Problem-based Learning Curriculum Research Articles

Can PBL Group Assignment Affect Examination Performance?

Medical student examination performance in an integrated problem-based learning (PBL) curriculum related to group and faculty facilitator (tutor) assignment has not been well studied. The aim of this study is to investigate whether the PBL group and tutor to which a student is assigned affect examination performance. We found that only 3.6% of all groups had non-Gaussian student examination score distributions. Tutorial group average scores varied by less than 10% from the examination mean. Faculty tutor experience in PBL or expertise by either clinical or basic science background did not appear to have a significant effect upon student knowledge based examination performance, as measured within an integrated basic science PBL curriculum.

Introducing integrated laboratory classes in a PBL curriculum: impact on student's learning and satisfaction.

BackgroundWith the introduction of integrated problem-based learning (PBL) program in the medical curriculum, there is a need to create laboratory classes that suit students’ learning needs and the changes introduced to the curriculum. This paper outlines the development and implementation of four integrated laboratory classes (ILCs) at King Saud University College of Medicine. It also examines whether core concepts addressed in these classes were learned and retained and how the students perceived the ILCs.MethodsILCs are based on enhancing enquiry-based learning, and encouraging students to work on tasks in small groups (apply and integrate knowledge from biochemistry, pathology and microbiology) and conduct a laboratory procedure (practical part). In two of these ILCs, a pretest comprising 15 multiple-choice questions were administrated at the start of the class and an identical posttest was administrated at the end of these classes. Performance of the students in the Objective Structured Practical Examination (OSPE) at the end of the blocks was also evaluated. Students’ perceptions were evaluated using a questionnaire completed at the end of each class.ResultsA total of 247, 252, 238, and 244 students participated in practical classes covering cerebrospinal fluid infection, small intestine, liver function tests and adrenal gland function, respectively. Students got higher scores in posttests compared to pre-test scores in two classes (12.68 ± 2.03 vs 6.58 ± 3.39 and 13.02 ± 2.03 vs 7.43 ± 2.68, respectively). Paired t-test showed that the difference was significant (P < 0.001) in both tests. The mean scores of students in stations dealing with ILCs at the end of the block examinations were not significantly different from the mean scores for other stations not related to ILCs. The questionnaire indicated that most students expressed positive attitude towards working on tasks and applying knowledge learnt. Students also felt that conducting laboratory procedures and interpreting laboratory findings were valuable to their learning.ConclusionsGiven the increase in the posttest scores (short-term retention) and the satisfactory performance of students at the end of block examinations (long-term retention) together with the students’ satisfaction, the study suggests that the core concepts addressed in these classes were learned and retained.

Introducing technology into medical education: Two pilot studies

ObjectivesEducators are integrating new technology into medical curriculum. The impact of newer technology on educational outcomes remains unclear. We aimed to determine if two pilot interventions, (1) introducing iPads into problem-based learning (PBL) sessions and (2) online tutoring would improve the educational experience of our learners. MethodsWe voluntarily assigned 26 second-year medical students to iPad-based PBL sessions. Five students were assigned to Skype for exam remediation. We performed a mixed-method evaluation to determine efficacy. ResultsPilot 1: Seventeen students completed a survey following their use of an iPad during the second-year PBL curriculum. Students noted the iPad allows for researching information in real time, annotating lecture notes, and viewing sharper images. Data indicate that iPads have value in medical education and are a positive addition to the curriculum. Pilot 2: Students agreed that online tutoring is at least or more effective than in-person tutoring. ConclusionsIn our pilot studies, students experienced that iPads and Skype are beneficial in medical education and can be successfully employed in areas such as PBL and remediation. Practice implicationsEducators should continue to further examine innovative opportunities for introducing technology into medical education.

Impact of Introducing a Diagnostic Scheme to Medical Students in a Problem Based Learning Curriculum

The curriculum at our Faculty of Medicine is hybrid problem based learning curriculum. Scheme inductive reasoning is one of the strategies used during problem solving. The Aim of this study is to determine the effect of using schemes in problem-solving for the undergraduate medical students, to study the relationship between its use and students’ performance in exams and to have students’ feed-back on this educational method. Two schemes had been introduced to students during the second half of the Endocrine block, one for Diabetes Mellitus, and the second for Cushing syndrome. Students’ approach to clinical problems and their grades in quizzes was compared before and after schemes use. Also students’ feedback on scheme use was investigated through a questionnaire. The results showed that the mean of students’ marks in quizzes was higher (7.47 ± 1.82) after the use of the scheme, than before its use (7.11 ± 2.14), but the difference was statistically insignificant (P=0.326). Number of students with efficient approach to problem solving significantly increased after introduction of schemes, their percentage was 60% before scheme use versus 85.7% after scheme use OR=4, 95% CI (0.84<OR<20.25) P=0.042. In conclusion: Medical students’ skills regarding problem solving was improved after using schemes. Their response to this educational method has been favorable, and most of them recommended use of schemes throughout the PBL process.

The Relationships Between Problem Design and Learning Process in Problem-Based Learning Environments: Two Cases

Some researchers have argued that the design of problems used in a Problem-based Learning (PBL) course or curriculum could have an impact on student learning cognitively or psychologically, such as students' self-directed learning process or engagement. To investi- gate the relationship between PBL problem design and students' self-directed learning as well as mindful engagement in the problem solving and learning process, this study explored two cases of PBL implementation in a Midwest university in the United States. Two classes of upper class college students participated in this study, including one wildlife management class and one class- room management class. The two classes underwent PBL instruction and solved a number of PBL problems. After the instruction, the students were surveyed about their perceptions toward the PBL problems. The data analysis and interpretation focused possible relationship between various elements of the problems and the students' self- directed learning process as well as their engagement during the PBL process. The similarities and differences between the two majors in terms of the students' percep- tions were also discussed.

Using Multi-Robot Systems for Engineering Education: Teaching and Outreach With Large Numbers of an Advanced, Low-Cost Robot

This paper describes the experiences of using an advanced, low-cost robot in science, technology, engineering, and mathematics (STEM) education. It presents three innovations: It is a powerful, cheap, robust, and small advanced personal robot; it forms the foundation of a problem-based learning curriculum; and it enables a novel multi-robot curriculum while fostering collaborative team work on assignments. The robot design has many features specific to educators: It is advanced enough for academic research, has a broad feature set to support a wide range of curricula, and is inexpensive enough to be an effective outreach tool. The low cost allows each student to have their own robot for the semester, so they can work on activities outside the classroom. This robot was used in three different classes in which it was the foundation for an innovative problem-based learning curriculum. In particular, the robot has specialized sensors and a communications system that supports novel multi-robot curricula, which encourage student interaction in new ways. The results are promising; the robot was a big success in graduate, undergraduate, and outreach activities. Finally, student assessments indicate a greater interest and understanding of engineering and other STEM majors, and class evaluations were consistently above average.

Creating a Virtual Pharmacology Curriculum in a Problem-Based Learning Environment

Integrating pharmacology education into a problem-based learning (PBL) curriculum has proven challenging for many medical schools, including the Pennsylvania State University College of Medicine (Penn State COM). In response to pharmacology content gaps in its PBL-intensive curriculum, Penn State COM in 2003 hired a director of medical pharmacology instruction to oversee efforts to improve the structure of pharmacology education in the absence of a stand-alone course. In this article, the authors describe the ongoing development of the virtual pharmacology curriculum, which weaves pharmacology instruction through the entire medical school curriculum with particular emphasis on the organ-based second year. Pharmacology is taught in a spiraling manner designed to add to and build upon students' knowledge and competency. Key aspects of the virtual curriculum (as of 2011) include clearly stated and behaviorally oriented pharmacology learning objectives, pharmacology study guides that correspond to each PBL case, pharmacology review sessions that feature discussions of United States Medical Licensing Examination (USMLE)-type questions, and pharmacology questions for each PBL case on course examinations to increase student accountability. The authors report a trend toward improved USMLE Step 1 scores since these initiatives were introduced. Furthermore, graduates' ratings of their pharmacology education have improved on the Medical School Graduation Questionnaire. The authors suggest that the initiatives they describe for enhancing pharmacology medical education are relevant to other medical schools that are also seeking ways to better integrate pharmacology into PBL-based curricula.

Predicting educational success and attrition in problem-based learning: do first impressions count?

This study examines whether tutors (N = 15) in a problem-based learning curriculum were able to predict students' success in their first year and their entire bachelor programme. Tutors were asked to rate each student in their tutorial group in terms of the chance that this student would successfully finish their first year and the entire bachelor programme. The results indicated that tutors can predict students' first-year success and attrition in the bachelor programme, even on top of prior grades. Moreover, tutors seem to be better at predicting completion of the first year and bachelor programme versus failure or non-completion. The results suggest that tutors can assess whether students will be successful at an early stage of the programme. Tutor judgments of students' future success have the potential to be used as an additional source of information to identify students at risk of leaving college without a degree.

Evidence-Based Medicine: A Short History of a Modern Medical Movement

The history of McMaster University's problem-based learning curriculum and critical appraisal methods, which Gordon Guyatt and David Sackett would later advocate as evidence-based medicine.

A qualitative investigation into how problem-based learning impacts on the development of team-working skills in occupational therapy students

It has been suggested that problem-based learning (PBL) has a positive impact on the team-working skills of medical, health and social care students. These skills are important for graduates to master to enable effective collaborative working in today’s diverse health and social care settings. What is not clear from the literature is how students develop these skills through the PBL experience. This study used a qualitative method of open, in-depth interviews to explore the perceptions of ten occupational therapy students regarding the development of their team-working skills as they completed a PBL course. The research aimed to investigate how a PBL curriculum impacted on the development of team-working skills and how this prepared the students for professional practice in respect to working as part of a team on completion of the course. The interview data was analysed using thematic analysis and four key themes relating to team working were identified: socio-emotional skills; the arena; the process; confidence. The findings of this project demonstrate what aspects of a PBL curriculum have an impact on the development of team-working skills from the students’ perspective. It will have value for educators of health and social care students as it supports the benefits of PBL as an appropriate teaching method to develop vital team-working skills in graduates and future practitioners

A Comparison of Student Knowledge Acquisition by Organ System and Skills in Parallel Problem-Based and Lecture-Based Curricula

A 5-year longitudinal study was conducted of students' acquisition of knowledge by organ system and skill development between two curricular tracks: problem-based learning (PBL) and lecture-based learning (LBL). Analysis of these data is reported. A comprehensive examination was administered to all students enrolled in the LBL and PBL curricular tracks on five occasions: 0, 4, 8, 12, and 24 months. The organ-system and skills subtest scores from these comprehensive examinations and the Physician Assistant National Certifying Exam were compared. Organ-system subtests: Of the 12 organ-system subtests measured, there was a statistically significant difference between the LBL and PBL curricula in the mean test scores for one subtest (psychiatric). In addition, there were significant differences in all organ-system subtests by time, and finally there was a curriculum by time interaction in 10 of 12 subtests. Skills subtests: There were statistically significant differences in the mean test scores for one of seven subtests (applying scientific concepts), as well as significant differences in all skills subtests by time and a curriculum by time interaction in six of seven subtests. Statistical differences observed could mostly be explained by differences in knowledge on program entry or in time of exposure to curricular content. The importance of clinical training was evidenced in some organ systems, particularly reproductive and psychiatric. More uniform learning appears to occur in skills education, and there is evidence that the PBL model provides a sound grounding in the application of basic science.

Development and implementation of an objective structured clinical examination (OSCE) in CMF-surgery for dental students

ObjectivesWe introduced the OSCE (objective structured clinical examination) as a method of assessment in a problem-based learning (PBL) curriculum. The OSCE is a clinical competency test and a very good example of a practical performance (shows how) assessment instead of a theoretical written measurement (knows and knows how). The OSCE at this Department was designed to assess some of the skills that are supposedly gained during a PBL curriculum (skills such as critical thinking, problem-solving and hypothesis formation).The aim of this study was to find where the strengths and weaknesses of learning contents are during the CMF practical course and how we may raise the students' clinical competence. Furthermore we wanted to examine the possibility of achieving an OSCE with ten stations for a single department. Material and methodsStudents rotated through ten test stations of 5 min duration, separated by a 1 min changeover break. At each station the students' performance was observed and assessed by an examiner using a standardized multi-item checklist.All students of the eighth semester (n = 26) of the “Carolinum Dental Institute” at the University of Frankfurt were evaluated in summer 2009 in a ten station circuit of different topics, including trauma, practical knowledge and oncology. Following this all the students and examiners evaluated the OSCE. ResultsThe overall average score was 63.2% (SD ± 8.89%). Subdivided the average results were; trauma (58.7 ± 6.79%), practical knowledge (66.1 ± 7.29%) and oncology (50 ± 4.81%). The overall rating of the OSCE was 1.69 (SD ± 0.78) for the students and 1.00 (SD ± 0) for the examiners. ConclusionWith good preparation, it is possible to run a ten station-OSCE circuit with ten examiners in one afternoon without interrupting patient care. The degree of difficulty was mainly acceptable. The overall average score for students' was within a range of 40–80%, which is similar to the international literature. The questionnaires showed that students and examiners viewed the new OSCE very positively.

Crafting Engineering Problems for Problem-Based Learning Curriculum

An effective problem is the heart of problem-based learning (PBL). Crafting problems according to effective PBL problems criteria is a challenging task to problem crafters especially in engineering. The aim of this paper is to describe a guided technique for crafting PBL problems based on the experience implementing PBL at Universiti Teknologi Malaysia (UTM). Based on literature, the criteria of effective PBL problem are condensed into five main principles and aligned with the objectives of using problems for learning. A sample case study from Process Control and Dynamics, a chemical engineering course taken by the third-year undergraduates, is presented to demonstrate the technique. Feedback from students on their perspective about effective engineering problems is also included.

Dysfunctional problem-based learning curricula: resolving the problem

BackgroundProblem-based learning (PBL) has become the most significant innovation in medical education of the past 40 years. In contrast to exam-centered, lecture-based conventional curricula, PBL is a comprehensive curricular strategy that fosters student-centred learning and the skills desired in physicians. The rapid spread of PBL has produced many variants. One of the most common is 'hybrid PBL' where conventional teaching methods are implemented alongside PBL. This paper contends that the mixing of these two opposing educational philosophies can undermine PBL and nullify its positive benefits. Schools using hybrid PBL and lacking medical education expertise may end up with a dysfunctional curriculum worse off than the traditional approach.DiscussionFor hybrid PBL schools with a dysfunctional curriculum, standard PBL is a cost-feasible option that confers the benefits of the PBL approach. This paper describes the signs of a dysfunctional PBL curriculum to aid hybrid PBL schools in recognising curricular breakdown. Next it discusses alternative curricular strategies and costs associated with PBL. It then details the four critical factors for successful conversion to standard PBL: dealing with staff resistance, understanding the role of lectures, adequate time for preparation and support from the administrative leadership.SummaryHybrid PBL curricula without oversight by staff with medical education expertise can degenerate into dysfunctional curricula inferior even to the traditional approach from which PBL emerged. Such schools should inspect their curriculum periodically for signs of dysfunction to enable timely corrective action. A decision to convert fully to standard PBL is cost feasible but will require time, expertise and commitment which is only sustainable with supportive leadership.

Management of Early- and Late-Stage Rheumatoid Arthritis: Are Physiotherapy Students' Intended Behaviours Consistent with Canadian Best Practice Guidelines?

This study examined whether physiotherapy students in a problem-based learning (PBL) curriculum intend to implement best practices for management of clients with rheumatoid arthritis (RA). Physiotherapy students (n=49) completed a subsection of the ACREU Primary Care Survey to evaluate the concordance between intended behaviours and Canadian best practices for early- and late-stage RA, before and after completing the relevant PBL content. Changes in scores were assessed using McNemar's test for dependent proportions. Most students indicated that they would recommend treatments or referrals for physiotherapy/exercise, education, and occupational therapy or joint protection pre- and post-PBL (>83% and >95%, respectively). Post-PBL, more students recommended referral to a rheumatologist and disease-modifying anti-rheumatic drugs (DMARDs) for both early and late RA; however, the increase was significant only for early RA (p=0.013 and 0.031 for referral to rheumatologist and DMARDs, respectively). More students recommended psychosocial support at both stages of RA post-PBL (early RA: p<0.001; late RA: p=0.031). Although more students recommended DMARDs post-PBL, only 8 students in total made this recommendation (16%), and fewer students considered use of non-steroidal anti-inflammatory drugs. Most students (94%) did not recommend referral to a surgeon for early or late RA. Intended behaviour of physiotherapy students was more consistent with Canadian best practice guidelines for managing clients with early- and late-stage RA following the PBL curriculum. Further study is required to determine whether the students were less aware of best practices related to pharmacologic interventions and timely referral to appropriate specialists, or whether they considered these issues to be outside their scope of practice.

Dental and Medical Students’ Perspectives on Early Exposure to PBL in Taiwan

A hybrid problem-based learning (PBL) curriculum adopted in 2002 for medical students at China Medical University, Taiwan, was extended to dental students in 2007. Before that, PBL workshops were conducted for all students. Two PBL cases on basic biomedical issues were used for second-year medical students and second-year dental students to explore the feasibility of adopting PBL as part of the dental curriculum. This study compared the medical and dental students' attitudes toward the PBL tutorials and PBL curricula. Upon completion of the PBL component, an eighteen-item questionnaire asked students to assess (on a ten-point scale with 10 as the most positive response) their perceptions of the learning process in the PBL tutorials. Forty-six dental students from a cohort of fifty (92 percent) and 107 medical students from a cohort of 119 (90 percent) completed the questionnaires (fifty-three females and 100 males). The importance of all items was rated above 6.00. The medical students' mean score (7.29) was higher than the dental students' mean score (7.10). Of the eighteen attributes of the PBL process, the students indicated being generally comfortable with fourteen. No statistical significance was found between the dental and medical students' scores, but there was a significant difference (p=0.006) in their perception of PBL curricula. Overall, the medical students expressed a more positive outlook toward the PBL learning process than the dental students and were more willing to accept PBL as a pedagogy.

Blended problem-based learning

This paper reports on the evaluation findings for a postgraduate Law programme following a problem-based learning (PBL) curriculum, which introduced group wiki and blogging tools for students to use in support of a series of unguided group research activities. Following a face-to-face PBL session where students were presented with a new problem and brainstormed learning outcomes and tasks as a framework to solve it, the virtual tools were then employed to support discussion and sharing of research outside the classroom, leading to the production of a collaborative solution by the group. The problem-based exercises targeted higher order thinking, with students encouraged to demonstrate skills in articulating and explaining the solutions they had reached in relation to the case problem, as well as negotiating and interpreting issues. This paper considers the online stage of the PBL process, looking at the reception of the study methods for the research activity and the effectiveness of the web tools in supporting the unguided group research tasks. Evaluation focused on levels of student engagement during the performance of the research tasks and the nature of the online learning exchanges to see whether they reflected the higher-order thinking which had been targeted by the course instructor in the PBL exercises. Findings are drawn from a mixed-mode evaluation of the first delivery of this course in 2009, carried out through activity logs, content analysis of blog posts and focus group interviews. The results reveal a positive reception for the learning methods and tools with evidence of higher order thinking and reflective skills in the logged exchanges as students became accustomed to the new learning methods. The pattern of contributions gradually evolved from 'one-shot' postings of solutions to critiques of peer contributions and revision of original posts, demonstrating collaborative working between group members towards an agreed solution. However, this study highlights the challenges for instructional support in the management of the learning process for these tasks - specifically in addressing students' anxiety over their performance in the online tasks and a perceived need for individual and collective feedback in support of the unguided research task. Getting the balance right in providing facilitation rather than direction in the conduct of the unguided research tasks, whilst providing adequate feedback on student performance, remains a challenge for PBL tutors and a theme for further research.

A Virtual Pharmacology Course in a PBL Curriculum

Providing medical students with a solid foundation in pharmacology (pharm) can be challenging within the confines of an intensive problem‐based learning (PBL) curricula. To address deficits uncovered at our medical school, a pharm educator was hired in 2002 and a variety of methodologies were used to fill curricular gaps. We evaluated the curricular enhancements and outcomes that have resulted. To accomplish this goal, we reviewed course syllabi, learning objectives from lectures, course examinations, and United States Medical Licensing Examination (USMLE) Step 1 scores for academic years 2002–2003 and 2009–2010. Our analysis revealed a non‐significant increase in didactic pharm lectures in most courses, albeit a more structured learning environment with more pharm learning objectives (P&lt;0.001). Additionally, students are incentivized to study PBL‐based pharm as the number of pharm questions on course examinations has increased (P&lt;0.001). Analysis indicates that students who regularly attend recently‐implemented voluntary pharm review sessions score higher on USMLE Step 1 (P=0.038); of, course, this may reflect self‐selection bias. Our balanced, thoughtful and deliberate attention to pharm education is particularly important in an integrated, organ‐based, and significantly PBL‐driven curriculum.

Measuring Change in Critical Thinking Skills of Dental Students Educated in a PBL Curriculum

This study measured the change in critical thinking skills of dental students educated in a problem-based learning (PBL) pedagogical method. The quantitative analysis was focused on measuring students' critical thinking skills achievement from their first through third years of dental education at the University of Southern California. This non-experimental evaluation was based on a volunteer sample of ninety-eight dental students who completed a demographics/academic questionnaire and a psychometric assessment known as the Health Sciences Reasoning Test (HSRT). The HSRT produced the overall critical thinking skills score. Additionally, the HSRT generated five subscale scores: analysis, inference, evaluation, deductive reasoning, and inductive reasoning. The results of this study concluded that the students showed no continuous and significant incremental improvement in their overall critical thinking skills score achievement during their PBL-based dental education. Except for the inductive reasoning score, this result was very consistent with the four subscale scores. Moreover, after performing the statistical adjustment on total score and subscale scores, no significant statistical differences were found among the three student groups. However, the results of this study found some aspects of critical thinking achievements that differed by categories of gender, race, English as first language, and education level.

Locus of Control in Nursing Students on a Problem-Based Learning Program: A Longitudinal Examination

In this survey carried out over a 4-year period we explored the changes perceived in the locus of control (LOC) of 58 nursing students enrolled in a baccalaureate nursing education program with an integrated problem-based learning curriculum. The results suggested that there was a statistically significant difference in LOC between the first and second years. A significant difference was found in the mean scores of the students according to year in personal control, fatalism, and belief in an unfair world. But, when analyzed further, there were no significant differences according to year in personal control and belief in an unfair world. However, a statistically significant difference was found in fatalism between the first- and third-year students. Implications for nursing training programs and curriculum development are discussed.