Abstract
BackgroundProblem-based learning (PBL) is well established in medical education and beyond, and continues to be developed and explored. Challenges include how to connect the somewhat abstract nature of classroom-based PBL with clinical practice and how to maintain learner engagement in the process of PBL over time.ObjectiveA study was conducted to investigate the efficacy of decision-PBL (D-PBL), a variant form of PBL that replaces linear PBL cases with virtual patients. These Web-based interactive cases provided learners with a series of patient management pathways. Learners were encouraged to consider and discuss courses of action, take their chosen management pathway, and experience the consequences of their decisions. A Web-based application was essential to allow scenarios to respond dynamically to learners’ decisions, to deliver the scenarios to multiple PBL classrooms in the same timeframe, and to record centrally the paths taken by the PBL groups.MethodsA randomized controlled trial in crossover design was run involving all learners (N=81) in the second year of the graduate entry stream for the undergraduate medicine program at St George’s University of London. Learners were randomized to study groups; half engaged in a D-PBL activity whereas the other half had a traditional linear PBL activity on the same subject material. Groups alternated D-PBL and linear PBL over the semester. The measure was mean cohort performance on specific face-to-face exam questions at the end of the semester.ResultsD-PBL groups performed better than linear PBL groups on questions related to D-PBL with the difference being statistically significant for all questions. Differences between the exam performances of the 2 groups were not statistically significant for the questions not related to D-PBL. The effect sizes for D-PBL–related questions were large and positive (>0.6) except for 1 question that showed a medium positive effect size. The effect sizes for questions not related to D-PBL were all small (≤0.3) with a mix of positive and negative values.ConclusionsThe efficacy of D-PBL was indicated by improved exam performance for learners who had D-PBL compared to those who had linear PBL. This suggests that the use of D-PBL leads to better midterm learning outcomes than linear PBL, at least for learners with prior experience with linear PBL. On the basis of tutor and student feedback, St George’s University of London and the University of Nicosia, Cyprus have replaced paper PBL cases for midstage undergraduate teaching with D-PBL virtual patients, and 6 more institutions in the ePBLnet partnership will be implementing D-PBL in Autumn 2015.
Highlights
OverviewThe early years of medical training have seen a progressive move away from curricula organized around single-discipline bioscience material and the use of passive forms of instruction [1]
D-Problem-based learning (PBL) groups performed better than linear PBL groups on questions related to D-PBL with the difference being statistically significant for all questions
This study investigated the efficacy of D-PBL, a variant form of Web-based PBL that replaced linear PBL cases with branched virtual patients to present medical learners with alternative patient management decisions and having made a decision to deal with the consequences
Summary
OverviewThe early years of medical training have seen a progressive move away from curricula organized around single-discipline bioscience material and the use of passive forms of instruction [1]. Virtual patients are on-screen learning resources that typically present a clinical problem for learners to solve or manage, and in doing so involve aspects of both PBL and simulation [3]. Each group works through a predefined patient case, discussing the information provided and implied, exploring possible diagnoses, suggesting investigations and treatments, and identifying the research they need to undertake to be able to resolve the case [6]. Each PBL group will approach a case in different ways, the group facilitator directs the proceedings using the predefined PBL case outline (that the learners do not see) that sets out the key issues, anticipated learning objectives, and other intended features of the case, that allows them to keep learners from straying too far from the intended learning outcomes for each case
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