Problem-based Learning Tutorials Research Articles

Assessment of the Midwifery Education Program at the University of British Columbia – A Survey of Graduates and Midwife Mentors

The Midwifery Program at the University of British Columbia is the only academic centre for midwifery education in British Columbia. The program consists of arts and science courses, midwifery theoretical and clinical courses, problem-based learning tutorials, laboratory simulations, clinical experiences in community midwifery, and a semester of interprofessional placements in a local or global setting. As university based midwifery education is new to British Columbia, critical evaluation of the curriculum is essential. Between 2005 and 2010, we examined the curriculum annually from the perspective of new graduates (n=34) and their mentors (n=21) to inform curriculum renewal and development. Overall graduates felt well prepared for clinical practice after graduating, and highly valued their clinical placements. Both graduates and midwife mentors reported competence with most clinical skills, and senior midwives noted the graduates’ fluency with both the hospital and home setting. Need for improvement was noted with respect to suturing and venipuncture. There were some discrepancies in the assessment of competencies. While all graduates felt well or adequately prepared to recognize and manage when a normal birth changes to abnormal, not all mentor midwives agreed. Conversely, midwife mentors felt that graduates were prepared in the area of client communication and counseling, yet graduates felt less confident in this area. Over the years, the Midwifery Education curriculum has evolved to address feedback received via the yearly curriculum evaluation. The academic calendar has been modified to allow students and faculty more time for preparation, integration and reflection during the introductory year, to facilitate the consolidation phase in the core clinical courses, and to facilitate senior research projects. Courses on counseling, pharmacology for midwives, lactation consultation, global maternity care, and anatomy labs have been added to the curriculum. The program continues its effort to enhance theoretical and clinical teaching by offering regular preceptor workshops.

Online or face-to-face problem-based learning tutorials? Comparing perceptions and preferences of students and tutors

IntroductionProblem-based learning (PBL) tutorials are recognized as an effective strategy for building clinical and research skills in modern-day medical education. Despite the wide adoption of this instructional strategy, worldwide research findings reported noticeable differences in the perceptions towards online versus face-to-face modes of PBL conduction among students and their tutors.MethodsThis cross-sectional analytical study was conducted at the College of Medicine and Medical Sciences, Arabian Gulf University (CMMS-AGU), Kingdom of Bahrain, during the academic year 2022-2023. The study examined the differences in perceptions and preferences among students and tutors regarding online and face-to-face modes of PBL tutorials. The study also compared the performance of 3rd and 4th year medical students who were exposed to PBL tutorials through both modes.ResultsThe performance of students in tutorials in both modes revealed no statistically significant difference. The study found that tutors reported more positive perception toward the face-to-face mode compared to the online mode of conducting PBL tutorials than students, while students reported more positive perception toward the online mode compared to the face-to-face mode of conducting PBL tutorials than tutors. Several advantages and challenges of both modes were recounted by the students and tutors.ConclusionOur study concludes that students were in favor of the online mode of conducting PBL sessions, while tutors were in favor of the face-to-face mode. Comparable performance of students in PBL tutorials implies that the online mode of conducting PBL tutorials might be as effective as the face-to-face mode for meeting teaching objectives and students’ learning outcomes. The difference between perceptions of students and faculty can be attributed to multiple factors including generation difference, previous experiences, and digital literacy. It is recommended that faculty receive proper training for effectively adopting online modes of learning.

Influence of tutor interventions and group process on medical students' engagement in problem-based learning.

Student engagement is influenced by several variables, among which are the teaching styles employed by faculty. In problem-based learning (PBL), the role of faculty is to facilitate the learning of the tutorial group as they work through clinical problems. However, the influence of tutor intervention styles and group process on engagement of students in PBL tutorials is unclear. The study was conducted with year 2 and 3 medical students (n= 176) in PBL tutorial groups at the end of an integrated PBL course. Students evaluated their behavioural, cognitive and emotional engagement in PBL tutorials using a pre-validated 11-item questionnaire. Students also filled in a modified version of a previously published tutor intervention profile (TIP) questionnaire. The modified TIP questionnaire represents three constructs (1) steering the learning process (6 items), (2) stimulating student autonomy (4 items) and (3) establishing relatedness with students (3 items). In addition, PBL group process was evaluated using a 5-item nominal scale: (1) tutorial atmosphere, (2) listening and information sharing, (3) group performance, (4) decision making and (5) reaction to leadership. Establishing sense of relatedness in the group by PBL tutors was the most important predictor of emotional engagement (F= 41.213, ΔR2=0.191, β=0.438, P= 0.000). On the other hand, steering the learning process was a significant predictor of behavioural engagement (F= 19.0, ΔR2=0.098, β=0.314, P= 0.000). However, stimulating student autonomy was not a significant predictor of student engagement in PBL tutorials. On the other hand, enhancing the group process in PBL tutorials significantly predicts student engagement with strong impact on emotional and cognitive engagement of students. Establishing the sense of relatedness in the group and steering the learning process by PBL tutors as well as improving PBL group process are significant predictors of student engagement in PBL tutorials with emotional and cognitive engagement being the most sensitive variables affected.

Tutor assessment of medical students in problem-based learning sessions.

Problem-based learning (PBL) is a method of learning that has been adopted in different curricula of different disciplines for more than 30 years; the assessment of the students in PBL sessions in medical schools is fundamental to ensure students' attainment of the expected outcomes of conducting PBL sessions and in providing the students with the feedback that help them to develop and encourage their learning. This study investigated the inter-rater reliability of the tutor assessment in assessing medical students' performance in their PBL tutorial sessions. This study was conducted in the College of Medicine (COM), in the academic year 2021-2022. The study involved ten raters (tutors) of two genders who assessed 33 students in three separate PBL tutorial sessions. The PBL sessions were prerecorded and shown to the 10 raters for their assessment of PBL sessions. This study showed that male raters gave higher scores to students compared with female raters. In addition, this investigation showed low inter-rater reliability and poor agreement among the raters in assessing students' performance in PBL tutorial sessions. This study suggests that PBL tutor assessment should be reviewed and evaluated; this should be performed with consideration of using assessment domains and criteria of performance. Thus, we recommend that 360-degree assessment including tutor, self, and peer assessment should be used to provide effective feedback to students in PBL tutorial sessions.

Construct validity of a questionnaire for measuring student engagement in problem-based learning tutorials

BackgroundStudent engagement is student investment of time and energy in academic and non-academic experiences that include learning, teaching, research, governance, and community activities. Although previous studies provided some evidence of measuring student engagement in PBL tutorials, there are no existing quantitative studies in which cognitive, behavioral, and emotional engagement of students in PBL tutorials is measured. Therefore, this study aims to develop and examine the construct validity of a questionnaire for measuring cognitive, behavioral, and emotional engagement of students in PBL tutorials.MethodsA 15-item questionnaire was developed guided by a previously published conceptual framework of student engagement. Focus group discussion (n = 12) with medical education experts was then conducted and the questionnaire was piloted with medical students. The questionnaire was then distributed to year 2 and 3 medical students (n = 176) in problem-based tutorial groups at the end of an integrated course, where PBL is the main strategy of learning. The validity of the internal structure of the questionnaire was tested by confirmatory factor analysis using structural equation modeling assuming five different models. Predictive validity evidence of the questionnaire was studied by examining the correlations between students’ engagement and academic achievement.ResultsConfirmatory factor analysis indicates a good fit between the measurement and structural model of an 11-item questionnaire composed of a three-factor structure: behavioral engagement (3 items), emotional engagement (4 items), and cognitive engagement (4 items). Models in which the three latent factors were considered semi-independent provided the best fit. The construct reliabilities of behavioral, cognitive, and emotional factors were 0.82, 0.82, and 0.76, respectively. We failed however to find significant relationships between academic achievement and engagement.ConclusionsWe found a strong evidence to support the construct validity of a three-factor structure of student engagement in PBL tutorial questionnaire. Further studies are required to test the validity of this instrument in other educational settings. The predictive validity is another area needing further scrutiny.

The evaluation of the processes of problem based learning tutorials: Online or face-to-face?

Objective: The purpose of this research is to evaluate e-PBL tutorials and compare these sessions with face-to-face PBL sessions.
 Patients and Methods: This research is a program evaluation study in which quantitative methods were used. In the research, four
 90-minute e-PBL sessions held between April and June 2020 were evaluated. Sessions conducted online were realised using the sevenstep
 approach in groups of 13-14 students and a tutor. Video recordings were analysed with the thin slicing method. In addition,
 various quantitative data on evaluation were analysed using multiple tools and materials, including the end-of-program evaluation
 form. Friedman test and Mann-Whitney U test were used in the analyses of quantitative data.
 Results: Upon evaluating the analyses of the feedback received from the students about the structure, content and process of the
 program regarding the e-PBL tutorials, the students gave a positive opinion of 80% or more. In regards with the cases, the students
 had positive opinions of over 80% in terms of “motivation for learning and researching”, “daily life and its relation to their individual
 development”, “suitability to their levels of knowledge and skills”, “reinforcement of topics”. Support, guidance and feedback received
 from the tutor as a group and individually during online tutorials were statistically significantly higher than the face-to-face PBL
 tutorials (P

Effect of problem-based learning tutor seniority on medical students’ emotions: an equivalence study

BackgroundThe effectiveness of peer learning has been recognized and discussed by many scholars, and implemented in the formal curriculums of medical schools internationally. However, there is a general dearth of studies in measuring the objective outcomes in learning.MethodsWe investigated the objective effect of near-peer learning on tutee’s emotions and its equivalence within the formal curriculum of a clinical reasoning Problem Based Learning session in a Japanese medical school. Fourth-year medical students were assigned to the group tutored by 6th-year students or by faculties. The positive activating emotion, positive deactivating emotion, negative activating emotion, negative deactivating emotion, Neutral emotion were measured using the Japanese version of the Medical Emotion Scale (J-MES), and self-efficacy scores were also assessed. We calculated the mean differences of these variables between the faculty and the peer tutor groups and were statistically analyzed the equivalence of these scores. The equivalence margin was defined as a score of 0.4 for J-MES and 10.0 for the self-efficacy score, respectively.ResultsOf the 143 eligible participant students, 90 were allocated to the peer tutor group and 53 were allocated to the faculty group. There was no significant difference between the groups. The 95% confidence interval of the mean score difference for positive activating emotions (–0.22 to 0.15), positive deactivating emotions (–0.35 to 0.18), negative activating emotions (–0.20 to 0.22), negative deactivating emotions (–0.20 to 0.23), and self-efficacy (–6.83 to 5.04) were withing the predetermined equivalence margins for emotion scores, meaning that equivalence was confirmed for these variables.ConclusionsEmotional outcomes were equivalent between near-peer PBL sessions and faculty-led sessions. This comparative measurement of the emotional outcomes in near-peer learning contributes to understanding PBL in the field of medical education.

Problem-Based Learning virtual with a peer tutor in pandemic

To know the experience of first-year medical students at Universidad Austral de Chile regarding virtual Problem-Based learning (PBL) tutorials carried out by peer tutors during the second semester of 2021. Quantitative and qualitative research, transversal, descriptive. The non-probabilistic sample consisted of 45 medical students who participated in virtual PBL tutorials with peer tutors. Data collection through an anonymous and voluntary opinion survey comprised two areas: methodology and role of the tutor, considering open questions related to facilitating and hindering aspects. Quantitative data analysis was performed using descriptive statistics with frequency measurements. The qualitative ones with progressive reduction. Study approved by the Scientific Ethics Committee, Valdivia Health Service. There is a high degree of satisfaction in all three areas. Both in the qualitative and quantitative results, the participants positively value the performance of the peer tutor, highlighting empathy, commitment, trust, facilitation, feedback, and a good learning environment, allowing collaborative learning. Unlike the quantitative, the qualitative is more frequently identified as hindering factors, poor internet connection, excessive curricular load, and lack of knowledge about the methodology by the tutor. Although the preparation of peer tutors for PBL tutorials is essential, it is even more critical in virtual mode since they face challenges such as managing virtual platforms and achieving effective communication that allows learning collaboratively.

Evaluation of Problem-Based Learning in College of Medicine: An Indicator of Quality Education in a Hybrid Curriculum

Background. A culture of quality is believed to drive institutes toward excellence through feedback. Multiple surveys at educational institute help to get a deeper insight into institutional performance and curricular execution. Since problem-based learning (PBL) is an important component of the hybrid curriculum, thus stakeholders’ opinion on PBL satisfaction is worth discussing. This study intended to determine the trends in students’ satisfaction with PBL over the years and to report on the importance of curricular changes that can be incorporated based on students’ needs. Methods. This is a descriptive cross-sectional study that was conducted at the College of Medicine (COM), King Saud Bin Abdul Aziz University for Health Sciences (KSAU-HS), Jeddah, Saudi Arabia. All male and female medical students, using consecutive sampling technique, were included in the study. End-of-course evaluation reports for the academic years ranging from 2013 to 2019 on PBL satisfaction, with a response rate of ≥60%, were included in this study. Results. Overall, students at the COM, Jeddah were satisfied with PBL. A declining but satisfactory trend followed by a sharp rise in satisfaction was observed in this study. Pearson correlation reported a positive relationship between PBL problems, tutors, and PBL sessions (r = 0.82, p < 0.001 ). Conclusions. Transition from three sessions to two sessions per PBL case can be considered as an effective and efficient way of curricular execution. We found that the tutor, the case, and session dynamics were positively correlated after the incorporation of the feedback. Thus, highlighting the facts that inculcating a culture of responding to feedback can lead to innovations in medical teaching and can help to improve the curricular execution and students’ satisfaction.

Interactive Knowledge Construction in Medical Problem-Based Learning: A Corpus-Based Study

Introduction: Due to methodological limitations, process-oriented studies have analyzed a group or fragments of problem-based learning (PBL) tutorial talk. Studies that examined several PBL tutorial talk and profile talk data into linguistic categories within a mixed methods analysis are scarce. The study aims to describe the knowledge construction processes of graduate entry medical students at Derby medical school PBL hybrid curriculum in the United Kingdom.

Connecting knowledge: First-year health care students’ learning in early interprofessional tutorials

ABSTRACT Collaboration across professional boundaries is an essential aspect of health care, and interprofessional education (IPE) is a common way to help increase students’ collaborative abilities. Research on how and when IPE should be arranged in a curriculum remains, however, inconclusive. How students actually develop interprofessional competencies have been difficult to demonstrate and is still an under-researched area. Studying IPE in context is therefore important to understand its full complexity. This paper examines how students work with scenarios from professional health care contexts when learning together in interprofessional problem-based learning tutorials during the first year of undergraduate education. The data are video-recorded tutorials of students from medicine, nursing, occupational therapy, speech and language pathology, and physiotherapy programmes. The analysis focuses on students’ discussing their readings of the literature. Drawing on “Communities of Practice,” findings show that students discuss and connect professional knowledge, with “brokers” (the tutors) and “boundary objects” (scenarios) supporting the emergence of students’ professional knowledge. The scenarios, as boundary objects, also enabled the students to turn into brokers themselves. The paper contributes to research on interprofessional learning and offers support for implementing IPE in the early stages of undergraduate education.

Interactive Conversational Words as Markers of Knowledge-Negotiation in Medical Problem-Based Learning Transcripts: A Corpus-Based Study

Background: The study aims to provide a more global understanding of the knowledge-negotiation interactions occurring in problem-based learning tutorials by analysing interactive conversational words (ICWs) as structural markers of students’ interactional boundaries. Methods: We used Wmatrix 3 software to extract frequent ICWs from 253,145 word-corpus compiled from professionally transcribed transcripts of 56 first-year medical students and seven facilitators. The concordance lines of the frequent ICWs were thematically analysed to define their functions. Extracts of verbal exchanges were provided to illustrate how the knowledge negotiation unfolded. Chi-square statistics were used to quantitatively compare the ICWs frequencies across the tutorial sessions. A significant p-value was set at less than 0.05. Results: Overall, the ICWs were least prevalent in the second tutorial session. Affirmation ICWs were more prevalent than other types of ICWs across the tutorial sessions. The ICWs served seventeen frequent functions of which acknowledgement, confirming and addition predominated. The students frequently discussed subject matter content, and the discussion was of exploratory nature. There were several incomplete and sentence-completion statements. Conclusion: The corpus-based analysis provides a complementary perspective on the verbal interactions occurring in the PBL tutorials in practice. The students’ verbal exchanges were collaborative and exploratory, but the students seemed to have had turn-taking problems. The implications of the study are that the corpus-based methodology could be used to explore several PBL research questions including those previously explored non-linguistically. The PBL discourse, as a means of initiating medical students into professional practice, requires monitoring to ensure compliance with educational theory and policy

Usefulness of Clinical Lectures in First Two Years of Integrated Teaching; Student’s Perspective

Background: Integrating clinical content into problem-based learning tutorials is associated with learning motivation of undergraduate medical students. Medical students are being exposed to clinical lectures and rotations starting from 1st year in most of the medical colleges across Pakistan. Aim: To determine perspective of 1st and 2nd Year MBBS students regarding clinical lectures as part of integrated teaching. Study Design: Cross-sectional study Place and Duration of Study: HITEC Institute of Medical Sciences, Taxila from 1st July 2021 to 31st December 2021. Methodology: One hundred and seventy eight students of 1st and 2nd year were enrolled. Students who attended clinical lectures for last three months were randomly selected in this study. Structure proforma having ten items scored on five-point Likert scale was used to collect data. Data was analyzed using SPSS version 28. Frequencies were calculated for categorical variables, whereas mean and standard deviation was calculated for continuous variables (age). Results: Eighty (44.9%) were males and 98 (55.1%) were females. Ninety eight (55.1%) were from first year and 80 (44.9%) were from second year. Integration of clinical lectures in early years was reported to help in concept building by 46.6% (n=83, strongly agree) students. According to 45.5% (n=81) students, integration of clinical content makes learning interesting. Median score calculated for the participant’s perception about role of integrated teaching in stimulating interest, concept building, passing exams, ease of schedule was 4 which suggested that majority of the participants agreed to it. Conclusion: Our data showed that early clinical exposure through lectures and clinical rotation stimulates interest in learning by concept building and helps medical students to perform better in their professional examinations. Keywords: Medical education, Integrated curriculum, Early clinical exposure, Students perception

Self-assessment of active learning and critical thinking during problem-based learning: An exploratory study.

To assess whether problem-based learning enhances students' perception of their active learning and critical thinking skills with time, and to validate the self-assessment scale regarding active learning and critical thinking in the local context. The exploratory study was conducted at the Bahria University Dental College, Karachi, from February to September 2020, and comprised dental undergraduates in their first and second years of the academic programme. Data was collected using the self-assessment scale on active learning and critical thinking questionnaire which was administered twice after problem-based learning tutorials. Data was analysed using SPSS 23. There was a significant difference in the mean questionnaire scores of modules 1 and 3 of the first-year batch and modules 4 and 6 of the second-year batch (p=0.001). Cronbach's alpha value was 0.735 in the first-year cohort and 0.802 in the second-year cohort. Dental students' perception of active learning and critical thinking increased with time using problem-based learning as the tool. The self-assessment scale on active learning and critical thinking was also found validated in the local context.

Effectiveness of tutor shadowing on faculty development in problem-based learning

BackgroundTo enhance tutors’ teaching skills, tutor shadowing for novice tutors of problem-based learning (PBL) in addition to conventional faculty development (FD) was applied. This study aimed to develop a tutoring-skill scale (TS-scale) and evaluate the effect of shadowing on PBL tutors.MethodsThis study employed a before-and-after study design with three phases. In phase 1, a TS-scale was elaborated. A validity examination was performed in phase 2. Phase 3 was a study of the effectiveness using a TS-scale survey of novice PBL tutors before and after the FD course. The FD course for novice PBL tutors included an FD workshop and PBL shadowing activities.ResultsA TS-scale with a 32-item questionnaire of self-rated confidence for PBL tutors was identified in phase 1. In phase 2, 7 experienced specialists in medical education were invited to evaluate the content validity of the scale. The item content validity index (I-CVI) ranged from 0.86 to 1, and the scale-CVI (S-CVI) was 0.95. A total of 85 novice PBL tutors completed the TS-scale before the FD course, yielding a Cronbach’s alpha of 0.98. An exploratory factor analysis with varimax rotation was performed. The twenty-four items with significant loadings greater than 0.5 were incorporated into a new TS-scale and were grouped into three factors: student contact, medical expertise, and teaching expertise. In phase 3, 76 novice PBL tutors completed the 24-item TS-scale before (pretest) and after (posttest) the FD course. Their self-rated confidence improved significantly across the three factors after the FD course. The pretest and posttest scores did not differ according to the tutors’ gender, the grades they taught, or their specialty background.ConclusionsNovice PBL tutors benefit from FD that incorporates tutor shadowing in the 3 key domains of tutoring competencies. The TS-scale developed in this study can be applied in future research on FD design.

DEVELOPING PBL SCENARIO FOR ONLINE TUTORIALS

Background: Scenario is one of the three main components of Problem-based Learning (PBL) besides students and tutors. Besides being an essential component in triggering interest in learning, scenarios also affect group dynamics and academic achievement. During the COVID-19 pandemic, most of the learning process was conducted online, including PBL tutorial discussions. Distraction during online PBL learning is a challenge that must be faced so that the discussion process can achieve the learning objectives. This condition requires the commitment of tutors and students and engaging scenarios that will also help students and tutors stay focused on the discussion. This article is a recommendation based on the IAMHPE Webinar #5 on the scenario development process to support the online PBL process. This article may provide a guide in developing PBL scenarios.Recommendation: The development of PBL scenarios in pandemic conditions still needs to consider various aspects of preparing a good and immersive scenario. The steps needed are ensuring the scenario development team, determining learning objectives and tutorial issues, designing innovative scenarios, conducting reviews and improving the quality of scenarios regularly, and preparing informative tutor guides.Conclusion: Scenarios for online PBL tutorials must support the application of the four PBL principles, namely constructive, contextual, self-directed learning, and collaborative learning. Each institution needs to create scenarios that are appropriate to its learning context.

Piloting a constructive feedback model for problem-based learning in medical education.

PurposeConstructive feedback is key to successful teaching and learning. The unique characteristics of problem-based learning (PBL) tutorials require a unique feedback intervention. Based on the review of existing literature, we developed a feedback model for PBL tutorials, as an extension of the feedback facilitator guide of Mubuuke and his colleagues. This study was aimed to examine the perceptions of students and tutors on the feedback model that was piloted in PBL tutorials.MethodsThis study employed a qualitative research design. The model was tested in nine online PBL sessions, selected using the maximum variation sampling strategy based on tutors’ characteristics. All sessions were observed by the researcher. Afterwards, tutors and students in the PBL sessions were interviewed to explore their perceptions of the model.ResultsThree themes were identified based on the perceptions of the tutors and students: cognitive changes, behavioral changes, and challenges of the use of the feedback model. Both tutors and students benefited from improved cognition and behavior. However, the use of the feedback model still encountered some challenges, such as limited sources of feedback data, flexibility and adaptability of the model, content of feedback delivered, students’ characteristics and performance, tutors’ characteristics and self-perceptions, and supportive infrastructure.ConclusionThe model can be used as a reference for tutors to deliver constructive feedback during PBL tutorials. The challenges identified in using the constructive feedback model include the need for synchronized guidelines, ample time to adapt to the model, and skills training for tutors.

Nursing Students’ Perception on Tutor Performance and Students’ Critical Thinking in PBL Online

Background: The COVID-19 pandemic has influenced health education in many countries, including nursing education that moves to online learning. It has affected the tutor's performance and students' critical thinking skills, especially in online PBL tutorials. Tutor and nursing students have to re-adapt to a new online meeting atmosphere that previously had face-to-face meetings. There was no previous investigation into the effect of online PBL on tutor performance and nursing students’ critical thinking skills in UMY.Purpose: This study aims to determine students’ perceptions of tutor performance in online problem-based learning tutorials and the critical thinking skills of nursing students in UMY.Methods: This research is a cross-sectional quantitative study. The sample included 91 second-year nursing students, using the total sampling technique. The researchers used two questionnaires with closed questions about the tutor's performance in PBL tutorials and the critical thinking skills. Data were analyzed by univariate analysis. Result: The majority of respondents were female (83.5%) and 19-20 years old (91.2%). The study results showed that the tutor's performance on the online PBL tutorial was good (95.6%), while the critical thinking ability was poor (54.9%).Conclusion: This study showed that students still needed to adjust and adapt maximally to online problem-based learning tutorials and needed support and motivation to improve the quality of learning.

A processual view on the use of problem-based learning in high school physiology teaching.

In problem-based learning (PBL), the steps and processes present in the PBL tutorial cycle are essential for constructive, self-directed, collaborative, and contextual student learning. This article presents a procedural study of a PBL tutorial cycle with high school students new to the method regarding human respiration and circulation physiology. We observed group dynamics and the learning process that occurred throughout the PBL tutorial cycle. The results indicate that conceptual changes were close to the planned learning objectives and that students enjoyed studying applying PBL. Moreover, a positive correlation was observed between group dynamics, self-directed learning and learning outcomes. Our results provide grounds for restructuring the tutorial cycle, especially important for novice PBL students, such as problem reformulation and the development and diversification of applied learning scaffolds. We conclude that the qualitative analysis performed herein can yield a deeper understanding of the PBL tutorial cycle and may be used to foster PBL implementation in institutions with little experience with the method and monitor its outcomes in organizations with mature PBL use.

PBL session conducted for second year undergraduate students of medicine and dentistry at Universal College of Medical Sciences Nepal: Perception of the participants

Background and Objectives: Problem-based-learning (PBL) is generally recognized as a student centered instructional approach. Universal College of Medical Sciences Nepal introduced PBL to second year MBBS and BDS students in July 2019.This study assessed the perceptions of students of second year MBBS and BDS who participated in PBL session. 
 Material and Methods: This was a cross-sectional questionnaire-based study assessing perceptions of the participant students. The validated questionnaire was used for the collection of data at the end of PBL session. The questionnaire comprised of two parts; Part I- Students’ perceptions and attitude towards PBL (9 statements) and Part II Students’ perceptions about the role of tutor in PBL(11 statements).Data were analyzed using SPSS version 21. The frequency, mean and standard deviation were computed and t test was used for the comparison of responses on statements of MBBS and BDS groups. 
 Results: The mean scores on7 out of 9 statements on students’ perceptions and attitude towards PBL was higher than fourat Likert scale 1-5 (5=strongly agree, 4=agree, 3=to some extent agree, 2=disagree, 1=strongly disagree) and on 2 statements was higher than 3.5. The mean scores on all the statements with regard to students’ perception about the role of tutor in PBL were higher than four. The mean scores of both MBBS and BDS groups of students on all statements were compared; the significant differences were obtained only on 2 statements out of 20. 
 Conclusion: The perceptions and attitude of students towards PBL and perceptions about the role of tutor were positive.