Problem-based learning and digital platforms in medical education

INTRODUCTION: Problem based learning (PBL) has many benefits; however, research on PBL indicates that students are not quite good at integrating knowledge in basic sciences and clinical aspects. Case-based learning (CBL) might be an alternative method to enhance the integration of this knowledge. No research explored the way these two methods stimulate cognitive skills. This study aimed to explore the differences between PBL and CBL in stimulating cognitive skill by analyzing verbal interaction. MATERIALS AND METHODS: This descriptive research was performed at the Faculty of Medicine, Universitas Islam Indonesia (FM UII). Twenty-one undergraduate students contributed voluntarily to this study. The students were then split up randomly into a PBL Group (n=10) and a CBL group (n=11). Each group performed twice discussion meetings facilitated by an experienced tutor. The discussion processes were video recorded and analyzed using a coding scheme categorizing the verbal interaction into five types: cumulative reasoning, exploratory questioning, procedural interaction, handling conflict about knowledge, off-task/ irrelevant interactions. RESULTS: Students in both PBL and CBL groups spent most of their time-sharing cumulative reasoning and then asking exploratory question. Students in the PBL group were more frequently asking exploratory questions. Students in both groups rarely handled conflict about knowledge since it was a high order thinking skill. Students in the CBL group were more frequent than the PBL group in performing procedural interaction. CONCLUSIONS: Students performed various cognitive skills in both PBL and CBL. Each method has its own strengths in stimulating reasoning skills of students.

Background:Medical students are prone to burnout, and several stressors have been associated with it. From the literature, it is yet unclear if type of curricula in medical schools plays a role in burnout among students.Aims:To assess the prevalence of burnout and its associated stressors in medical students in problem-based learning and traditional curricula at Imam Abdulrahman Bin Faisal University.Subjects and Methods:The analytical, cross-sectional study was conducted between February and May 2017 and included all third- to sixth-year medical students of Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia. In the 2016–2017 academic year, third- and fourth-year students were in problem-based learning, whereas fifth- and sixth-year students were in traditional learning. All eligible students were verbally invited to complete a 56-item questionnaire comprising three sections eliciting sociodemographic information, level of burnout (using a modified Copenhagen Burnout Inventory with personal, medical school- and faculty-related subsections) and stressors associated with burnout. Burnout was measured using a Likert-type scale, and scores of >50 were considered as high burnout. Chi-square and logistic regression analysis were used for statistical analysis.Results:Of 947 eligible students, 593 (62.6%) completed the questionnaire: 317 (53.5%) were in problem-based learning and 276 (46.5%) in traditional learning. Of these, 329 (55.5%) had high burnout, with no difference between type of curricula (problem-based learning = 178 [56.2%]; traditional = 151 [54.7%]; P = 0.73). All measured stressors were significantly associated with high burnout, including lack of sleep (odds ratio [OR] = 2.139, P = 0.005) and perceiving teaching staff as inflexible and unsupportive (OR = 2.995, P < 0.001).Conclusions:This study found high prevalence of burnout among medical students in a university from Saudi Arabia, but no significant difference between students in problem-based learning and traditional curricula. A longitudinal study is recommended to better understand the long-term effect of type of curricula on burnout.

The effects of problem-based learning (PBL) were examined by conducting a meta-analysis-type review of the English-language international literature from 1972 to 1992. Compared with conventional instruction, PBL, as suggested by the findings, is more nurturing and enjoyable; PBL graduates perform as well, and sometimes better, on clinical examinations and faculty evaluations; and they are more likely to enter family medicine. Further, faculty tend to enjoy teaching using PBL. However, PBL students in a few instances scored lower on basic sciences examinations and viewed themselves as less well prepared in the basic sciences than were their conventionally trained counterparts. PBL graduates tended to engage in backward reasoning rather than the forward reasoning experts engage in, and there appeared to be gaps in their cognitive knowledge base that could affect practice outcomes. The costs of PBL may slow its implementation in schools with class sizes larger than 100. While weaknesses in the criteria used to assess the outcomes of PBL and general weaknesses in study design limit the confidence one can give conclusions drawn from the literature, the authors recommend that caution be exercised in making comprehensive, curriculum-wide conversions to PBL until more is learned about (1) the extent to which faculty should direct students throughout medical training, (2) PBL methods that are less costly, (3) cognitive-processing weaknesses shown by PBL students, and (4) the apparent high resource utilization by PBL graduates.

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

The influence of problem-based learning (PBL) and open-book tests on long-term knowledge retention is unclear and subject of discussion. Hypotheses were that PBL as well as open-book tests positively affect long-term knowledge retention. Four progress test results of fifth and sixth-year medical students (n = 1,648) of three medical schools were analyzed. Two schools had PBL driven curricula, and the third one had a traditional curriculum (TC). One of the PBL schools (PBLob) used a combination of open-book (assessing backup knowledge) and closed-book tests (assessing core knowledge); the other two schools (TC and PBLcb) only used closed-book tests. The items of the progress tests were divided into core and backup knowledge. T tests (with Bonferroni correction) were used to analyze differences between curricula. PBL students performed significantly better than TC students on core knowledge (average effect size (av ES) = 0.37–0.74) and PBL students tested with open-book tests scored somewhat higher than PBL students tested without such tests (av ES = 0.23–0.30). Concerning backup knowledge, no differences were found between the scores of the three curricula. Students of the two PBL curricula showed a substantially better long-term knowledge retention than TC students. PBLob students performed somewhat better on core knowledge than PBLcb students. These outcomes suggest that a problem-based instructional approach in particular can stimulate long-term knowledge retention. Distinguishing knowledge into core and backup knowledge and using open-book tests alongside closed-book tests could enhance long-term core knowledge retention.

Traditional learning and problem-based learning: Self-perception of preparedness for internship

The recent trend in medical education has been toward problem-based learning (PBL) and performance-based testing. An attractive alternative to traditional lecture-based instruction, problem-based learning emphasizes knowledge acquisition and its application in the clinical setting. In conjunction, performance-based testing offers a means of assessing student performance that measures not only the mastery of factual information, but also the application of knowledge in solving clinical problems often encountered in patient care. Since the installation of an undergraduate PBL surgery clerkship at the University of Kentucky (UKY) in 1989, several studies have shown that the performance of PBL students equals or exceeds that of students in lecture-based instruction on tests of factual knowledge. More importantly, PBL students perform significantly better on examinations designed to measure the clinical application of knowledge. The UKY studies also show that PBL students develop better clinical reasoning skills, increase their medical knowledge base significantly, and learn important time-management skills during the course of their PBL instruction. Moreover, the UKY data reveal clearly that performance-based testing provides an accurate and reliable method of assessing areas of student learning that traditional testing techniques (i.e. multiple-choice tests) fail to evaluate adequately.

The increasing use of mobile devices among health sciences students presents both opportunities and challenges to problem-based learning (PBL) in face-to-face tutorials and during self-directed learning. The purpose of the present study was to find out how common the use of mobile devices is among students in PBL, how they are used, and whether some general recommendations can be made to help students make more effective use of mobile devices during PBL. Based on the findings of focus interviews of students and facilitators (Chan et al., 2015), the authors developed a self-administered online questionnaire to examine students’ usage of mobile devices in PBL. The students from three healthcare professional programmes in a university in Hong Kong were invited to take part in the online survey. A total of 346 students (response rate of 31.89 %) completed the online questionnaire. It was found that almost all of them (99 %) own one or more mobile devices. Most of them (98 %) used their mobile devices in PBL, usually for educational purposes, such as the search and synthesis of information and the use of specific software on these devices, especially those for the visualization of knowledge (like atlases or software for creation of concept maps). There was a small percentage of students who never used mobile devices in PBL. The reasons included the facilitators’ explicit discouragement of their use, and the desire to focus on the discussion instead of searching for information. Based on the findings of the survey, the authors arrived at four recommendations aiming at more effective use of mobile devices in PBL: students should be free to choose to use mobile devices; mobile devices should be used for educational purposes only, such as the search for factual information or multimedia files; PBL tutorial time should mostly be spent on discussion, instead of searching for information; students should be encouraged to use cloud-based services for collaborative activities such as note-making and concept mapping in PBL.

This study explored 1) whether there were any differences in the way medical students used library resources under problem-based learning (PBL) and scenario-based learning (SBL) curricula; and 2) what improvements the library could make to facilitate its use by medical students using the different curricula. Twenty medical students selected from two different medical universities in different countries were interviewed in depth. The study found that a) PBL and SBL students used the library significantly differently; b) SBL students presented a wider range of demands and behaviors in seeking information; c) more PBL students preferred using solely electronic resources to solve PBL problems; and d) more SBL students preferred using textbooks in their study and to solve the problems. It is concluded that the characteristics of the two learning approaches affect the medical students in their uses of library resources. The library staff must interact differently with students depending on the curriculum they are following. The study suggests several directions (‘SHELTER’) to the library and recommends it to provide service targeting students’ needs after exploring the following three dimensions of the curriculum: students’ perceptions of the library’s collection related to the curriculum, course requirements for gathering information, and the librarian’s role in the curriculum. When new reforms are initiated it is necessary for the library to undertake a comprehensive review and to gain understanding of the curriculum at the outset.

Problem-based learning (PBL) has been shown to be effective for promoting student competencies in self-directed and collaborative learning, critical thinking, self-reflection and tackling novel situations. However, the need for face-to-face interactions at the same place and time severely limits the potential of traditional PBL. The requirements of space and for meeting at a specific location at the same time create timetabling difficulties. Such limitations need to be tackled before all potentials of PBL learning can be realized. The present study aimed at designing and implementing an online PBL environment for undergraduate speech/language pathology students, and assessing the associated pedagogical effectiveness. A group of eight PBL students were randomly selected to participate in the study. They underwent 4 weeks of online PBL using Adobe Connect. Upon completion of the experiment, they were assessed via a self-reported questionnaire and quantitative comparison with traditional PBL students based on the same written assignment. The questionnaire revealed that all participating students enjoyed online PBL, without any perceived negative effects on learning. Online PBL unanimously saved the students travel time to and from school. Statistical analysis indicated no significant difference in assignment grades between the online and traditional PBL groups, indicating that online PBL learning appears to be similarly effective as traditional face-to-face PBL learning.

We present an initial experiment in the teaching of haematology using the problem-based learning technique in the third year of medicine at the Bobigny Faculty of Medicine (Université Paris-Nord). This new approach to the clinical and bioclinical teaching of medicine is used in several hundred medical faculties throughout the world. It is based on students' integrated learning of concepts (scientific, clinical, psycho-social) through patient problems. The method alternates group meetings with a tutor and individual learning. Sixty-eight students with no previous training in haematology and eight tutors (eight groups) took part in this experiment, which lasted five weeks (with no other teaching) and enabled them to study ten patient problems representing the bulk of the objectives pursued in this discipline. The preparation of students and teachers for this experiment is described, as well as its conduct and the results obtained. These show that the problem-based learning students performed better in their clinical problem-solving examinations than did students from a previous year who had been taught using traditional methods for the same period of time. The comparison does not indicate, however, that problem-based learning students had any advantage in the acquisition of factual information. The high degree of satisfaction of the students beginning their third year and of tutors in respect of this experiment constitutes a very favourable point. The limitations of the experiment and the teaching method itself are also discussed.

Este estudo tem por objetivo investigar o aproveitamento dos estudantes do Curso de Engenharia Civil em que foi aplicado o método Aprendizagem Baseada em Problemas – Problem Based Learning (PBL) como parte de inovações pedagógicas implementadas em uma disciplina de Engenharia de Transportes. Para analisar o aproveitamento da amostra submetida às alternativas instrucionais foram utilizadas as respostas dos estudantes a um questionário para avaliação do aprendizado, elaborado pelo professor. Este instrumento contribuiu para avaliar e comparar o aprendizado da amostra com uma turma de alunos submetida ao modelo tradicional de ensino. As respostas foram agrupadas e analisadas por meio de mapas cognitivos, contribuindo para a investigação dos efeitos do método PBL e da ocorrência de aproveitamentos diferenciados entre os alunos. Os resultados indicam que os estudantes obtiveram maior envolvimento, desenvolvimento de comportamentos e atitudes, comprometimento com a própria aprendizagem e um aproveitamento significativamente melhor com o novo desenho da disciplina.Palavras-chaveAprendizagem Baseada em Problemas; Mapas cognitivos; Ensino; Avaliação

BackgroundIdentification and assessment of professional competencies for medical students is challenging. We have recently developed an instrument for assessing the essential professional competencies for medical students in Problem-Based Learning (PBL) programs by PBL tutors. This study aims to evaluate the reliability and validity of professional competency scores of medical students using this instrument in PBL tutorials.MethodsEach group of seven to eight students in PBL tutorials (Year 2, n = 46) were assessed independently by two faculty members. Each tutor assessed students in his/her group every five weeks on four occasions. The instrument consists of ten items, which measure three main competency domains: interpersonal, cognitive and professional behavior. Each item is scored using a five-point Likert scale (1 = poor, 5 = exceptional). Reliability of professional competencies scores was calculated using G-theory with raters nested in occasions. Furthermore, criterion-related validity was measured by testing the correlations with students’ scores in written examination.ResultsThe overall generalizability coefficient (G) of the professional competency scores was 0.80. Students’ professional competencies scores (universe scores) accounted for 27% of the total variance across all score comparisons. The variance due to occasions accounted for 10%, while the student-occasion interaction was zero. The variance due to raters to occasions represented 8% of the total variance, and the remaining 55% of the variance was due to unexplained sources of error. The highest reliability measured was the interpersonal domain (G = 0.84) and the lowest reliability was the professional behavior domain (G = 0.76). Results from the decision (D) study suggested that an adequate dependability (G = 0.71) can be achieved by using one rater for five occasions. Furthermore, there was a positive correlation between the written examination scores and cognitive competencies scores (r = 0.46, P < 0.01), but not with the other two competency domains (interpersonal and professionalism).ConclusionsThis study demonstrates that professional competency assessment scores of medical students in PBL tutorials have an acceptable reliability. Further studies for validating the instrument are required before using it for summative evaluation of students by PBL tutors.

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.

Critical thinking plays a crucial role in the learning process. Critical thinking should become the focus of learning since it encourages the development of knowledge and includes the act of contemplating subjects, content, and problems. The current study aimed to investigate the effectiveness of Problem-Based Learning (PBL) and Digital Mind Maps-Integrated PBL (DMM-Integrated PBL) in improving students’ critical thinking. This quasi-experiment study employed a pretest-posttest control group design, involving 103 university students from the Biology Department of University in Riau, Indonesia, as the sample. The details of each group consist of 31 students in conventional, PBL (37 students), and DMM-Integrated PBL (35 students) classes. The research data was collected using an essay test. The data obtained were analyzed using ANCOVA at a significance level of 5% and an LSD test. Essay test developed based on critical thinking indicators: basic clarification, bases for a decision, inference, advanced clarification, supposition and integration, and strategies and tactics. All the instruments had been validated. The ANCOVA analysis results proved that PBL and DMM-Integrated PBL affected the students' critical thinking. However, the LSD test showed no significant difference between PBL and DMM-Integrated PBL in promoting students' critical thinking. Finally, to promote students’ critical thinking, educators are recommended to use PBL or DMM-Integrated PBL in the classroom.