Globalization of Problem-based Learning (PBL): Cross-cultural Implications

Systematic research on faculty attitudes toward problem-based learning (PBL) has focused exclusively on the opinions of tutors. The purpose of the present study was to examine the attitudes of faculty at a single medical school who either (1) did not participate in the first year of a new PBL curriculum or (2) participated in ways other than as PBL tutors. In 1993-94, at the end of the first year of a new PBL curriculum, a questionnaire used in an earlier, larger study of PBL tutors was sent to all 494 faculty at the University of Missouri-Columbia School of Medicine. The response rate was better for participants (76%, 115 of 151) than for non-participants (28%, 96 of 343). Overall, nonparticipants judged the new curriculum to be approximately equal to the "old" curriculum that preceded it. In contrast, participants were significantly more positive and judged the new PBL curriculum to be superior in most respects. For both groups the new curriculum received its highest ratings in the areas of student interest, clinical preparation, and medical reasoning and its lowest ratings in the teaching of factual knowledge in the basic sciences and efficiency of learning. The attitudes of participating faculty varied with their teaching roles in the new curriculum. Those whose primary roles were as PBL tutors or as leaders of other small discussion groups were more favorable to the new curriculum than those who primarily served as lecturers. Faculty who served in several different roles were more positive than faculty who served in only one role. There were also plausible qualitative differences among the teaching-role groups in what they liked and disliked about the new curriculum. In general, the attitudes and opinions of the faculty varied with the degrees and types of participation in the new curriculum. The attitudes and opinions of faculty with different teaching roles were plausibly related to differences in these roles. The opinions of the faculty about the strengths and weaknesses of PBL that emerged in this survey are much like those found in prior research. In addition, student performances on Step 1 of the United States Medical Licensing Examination suggest that the faculty may have underestimated the value of the new PBL curriculum for helping students acquire factual knowledge in the basic sciences.

This meta-analytic study 1) examines outcomes from primary research comparing the impact of problem-based learning (PBL) and traditional curricula on medical students' National Board of Medical Examiners (NBME) I and II performance and 2) explores the use of Hierarchical Linear Modeling (HLM) in identifying study and PBL implementation characteristics that predict these outcomes. NBME I and II overall scores were used as dependent variables, with study design (randomized/non-randomized), publication year, and PBL experience (number of years since the adoption of PBL as an instructional method at the time of the reported NBME results) as explanatory variables. Initial unconditional HLM (i.e., without inclusion of potential explanatory variables) results indicated PBL curricula had: 1) a positive, albeit not statistically significant, effect on NBME II, with an average effect size of 0.16; and 2) a negative effect on NBME I, with an average effect size of -0.15. Including explanatory variables in HLM analyses explained additional variability in NBME I effect sizes, and identified study design (gamma^1 = 0.82, p = 0.01) and PBL experience (gamma^3 = 0.07, p = 0.02) as significant predictors of positive PBL effects. Publication year, in contrast, had significant negative effects (gamma^2 = -0.06, p = 0.02). This study explained variability in NBME I effect sizes and clarified the impact of PBL discerned in previous reviews. Implications for future research include the need to examine curriculum features that operationally define PBL, as well as extend the consideration of outcomes on which PBL's impact can be examined.

BackgroundLifelong learning is integral to providing safe and effective healthcare. This requires effective strategies for self-regulated learning (SRL). Problem-based learning (PBL) is one recognized method for fostering SRL skills. While self-assessment is known to promote SRL, its effectiveness within PBL tutorials, especially for new medical students, remains underexplored. Given the established evidence of self-assessment’s impact on SRL, this study examines its role specifically within PBL to explore whether it enhances self-regulatory processes in novice learners.MethodsUsing a post-positivist approach, a multi-method study was conducted, with Zimmerman’s SRL framework as a theoretical lens. A correlation analysis assessed the relationship between self-assessment and SRL. A pre-test post-test interventional study without a control group measured changes in SRL following implementation of self-assessment. Hierarchical multiple regression analysis was conducted to assess whether self-assessment predict students’ self-regulated learning improvement. The intervention used a previously validated tool the “Self-assessment Scale for Active learning and Critical Thinking (SSACT).” Additionally, qualitative methods explored the impact of self-assessment on SRL skills in the PBL tutorial context.ResultsOur findings indicate a positive correlation between self-assessment and SRL, suggesting a potential dynamic relationship between the two constructs. The students’ motivation after implementation of self-assessment is significantly increased. Self-assessment played a crucial role on the development of students’ self-regulated learning. Qualitative analysis reveals that self-assessment contributes to heightened self-awareness, goal orientation, and effective task planning among medical students in PBL tutorials. Furthermore, the provision of external feedback and revision opportunities enhanced students’ self-regulation in the learning process.ConclusionThis study sheds light on the promising role of self-assessment in augmenting SRL skills among novice medical students within PBL settings. The findings underscore the potential of self-assessment as a valuable tool to cultivate self-regulation. By bridging the gap in understanding the impact of self-assessment on SRL within PBL, this research not only contributes valuable insights but also informs the design of effective educational interventions. The use of a validated self-assessment tool can empower medical learners to develop the crucial skill of self-regulation, thereby enhancing their overall educational experience.

Problem-Based Learning Curriculum as a Tool to Increase Medical Student Exposure to Radiation Oncology

Problem-based Learning and Task-based Learning: A Practical Synthesis

Many medical schools are shifting to a problem-based learning (PBL) curriculum, some without any transition period, others using periods of parallel-track curricula. The authors report on and discuss a third strategy for implementing PBL: using a pilot course as a model to facilitate the transition. After the Université de Montréal Faculty of Medicine chose to switch PBL, one course in the third year of the traditional curriculum was changed to PBL format 11 months before the new curriculum was to start in September 1993. This was done to develop local expertise, to gain confidence, to test the feasibility of the method, to produce a showcase, to assess more accurately the resources required, and to provide a practice ground for the curriculum planners and managers and the faculty-development training team. The authors discuss the planning of the pilot course, the training of the faculty in various aspects of PBL (writing problems, tutoring methods, etc.), the course implementation, and the course evaluation. Overall, the pilot course was well received by both the faculty and the students and provided much beneficial information that assisted the university in its transition to a new PBL curriculum.

Status of Medical Education Reform at Saga Medical School 5 Years After Introducing PBL

Background: Teaching and learning are fundamentally different between conventional and problem based learning (PBL) curricula. There is a transformation in the College of Medicine, Taibah University, Saudi Arabia (CMTU) from the conventional to a PBL curriculum. Aim: To compare students’ approaches to learning and their perception of learning environment between conventional and PBL curricula at CMTU. Method: A cross sectional study was conducted through a self-administered questionnaire on a convenience sample from the third year undergraduate male and female medical students enrolled in both PBL and conventional curricula during the academic year 2015- 2016. Students' approaches to learning and perception of learning environment were measured using the “Approaches and Study Skills Inventory for Students (ASSIST)” and the “Dundee Ready Education Environment Measure (DREEM)” instruments, respectively. Results: A total of 101 questionnaires (49 (48.5%) and 52 (51.5%) from traditional and PBL curricula, respectively) were analyzed. When compared to conventional curriculum students, PBL curriculum students showed a significantly higher overall DREEM (136.98 ±21.45 vs. 111.59 ±27.93; p <0.001) as well as all its subscales. Significantly higher ratings for strategic approach towards learning (60.77 ±9.12 vs. 56.35 ±9.93; p=0.02) and net learning orientation (deep approach + strategic approach - surface apathetic approach; 85.60 ±17.32 vs. 77.76 ±20.63; p=0.04) were seen in PBL curriculum students. Conclusion: The transformation to a PBL curriculum at CMTU was accompanied by a tilt in the learning style towards a desired deep and strategic learning styles and a definite improvement in the perception of learning environment among students.

Phenomenon: In recent decades, medical education practices developed in Western countries have been widely adopted in non-Western countries. Problem-based Learning (PBL) was first developed in North America and it relies on Western educational and cultural values, thereby raising concerns about its ‘lift and shift’ to non-Western settings. Approach: This review systematically identified and interpretively synthesized studies on students’ and teachers’ experiences of PBL in non-Western medical schools. Three databases (ERIC, PsycINFO, and MEDLINE) were searched. Forty-one articles were assessed for quality using the Critical Appraisal Skills Program (CASP) checklist and synthesized using meta-ethnography. The final synthesis represented over 5,400 participants from 18 countries. Findings: Findings were categorized into three different constructs: Student Engagement, Tutor Skills, and Organization and Planning. Our synthesis demonstrates that medical students and teachers in non-Western countries have varied experiences of PBL. Students engage variably with PBL, consider knowledge to be better acquired from authoritative figures, and deem PBL to be ineffective for assessment preparation. Student participation is limited by linguistic challenges when they are not native English speakers. Teachers are often unfamiliar with the underlying philosophical assumptions of PBL and struggle with the facilitation style needed. Both students and teachers have developed modifications to ensure that PBL better fits in their local settings. Insights: Given the significant adjustments and resource requirements needed to adopt PBL, medical school leaders and policy makers in non-Western countries should carefully consider possible consequences of its implementation for their students and teachers, and proactively consider ways to ‘hybridize’ it for local contexts.

In 1969, the McMaster Medical School in Canada was the first to assert that students could learn basic science content without sitting in a lecture hall 8 hours a day for 2 years. The medical school transformed the curriculum so that small-group problem-based learning (PBL) tutorials, with a trained faculty member, became the forum for content enquiry, shared learning, and knowledge transfer. Time spent in passive learning environments, such as lectures, took a back seat to problem-focused, learner-centred, enquiry-based small-group discussions (Barrows & Tamblyn, 1980). It was not until 1985, when Harvard Medical School made the bold decision to revise its curriculum to reflect a hybrid model which involved limited lecture and laboratory time balanced with problem-based learning tutorials (Moore, 1994; Wilkerson, Steven, & Krasne, 2009), that many medical schools worldwide began adopting a problem-based pedagogical approach to address knowledge integration across courses and years (Cooke, Irby, Sullivan, & Ludmerer, 2006; Harden, Sowden, & Dunn, 1984; Irby and Wilkerson, 2003; Woods, 2007). In 2005, Kincade estimated that, in the United States, 70% of all medical schools had implemented PBL to some degree. It is precisely because of this “prevailing trend in basic science curriculum change around the world . . . towards integration, both horizontally among disciplines and vertically, between basic and clinical sciences, often including PBL as an integrative function” (Wilkerson et al., 2009, p. 813) that innovative case design and delivery methods are a top priority.

Although problem-based learning (PBL) has been widely used in medical schools, few studies have attended to the assessment of PBL processes using validated instruments. This study examined reliability and validity for an instrument assessing PBL performance in four domains: Problem Solving, Use of Information, Group Process, and Professionalism. Two cohorts of medical students (N = 310) participated in the study, with 2 years of PBL evaluation data extracted from archive rated by a total of 158 faculty raters. Analyses based on generalizability theory were conducted for reliability examination. Validity was examined through following the Standards for Educational and Psychological Testing to evaluate content validity, response processes, construct validity, predictive validity, and the relationship to the variable of training. For construct validity, correlations of PBL scores with six other outcome measures were examined, including Medical College Admission Test, United States Medical Licensing Examination (USMLE) Step 1, National Board of Medical Examiners (NBME) Comprehensive Basic Science Examination, NBME Comprehensive Clinical Science Examination, Clinical Performance Examination, and USMLE Step 2 Clinical Knowledge. Predictive validity was examined by using PBL scores to predict five medical school outcomes. The highest percentage of PBL total score variance was associated with students (60 %), indicating students in the study differed in their PBL performance. The generalizability and dependability coefficients were moderately high (Ep(2) = .68, ϕ = .60), showing the instrument is reliable for ranking students and identifying competent PBL performers. The patterns of correlations between PBL domain scores and the outcome measures partially support construct validity. PBL performance ratings as a whole significantly (p < .01) predicted all the major medical school achievements. The second year PBL scores were significantly higher than those of the first year, indicating a training effect. Psychometric findings provided support for reliability and many aspects of validity of PBL performance assessment using the instrument.

Problem-based learning (PBL) is a learner-centred approach “that empowers learners to conduct research, integrate theory and practice, and apply knowledge and skills to develop a viable solution to a defined problem” (Savery, 2006, p. 12). Thus, the PBL classes differ pedagogically from traditional teacher-led classes. This learner-centred pedagogy, which was originally developed in medical education at a Canadian university in the late 1960s, was first incorporated into a tertiary-level curriculum in Japan in 1990. Since its initiation, 75 Japanese medical schools (94%) have adopted the PBL approach in their curriculum. Notwithstanding the great interest in using PBL in Japanese medical education, there is little qualitative research on the cultural dimensions of students’ participation in PBL tutorials.&#13;\n&#13;\nThis study explored these issues by providing a close examination of classroom discourse and students’ introspection on their learning in PBL tutorials. In this qualitative case study, nine focal students and 36 of their group members, all of whom were first-year undergraduate students at a Japanese university, were selected as the main research participants. Data were collected over an entire academic year through classroom observations, video-recordings of PBL tutorials and interviews. Analysis of the classroom interactions involved the application of classroom discourse analysis (Eggins &amp; Slade, 1997; Sinclair &amp; Coulthard, 1975; Tsui, 1994). Moreover, interview data were analyzed by following a Grounded Theory approach (Strauss &amp; Corbin, 1998) to provide further insights into their changing thoughts during their ongoing participation.&#13;\n&#13;\nGrounded in the notion of community of practice (Lave &amp; Wenger, 1991; Wenger, 1998), this study examined the cultural dimensions of Japanese students’ participation in PBL tutorials. In particular, it focused on gaining a better understanding of what they actually do in the discussions, identifying factors mediating their participation and examining the relationships between their actual engagement and thoughts in the tutorials. In this study, there was considerable variation amongst the Japanese students in the ways they participated in and responded to PBL practices. Furthermore, this study demonstrated that their participation was mediated by their cultural assumptions, recognition of competence, negotiation of power relations and identity formation as a group member in the social context of PBL tutorials. Therefore, Japanese students cannot simply be categorized into quiet, passive and dependent learners. Rather, their ongoing participation in PBL tutorials is situated in the specific cultural context. The findings suggest that exploring the cultural dimensions of students’ participation and negotiation of identities, power relations and competence provides a broad view of their learning, including their ways of knowing, doing and being a member in a context of student-centered classroom.&#13;\nThis study concluded that the inquiry into Japanese students’ participation contributed to our understanding of the processes of students’ learning and the social and cultural factors mediating their participation in a new classroom community. In particular, the mere adoption of a certain approach of learning will not bring about positive learning outcomes. It should be noted that students’ participation in a new classroom context involves complex, dynamic, social and cultural processes.

BackgroundProblem-based learning (PBL) involves discussions among students who resolve loosely-structured problems to facilitate learning. In the PBL curriculum, faculty tutors are employed as facilitators for small groups of students. Because of lack of time and staff shortage, the effectiveness of tutorless PBL has been discussed as an alternate option.MethodsSessions in which tutored and tutorless PBL groups are mixed were presented by 1st-year medical students, who experienced both tutored and tutorless groups alternately in the two sessions of a year. To examine the effectiveness of tutored and tutorless PBL, written examination scores (WES) and self-contentment scores (SCS) were statistically analysed.ResultsWES averages did not significantly differ between the tutored and tutorless groups; however, a significantly greater variation was observed in WES in the tutorless group. SCS averages tended to be higher in the tutored PBL than in tutorless PBL groups.ConclusionsStudents in these tutorless PBL groups performed well in their written examinations, whereas those in the tutored PBL groups, achieved this and reported better self-contentment with their learning experience. Tutorless PBL sessions were considered to be comparable to tutored PBL sessions at least in the early stages.

Background: Coaching is a form of supervision which is about unlocking a person’s potential to maximize own performance. Recently, medical education has been bringing such one-to-one developmental activities to the fore. Objective: Is to explore opinions of experts and leaders in a PBL medical school about coaching as a method for students and faculty development. Methods: This is a qualitative study conducted in the Faculty of Medicine, Suez Canal University (FOM-SCU); a Problem-Based Learning (PBL) college in Egypt. A focus group discussion was conducted with 10 faculty members in the Medical Education Department. In addition, interviews were held with 5 faculty members in leadership positions. All sessions were audio recorded then transcribed verbatim. Data were organized around the themes: applications of coaching in medical education, potential benefits, expected outcomes and challenges. Results: Coaching is perceived as applicable within context of the PBL curriculum of FOM-SCU. To institute coaching as an efficient developmental tool, a lot of efforts are still indicated. Furthermore, coaching can comprise a set of other already existing developmental activities in the PBL curriculum. Resistance to change and lack of resources are the most anticipated challenges. Conclusion: Innovative curricula more receptive for coaching. The major against developing a coaching culture are resistance to change and shortage of financial resources.

Problem-based learning (PBL) has emerged as an important alternative or supplement to traditional lecture methods of teaching. In a PBL setting, student teams face challenging situations or cases, and the teams are expected to develop and recommend solutions. This article discusses the application of PBL to a class of 100 students enrolled in a required course in hospitality law. The case that was used involved a resort housekeeper being sexually harassed by a maintenance worker. The article reports on the experience with PBL, including problems, student evaluations, and recommendations for future PBL endeavors. Times change, and what were effective teaching methods may no longer be as effective with today's college students. The lecture method has been fundamental to higher education in the United States. The method is particularly helpful in delivering information to large numbers of students. From an efficiency standpoint, what could be better than one professor teaching a hundred or more students in one class? Problem-based learning (PBL) has emerged in educational circles as an important alternative to or supplement to lecturing. PBL engages students by confronting them with problems that they must resolve through analysis, the discovery of relevant information, and the application of that information. Students become active learners in a PBL setting, whereas students are expected to be passive in a lecture setting. This article reports on an experiment using problem-based learning to teach a required undergraduate course in hospitality law. The discussion begins with a review of the literature on PBL and then proceeds to discuss the background that led to the experiment. The article explains the overall course structure, including how problem-based learning was incorporated into a class of approximately 100 students. The problem-based learning portion utilized a web-based case set at a fictional resort. As is explained in the article, the students had two major sets of assignments based on the case spread out over fall semester 2001. The discussion concludes with an analysis of pre- and post-surveys of the students and a critique of various problems that were encountered. Recommendations for the future are included.