJECT

OBJECTIVE/SOBJECTIVE/S Introduction of problem based learning Introduction of problem based learning

method at four pilot departments of the method at four pilot departments of the SUMPh by the end of year 2006 - 2007. SUMPh by the end of year 2006 - 2007.

Introduction of evaluation of medical Introduction of evaluation of medical education at four pilot departments of the education at four pilot departments of the SUMPh through teachers and students SUMPh through teachers and students participation in the evaluation process participation in the evaluation process based on medical questionnairesbased on medical questionnaires..

Teachers/professors at selected pilot Teachers/professors at selected pilot departments became familiar with departments became familiar with problem based learning and case studies problem based learning and case studies method.method.

Problem based learning method was Problem based learning method was introduced in the teaching process at the introduced in the teaching process at the four pilot departments.four pilot departments.

Interactive learning techniques were Interactive learning techniques were introduced in the teaching process at the introduced in the teaching process at the four pilot departments.four pilot departments.

OUTPUTS AND OUTCOMES OUTPUTS AND OUTCOMES

OUTPUTS AND OUTCOMES OUTPUTS AND OUTCOMES

A "computer resource centre" was created A "computer resource centre" was created at SUMPh “Nicolae Testemitanu”at SUMPh “Nicolae Testemitanu”

Questionnaires of evaluation were Questionnaires of evaluation were developed and used to assess the courses developed and used to assess the courses held at the four selected pilot departmentsheld at the four selected pilot departments

Teachers motivation to make the course Teachers motivation to make the course more interesting have increased; student's more interesting have increased; student's awareness of their participation into the awareness of their participation into the improving the quality of their studies were improving the quality of their studies were increasedincreased   

DisseminationDissemination

Two reports on the Central Educational

Methodological Council of SUMPh; Publication and diffusion at local, national and

international level of teaching materials developed

within the framework of the projectBulletins of information sent to the target groups;Regular publications on University's newspaper

"Medic" as well as in local press;Workshops and seminars for SUMPh teaching

staff for dissemination of project results.

SustainabilitySustainability

The PBL and "case based study" will be main goals of future The PBL and "case based study" will be main goals of future curriculum reform in medical education for Moldova. curriculum reform in medical education for Moldova.

SMPhU Senate will support the PBL method introduction at SMPhU Senate will support the PBL method introduction at every department as an institutional reform.every department as an institutional reform.

When the PBL method will be implemented at majority of When the PBL method will be implemented at majority of Departments of SMPhU the activities for preparing and Departments of SMPhU the activities for preparing and perform this kind of teaching will become obligatory for all perform this kind of teaching will become obligatory for all teaching staff and will be financed by University budget.teaching staff and will be financed by University budget.

The "computer resource lab" will remain in place and will The "computer resource lab" will remain in place and will continue its activity with funding from SMPhU budget.continue its activity with funding from SMPhU budget.

Educational materials published in the Educational materials published in the framework offramework of JEP-25195-2004 JEP-25195-2004

““Study landscapeStudy landscape” – an interactive study ” – an interactive study center at the SUMPhcenter at the SUMPh

The rThe rezultezults s of students’ rating ofof students’ rating of PBL PBL

a.IV Patofiz. a.III Patofiz

Clinică (PBL=1) (PBL = 8)

1. Avntajele metodei PBL în comparaţie cu cea 3,48 4,40 tradiţională 2. Influenţa metodei PBL asupra ameliorării însuşirii 3,95 4,64 prelegerilor 3. Eficienţa asimilării materialului la combinarea informaţiei teoretice cu analiza exemplului clinic (PBL) 4,51 4,55

4. Eficienţa consolidării materialului la combinarea

informaţiei teoretice cu analiza exemplului clinic (PBL) 4,57 4,78

5. Influenţa metodei PBL asupra motivaţiei în raport cu:

a) învăţătura în general 4,36 4,60 b) însuşirea patofiziologiei (clinice) 4,06 4,62

Our students’ opinion about PBLOur students’ opinion about PBL

AdvantagesAdvantages over traditional over traditional approaches: approaches:

Greater Greater relevance to the practice of relevance to the practice of medicine;medicine;

Ability to Ability to promote retention and promote retention and application of knowledge;application of knowledge;

Encouragement of Encouragement of self-directed life-self-directed life-long learning;long learning;

Increase motivation to learn. Increase motivation to learn.

Disadvantages of PBLDisadvantages of PBL

CostlyCostly Difficult to implement when class Difficult to implement when class

sizes are largesizes are large

Thank you for Thank you for attentionattention