Problem-Based Learning virtual with a peer tutor in pandemic

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.
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\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 & Slade, 1997; Sinclair & Coulthard, 1975; Tsui, 1994). Moreover, interview data were analyzed by following a Grounded Theory approach (Strauss & Corbin, 1998) to provide further insights into their changing thoughts during their ongoing participation.
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\nGrounded in the notion of community of practice (Lave & 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.
\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.

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

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.

Male and female students behave differently in problem-based learning (PBL) tutorials. However, these differences could be partly attributed to faculty tutor behavior in male and female tutorials. This study aims to examine the gender differences in learning outcomes between medical students when peer tutors facilitate PBL tutorials. A questionnaire-based study conducted in single-gender student-led (SLT) and faculty-led (FLT) tutorials. The study involved third year medical students (n = 91) divided into ten groups (five groups each). The SLT groups consisted of 16 male and 28 female students, while the FLT group consisted of 20 male and 27 female students. Students evaluated their individual and group performance in tutorials and also skills of tutors. Student performance in end-unit examinations and their perceptions about peer tutoring were also analyzed. A total of 290 questionnaires (response rate = 63.7%) were collected over the five-week period of the study. Although individual performance in tutorials and achievement in examinations were comparable in both groups, there was significantly higher group performance in female compared with male student-led tutorials (p < 0.01). This difference between male and female groups was not attributed to improvement in the performance of female groups, but rather to a decline in performance of the male SLT groups. In addition, both male and female students expressed facing difficulties in discussion and analysis of the problem in the first tutorial session. Understanding the gender differences in the group behavior in student-led tutorials is important for PBL programs adopting this approach.

Objective: In order to address well-known challenges in dementia care, an inter-professional course was developed to improve medical students’ and nursing students’ competencies in the provision of evidence-based care for people with dementia. The course comprises lectures, problem-based learning (PbL) tutorials and visitations to care facilities. A pilot study was conducted to evaluate the acceptance and feasibility of the inter-professional course.Methodology: Alongside preliminary implementation of the newly developed course, a pre-post survey was carried out involving all participating students. The questionnaire contained standardized and open-ended questions on participants’ views regarding the quality and relevance of several course components and characteristics. The data were analyzed by means of descriptive statistics.Results: When the course was offered the first time, multiple barriers became evident, leading to premature course termination and subsequent revision of the curriculum. When the revised course was offered, 10 medical students and 8 nursing students participated. The course proved feasible, and the median overall quality was rated as “2” (IQR 2–3) at a rating scale ranging from 1 (very good) to 6 (inadequate). Following aspects were most frequently judged positively: the course’s inter-professional scope, the visitations to care facilities and the PbL tutorials. Potential for improvement was particularly noted with regard to a more distinct focus on well-defined, mainly practical learning outcomes. There were no indications of systematic between-group differences in the medical and nursing students’ perceptions of the course program.Conclusions: The results confirmed the feasibility of the inter-professional course on dementia care and the relevance of its inter-professional scope. However, to ensure sustainable course implementation in the long term, further program adaptations based on current findings and further evaluation studies focusing on objective parameters of the process and outcome quality are required.

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.

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.

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.

Problem-based learning (PBL) appears to have a potentially long-lasting impact on self-directed learning. Especially in hybrid PBL programs the quality of student learning seems to depend on PBL tutors being effective in their role. From our hybrid curriculum at Hamburg medical school 60 PBL tutorial groups including 495 students were investigated in 2007 from three perspectives: trained auditors observed the tutorial groups, and their PBL tutors and the participating students answered standardized questionnaires. Groups taught always by the same tutor during the whole term felt more satisfied with their tutor than groups with substitute tutors. Students with male tutors stated more frequently that they benefited from their tutorial. Students with a tutor who did not wear hospital clothing felt much more comfortable in their tutorial group. Tutors, students, and curricular planners need to regularly review the PBL tutorial process to improve the learning outcome.

Research has shown that educators may be reluctant to implement group work in their teaching due to concerns about students partaking in off-task behaviours. However, such off-task interactions have been shown to promote motivation, trust, and rapport-building. This paper details a study in which student groups were video recorded as they engaged in problem-based learning tutorials, with the aim of examining the social interaction within such settings. Eighty-five hours of data were collected from nine groups, with discursive psychology being used to analyse how group cohesion is constructed through off-topic talk such as gossiping and teasing. Two case studies are detailed in which we demonstrate how cohesion is established through a process of collective action against the ‘other’: highlighting the differences between ‘us’ and ‘them’, and how this can impact on group dynamics. There is often a discrepancy between self-reported and observed behaviour in groups and so the more we know about what actually happens in such environments, the better placed we are to support student learning. The paper concludes with recommendations on how analyses of social interaction and the management of psychological issues in problem-based learning tutorials can inform the use of problem-based learning as a teaching and learning approach.

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.

BackgroundEducational pedagogies were modified during the COVID-19 pandemic to minimise interruption to teaching. One approach has been the distance learning problem-based learning (PBL) tutorial utilising the online peer-to-peer platform. The aim of this study was to compare the performance of students using distance learning PBL tutorials using with that of students utilising the conventional face-to-face approach.MethodsThis retrospective study was conducted in a single academic institution. We compared two groups of fourth-year medical students from the same class: one group used distance learning (DL); the other, the face-to-face (FF) method. We used students’ baseline performance at the preceding block for one-to-one propensity score matching. Students utilising the PBL tutorial were given grades by their tutors according to a standardised scoring system encompassing five key areas (score range: 0–10). The main outcome was a student’s total score (i.e., the sum of the scores from the five key areas, ranging from 0 to 50).ResultWe matched 62 students in each group. With four tutorials, there were 490 observations, with 245 in each group. The mean total score for the DL group was 37.5 ± 4.6, which was significantly lower than that of the FF group (39.0 ± 4.4, p < 0.001). We noted that students in the DL group had a significantly lower scores for all five areas of proficiency: participation, communication, preparation, critical thinking and group skills.ConclusionFindings of this study revealed that the performance of students utilising the DL PBL tutorials was lower than that of students participating in the conventional FF approach. Further studies are needed to ascertain the underlying cause.

Problem-based learning (PBL) embraces principles of good learning and teaching. It is student-directed, fosters intrinsic motivation, promotes active learning, encourages peer teaching, involves timely feedback, and can support student self and peer assessment. The most important function of the assessment process is to enhance student learning, to improve the curriculum and to improve teaching. To improve the PBL tutorial in Chung Shan Medical University, we developed an online evaluation system containing the evaluation forms for students, tutor, self and peer. The Cronbach alpha reliability coefficients were 0.9480, 0.9103, and 0.9198 for the Student, Tutor and Self and Peer Evaluation Form, respectively. The online evaluations were mandatory to both students and tutors, and the information was completely anonymous. The survey response rates of the online evaluations ranged from 95.6% to 100%. The online evaluations provided a documented feedback to the students on their knowledge, skills and attitudes. Correspondingly, tutors too received feedback from students in evaluating their performance on the appropriateness and effectiveness of tutoring the group. Although there was an initial lack of coordination regarding responsibilities and how to use the online system for both students and the Faculty, the system enabled us to look into how effective our PBL course had been, and it provided both process and outcome evaluations. Our strategy for evaluating the success of PBL is only at its initial stage; we are in an ongoing process of collecting outcome data for further analysis which will hopefully provide more constructive information to the PBL curricula.

ABSTRACTProblem: Good teaching requires spontaneous, immediate, and appropriate action in response to various situations. It is even more crucial in problem-based learning (PBL) tutorials, as the tutors, while directing students toward the identification and attainment of learning objectives, must stimulate them to contribute to the process and provide them with constructive feedback. PBL tutors in medicine lack opportunities to receive feedback from their peers on their teaching strategies. Moreover, as tutorials provide little or no time to stop and think, more could be learned by reflecting on the experience than from the experience itself. We designed and evaluated a faculty development approach to developing PBL tutors that combined self-reflection and peer feedback processes, both powerful techniques for improving performance in education. Intervention: We developed an observation instrument for PBL facilitation to be used both by tutors to self-observe and reflect on own teaching strategies and by peers to observe and provide feedback to tutors. Twenty PBL sessions were video-recorded. Tutors completed the instrument immediately after their PBL session and again while watching their video-recorded session (self-observation). A group of three observers completed the instrument while watching each recorded session and provided feedback to each tutor (peer observation and feedback). We investigated tutors' perceptions of the feasibility and acceptability of the approach and gathered data on its effectiveness in enhancing tutors' facilitation skills. Context: The preclinical medical curriculum at the University of Geneva is essentially taught by PBL. A new program of faculty development based on self-observation and peer feedback was offered to voluntary tutors and evaluated. Outcome: Our results suggest that self-observation and peer feedback, supported by an instrument, can be effective in enhancing tutors' facilitation skills. Reflection on self-observation raised teachers' awareness of the effectiveness of the strategies they used to foster student learning. This motivated a need to change their teaching practice. However, for the changes to become operative, peer feedback was required, providing the cues and strategies needed to improve the facilitation skills. Lessons Learned: Peer coaching was considered feasible and useful to improve tutors' facilitation skills. Evaluating the program made it possible to assess tutors' needs and the reasons underlying their difficulties, and this in turn provided the basis for advanced workshops. Nonetheless, aspects related to logistics and the time constraints of such an individualized approach, as well as the cultural appropriation of peer coaching, might be obstacles that need to be addressed.

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