10.14601/TUTOR-24254
Today’s sprouting medical technology demands that students are more innovative in their approach towards medical practice. Problem based learning (PBL) has proven to be one of the most efficacious disciplines aimed at improving problem-solving skills and self-directed learning. The objective of this study was to review students’ perspectives on the implementation and effectiveness of PBL at Avalon University School of Medicine (AUSOM). A cross-sectional questionnaires survey was conducted among basic science students with qualitative and quantitative questionnaires. The response recorded and the data analysed using Stata-15 (StataCorp LLC). Most students believed PBL was beneficial to learning. 82.18% (n=83) agreed that they benefited from PBL and 91.09 % (n=92) were in concordance PBL provided a positive learning environment to enhance their understanding. The most important objectives of PBL identified by the students were to improve the presentation skills, enhance depth of understanding and develop critical thinking. PBL is helpful in improving students understanding of the basic medical science courses, allowing for self-improvement. PBL allows students to actively engage in the collaborative active learning process. It is imperative PBL should be introduced early in pre-clinical years and implemented effectively to enhance the learning environment with the favourable outcome.
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1971-8551
4791
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en
Yogesh Acharya
Tutor
Curriculum
Introduction and implementation of problem based learning in preclinical years: a survey on students’ perspective
Text.Serial.Journal
https://ojs.unito.it/index.php/tutor
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2018-11-27
2019-07-30
2018-11-27
12-16
1
Yogesh Acharya
2018/11/27
10.14601/TUTOR-24254
12
Avalon University School of Medicine, Netherland Antilles
1971-8551
1-2
Curriculum
16
Introduction and implementation of problem based learning in preclinical years: a survey on students’ perspective
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tutor                                                                                                     Vol. 18, N. 1-2 2018: 12-16
                                                                                                         DOI: 10.14601/Tutor-24254




           Introduction and implementation
           of problem based learning in
           preclinical years: a survey on
           students’ perspective
                  Oluwatosin Oluwateniola Oyadiran, Sajjad Ali Huda, Manish Prajwal Mane Manohar, Praveen Kottath
                  Veetil, Yogesh Acharya
                  Avalon University School of Medicine, Netherland Antilles



        INTRODUCTION                                                    involving group interaction between students while
        Basic medical science is an integral aspect of medi-            they analyze a clinical scenario presented as a case.
        cal education. Over the years, the quest to advance             Students identify the problems, set learning goals
        medical education, particularly basic sciences has              and present their findings during plenary discus-
        been on the rise. Various teaching methods have                 sion. They complete their assignments using study
        been explored to improve basic understanding, cri-              resources and prepare reports to the group. This
        tical thinking and enhance the transition from basic            is followed by sharing the knowledge during the
        science to clinical science (1). One such example               next plenary discussion, summarizing their findings
        is problem-based learning (PBL), which is designed              and writing an examination given by the preceptor.
        to apply basic knowledge to real-life problems, re-             Students have to actively construct the knowledge
        versing the traditional approach. These effective               themselves and share ideas amongst one another
        learning and teaching modules should be introdu-                through the group and learning assignments to
        ced and implemented early in pre-clinical years to              achieve maximum learning. (6, 7, 8, 9)
        benefit students (2, 3). PBL has been used to help              PBL in Avalon University School of Medicine (AU-
        develop self-directed learning skills through active            SOM), a Caribbean medical university in Curacao,
        participation and self-study (4). The information               Netherland Antilles was introduced in the fall of
        processing approach to learning stimulates the le-              2013. AUSOM is running a four-year comprehensi-
        arners to restructure the understanding, gain new               ve doctor of medicine (MD) program with discipli-
        knowledge and elaborate on the information. It has              ne based curriculum since its inception in 2003. The
        been shown to develop communication skills, team                change process was initiated when the university
        working capabilities, clinical judgement and reaso-             decided to move from the discipline-based curri-
        ning abilities.                                                 culum to integrated curriculum after the internal
        The traditional class room only teaching embraces               self evaluation and review from the Caribbean Ac-
        teacher-focused cognitive and psychomotor pro-                  creditation Authority for Education in Medicine
        cess without fully exploring student-oriented active            and other Health Professions (CAAM-HP). The
        learning. These new developments are attributed                 continuous quality improvement (CQI) committee
        to the shortcomings of traditional classroom tea-               placed the curriculum committee in charge to over-
        ching practices, mostly inability of the educators to           see this change process and co-ordinate with all the
        achieve holistic student development (5). PBL, on               departments for effective and smooth transitions.
        the other hand, focuses on collaborative learning by            This new curriculum employed PBL along with tra-



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                                                                               ISSN (print) 1971-7296       © Firenze University Press
                                                                               ISSN (online) 1971-8551      http://www.fupress.com/tutor
                                   Introduction and implementation of problem based learning in preclinical years



ditional lectures, presentations, group discussions,       PBL course objectives
standardized patients program and clinical skills          The objectives of PBL in AUSOM is to inculcate
classes, hands-on learning, and simulation. The aim        the self directed study habits, introduce integrated
of its implementation was to inculcate good study          clinical cases in basic medical sciences to enhance
habits and evolve exceptional critical thinking abili-     and develop understanding, critical reasoning and in
ty. It involves students tackling clinical vignettes so    depth learning skills in the students, promote group
that they may learn to diagnose, treat and manage          participation, presentation and communication
clinical cases. After discussing the problems, stu-        skills between the peers, consolidate professional
dents are required to give a presentation to their         behaviour, and establish peer and self assessment
peers the following week, along with a handwrit-           to promote reflective learning.
ten solution to be submitted to the instructor and
a formal assessment in the form of a quiz. Proper
coordination and monitoring, without interfering           PBL course delivery
with the PBL process, is needed to ensure active           PBL in AUSOM is conducted as per the classical
learning. The leader of a PBL classroom commonly           seven stages PBL approach (10). A standard set of
acts as a facilitator rather than a teacher, using their   a clinical vignettes based on the course objectives
expertise to encourage and guide the students as           and validated by the curriculum committee are
they tackle the clinical case. The objective of this       used in PBL session. Students are divided into small
study is to review student perspectives on the im-         random groups (8-10 students/group). Each group
plementation and effectiveness of PBL at AUSOM.            selects a chair and a scribe amongst them. Instruc-
                                                           tor acts as a facilitator without providing any know-
                                                           ledge based information. All the students are pro-
MATERIAL AND METHODS                                       vided with the standard study resources including
A cross-sectional questionnaire survey was con-            the clinical handbook and online database for every
ducted among 1st to 4th Semester (MD1 to MD4)              PBL sessions. The PBL session begins with the di-
basic science students of AUSOM in the fall 2017.          splay of the clinical vignette to all the groups simul-
All students currently admitted in the university          taneously. Students are required to discuss among
and attending PBL as a mandatory course curricu-           groups to identify the key words and the associated
lum were voluntary enrolled to assess their cogni-         clinical case. They create objectives thereafter in
sance and attitudes towards PBL at AUSOM. The              accordance to the case, which are to be approved
students with class attendance less than 90% were          by the facilitators. This is followed by a week of self
excluded from the study.                                   directed study to address the objectives. Each PBL
Approval for this study was received from the uni-         session last for two hours divided into a session of
versity ethical review committee, and the anony-           an hour for two weeks. Finally, students meet again
mity of participants was preserved. The study was          after a week to present the objectives, discuss and
consolidated with an online quantitative and qua-          critically analyze the case, and address its various
litative questionnaire. Qualitative questionnaires         determinants.
were designed to assess students’ perceptions on
the objectives of PBL. Similarly, the quantitative
questionnaires were graded on a five point scale to        PBL assessment strategies
evaluate the students’ opinion on its practice, and        Students are assessed with a multiple choice que-
to get feedback on its effectiveness. All the que-         stions (MCQ) based summative assessment and ru-
stionnaires were validated by the faculty senate un-       brics based peer assessment after each PBL case.
dertaking PBL course curriculum. Survey collected          MCQ based summative assessment is conducted
and data were analyzed using Stata-15 (©StataCorp          by the individual facilitator in the classroom setting
LLC) in the form of proportion, mean, median,              through online MCQ’s, normally including in and
mode, and standard deviation.



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 tutor Volume 18, Numero 1-2, agosto 2018

              around 10 questions for each PBL case. Questions
Prospettive




                                                                                           Mean±SD Median Mode            Range
              are based on the specific objectives created by the
                                                                       Inoculates
              individual groups. Similarly, peer assessment is ba-     self-study          3.59±1.27      4        5        1-5
              sed on the standard rubrics validated and presen-        habits
              ted to the students by the facilitator to address the    Develops team
              course objectives. Rubrics are divided into three                            3.62±1.17      4        4        1-5
                                                                       working ability
              major groups to assess knowledge, skills and atti-       Improve pre-
              tude. Facilitators make sure that students strictly                          3.96±1.20      4        5        1-5
                                                                       sentation skills
              adhere to the rubrics system while undergoing the        Develop
              peer assessment. As such, the final grades of the        research            3.65±1.25      4        5        1-5
              students represent the composite scores of both          capabilities
              the assessments in a 100 point scale. Feedback is        Enhance
              provided after completion of each PBL case based         understanding
                                                                                           3.75±1.16      4        4        1-5
                                                                       and learning
              on the Pendleton’s formula, and the rationale is         depth
              provided for each MCQ by the facilitator.
                                                                       Develop
                                                                       critical thinking   3.79±1.16      4        5        1-5
                                                                       ability
              RESULTS                                                  Establish
              101 {Males: 58.42%, (n=59), Female: 41.58% (n=42)},      professional        3.71±1.30      4        5        1-5
              among 110 total students participated in the stu-        Attitude
              dy. The students gave an overwhelming response           Reflect on
              to the introduction and implementation of PBL in         self-improve-       3.80±1.21      4        5        1-5
                                                                       ment
              the curriculum. Most of the students responded
              that they had a positive impact in learning and un-     Table 1. Scoring and assessment of the student’s
              derstanding with PBL. 82.18% (n=83) of students         perspectives in relation to the fulfilment of PBL objectives
              agreed that they benefited with PBL, 4.95% (n=5) of     and related factors (Objectives were ranked on a 5-point
              students were in disagreement and 12.87% (n=13)         scale, with a score of 1 meaning the objective was not
              gave an ambivalent response.                            effectively achieved and a score of 5 meaning that the
                                                                      objective was effectively achieved.)


              PBL objectives                                          of faculty in effective delivery of PBL had varied
              Students were asked to choose and grade the most        response with 34.65% (n=35) responding that the
              important PBL objective as a learning tool, followed    instructor should be fully involved in explaining all
              by how well each of those objectives was achieved       of the concepts in depth, while 30.70% (n=31) wan-
              (Table 1). The top three most chosen objectives         ted the limited role of the instructor as a facilitator
              were: to improve the presentation skills (37.63%,       only, and 34.65% (n=35) were divided in opinion on
              n=37), to enhance in the learning depth (15.84%,        whether the faculty should have a moderate invol-
              n=16), and to develop the critical thinking ability     vement or no involvement as such.
              (13.86%, n=14).

                                                                      Evaluation criteria
              Instructor involvement                                  54.5% (n=55) of the students responded that they
              The mean score for faculty satisfaction was 3.7 ±       were aware of the evaluation process and grading
              1.3 (5-point scale). 91.09 % (n=92) of the students     rubrics used in PBL. Students overall final evalua-
              agreed that PBL provided a positive learning envi-      tion yielded an average score of 77.54% (range: 60%
              ronment to enhance their understanding.                 to 90%).
              Students perspectives regarding the involvement



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                                   Introduction and implementation of problem based learning in preclinical years



Feedback and class time                                    past have shown students predominantly opt for a
60.4% (n=61) of the students responded that ade-           meticulously guided approach to learning, where
quate feedback was given after each PBL session,           there is a crucial role for the facilitator to organize
with 73.3% (n=74) believing that sufficient class time     the discussions (12). As such, the necessary level
had been provided to teach and implement PBL.              of receptor/facilitator involvement has not been
                                                           fully understood despite the fact that the most im-
                                                           portant aims of any teaching method is to boost
DISCUSSION                                                 study habits engaging students in an active and col-
PBL requires that students develop a systematic            laborative learning practice. Further assessment of
and critical attitude towards the presented pro-           different levels of instructor involvement and the
blems and integrate their current knowledge while          impact on learning outcomes on professional de-
reflecting on areas for learning and self-improve-         velopment, would be obviously beneficial in order
ment (11). Students recognized enhanced presen-            to optimize the PBL application and integration in
tation skills, understanding and critical thinking         course curriculum.
as being the primary objectives of PBL. Students’          The evaluation criteria in AUSOM chiefly focus on
ability to convey the information is crucial in en-        the active participation, team work and professio-
suring that concepts are understood correctly by           nalism. Understanding the evaluation criteria helps
their classmates. Communication skills are the ap-         the students to enhance goal-oriented learning.
propriate tool to improve collaborative learning to        Better self-assessment and motivation could be
allow for a more systematic approach to the basic          achieved through the use of all-inclusive, yet sim-
medical sciences. This helps the students to incor-        plified rubrics. Majority of students reported they
porate clinical skills and rudiments of basic science.     received adequate feedback on their performan-
PBL engages communication capacity while deve-             ce in PBL. A timely feedback motivates students,
loping a flexible knowledge of the core subject,           giving them an insight into their performance and
improving efficient problem-solving abilities, enhan-      weaknesses, as well as ways to hone their skills.
cing self-directed learning and effective intrinsic        This adequate feedback should be maintained in the
motivation.                                                use of PBL in order to remain aligned with goals
The instructor of a PBL classroom acts as a faci-          and enhance the student-teacher relationship. It
litator rather than a teacher, allowing students to        is worth noting that since the time of the survey,
better develop their reasoning skills and become           PBL at AUSOM has inculcated the use of educa-
independent learners (8). To preserve this role,           tional videos. It would be of interest to see if this
CQI and curriculum committee in AUSOM con-                 has helped the students to further consolidate their
ducts a regular faculty workshop concerning the            knowledge.
seven steps of PBL course delivery, and to align the
basic science course objectives to the PBL case se-
lection. This workshop is also able to address the         CONCLUSION
concerns regarding the case selection, validation          PBL allows students to actively engage in the lear-
and level of involvement of the facilitator. Similarly,    ning process. The majority of medical students at
a detail framework is presented to the individual          AUSOM benefitted from the use of PBL with favou-
facilitator’s at the beginning of the semesters re-        rable responses. Students believed that the intro-
garding their involvement and smooth delivery of           duction and implementation of PBL in their curri-
the course objectives. However, it is necessary to         culum enhanced presentation skills, understanding,
understand that the productivity of PBL groups de-         and critical thinking. It is imperative that PBL should
pends on faculty co-ordination, individual cognitive       be effectively implemented early in the pre-clinical
skills, self-reflective ability and interpersonal fun-     years to strengthen learning and bridge the void du-
ctioning of the student groups. Observations’ in the       ring this process.




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 tutor Volume 18, Numero 1-2, agosto 2018

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