Theoretical perspectives and applications of group learning in PBL

An essential part of problem-based learning (PBL) is group learning. Thus, an in depth understanding of the theoretical underpinnings of group learning in PBL allows educators to bridge theory and practice more effectively thus providing ideas and tools to enhance PBL practices and research. The theory-driven applications examined in this article establish grounds for future research in PBL. The purpose of this article is to describe and examine two theoretical perspectives of group learning in PBL and their potential applications to improve educational practice. They include: (1) social interdependence theory and the meaning of positive interdependence, (2) socio cognitive theory of networked expertise and the concept of knowledge creation in innovative knowledge communities (IKC). Potential applications include the following: development of instructional material to foster positive interdependency using concept maps; formal and structured use of peer feedback throughout PBL courses to promote individual and group accountability; creation and sharing of new knowledge about different topics within and across IKC; and use of rotating students with hybrid abilities across PBL groups to foster distributed cognition.     

Factors Influencing the Growth in Knowledge of Trainees in General Practice

Objectives: The relation between the content of postgraduate training for general practice and the outcome in terms of the growth in knowledge of trainees was investigated. The training variables included were: (1) the number of patients seen per day, (2) the trainer, (3) the practice and (4) the theoretical curriculum.Methods: Subjects were 58 trainee-trainer pairs. Growth in knowledge was assessed by two written tests administered with eight months interval. Training variables were evaluated by means of questionnaires and logbook-registration. The correlation was explored between each of the training variables and the knowledge tests scores. To correct for interactional effects, a step-wise multiple regression analysis was performed with the second test as dependent variable and the first test as well as the training variables as independent variables.Results: Significant growth in knowledge was demonstrated. Non of all training variables investigated explained the variance in scores on the second test equally good or better than the scores on the entry test.Conclusions: The impact of the separate training-components on the growth in knowledge, remains unclear. We may speculate, that the sort of knowledge assessed with the written literature based true/false test is different from the sort of knowledge transferred during every day training: evidence based knowledge versus experience based knowledge. Equally valid is the conclusion that these findings fit into the theory that in adult learning the outcome is more learner than teacher dependent.This revised version was published online in September 2005 with corrections to the Cover Date.     

An Inter- and Intra-University Comparison With Short Case-Based Testing

Comparisons between PBL and non-PBL medical schools on problem-solving ability often show no differences. This could be either due to the fact that no difference in problem-solving skills exists or that the instruments used are inadequate. In this study a key-feature approach case-based examination was used to compare two medical schools in the Netherlands, one of which has a PBL curriculum (Maastricht) and one which has a program half way a transition from a non-PBL towards a PBL curriculum (Groningen). Differences were found both in proficiency scores and in the pattern of response times, both supporting the assumption that a PBL approach would lead to a higher level of problem solving ability. The effect size, however, is not as large as originally assumed by the PBL proponents. Conclusions must be drawn with caution, but it seems likely that a test based on large numbers of short cases is the most sensitive in detecting differences in problem solving ability between students of different curricula. This revised version was published online in June 2006 with corrections to the Cover Date.     

Assessment of general practitioners by video observation of communicative and medical performance in daily practice: issues of validity, reliability and feasibility

OBJECTIVES: To develop a video assessment method for General Practitioners (GPs) by analysing issues of validity, reliability and feasibility of observation of videotaped regular consultations. DESIGN: In a cross-sectional study consultations of 93 GPs were video recorded in the practice during 1 week. The GPs registered consultation and patient data in a logbook; 16 consultations per GP were selected using preset criteria. The quality of communicative and medical performance of these consultations was assessed by GP observers with a validated instrument. The validity of the procedure was evaluated by checking the content of each GP's sample using specific sample criteria. Selection bias was estimated by multiple regression analysis, with sample characteristics as independent variables and scores on communication and medical performance as dependent variables. The influence of observation on GPs and patients was assessed by a questionnaire. Generalizability theory was used to estimate reliability. Feasibility was assessed by conducting a questionnaire, by keeping accounts, and by checking the technical quality of the videotaped consultations. SETTING: Universities of Nijmegen and Maastricht, The Netherlands. SUBJECTS: General Practitioners (GPs). RESULTS: The domain of general practice was well covered in the samples; content validity was satisfactory. With regard to the sample characteristics, only the total duration of consultations appeared to correlate significantly with both the score on communication and the score on medical performance. A majority (71%) of GPs reported not being influenced by the observation, except in the first cases, and recognizing their usual daily performance in the videotaped consultations. An acceptable level of reliability was reached after 2.5 hours of observation, i.e. 12 cases by a single observer. The method was well accepted by both GPs and patients. The costs were pound250 per GP. CONCLUSIONS: Video assessment of GPs in daily practice according to the procedures described is a valid and reliable method, one which is useful for education and quality improvement. There is a trade-off between feasibility on one hand and validity, reliability and credibility on the other hand. Compared to investments in observation methods in standardized settings, the costs of video observation of GPs' actual performance are acceptable.     

The impact of student-generated learning issues on individual study time and academic achievement

OBJECTIVES: The aim of this study was twofold. The first question concerns the way students make use of the learning issues they generate (as strict guidelines or as global guidelines) and whether this changes across years of training. The second question concerned the relationship between the way students make use of learning issues and the time spent on individual study and achievement on two tests of knowledge. DESIGN: A questionnaire was developed, containing seven items that measured to what extent students study strictly according to the student-generated learning issues and six items that measured to what extent students study beyond the student-generated learning issues. The questionnaire also contained one question in which students had to estimate the mean time spent on individual study. Achievement was measured by two forms of tests of knowledge, a block test assessing course content and a progress test assessing long-term functional knowledge. SETTING: Medical School of Maastricht University, the Netherlands. SUBJECTS: Medical students (response=69%) from the problem-based curriculum at the Maastricht University. RESULTS: During their first year students study strictly according to the content of the learning issues, whereas in later years students studied more according to their own learning needs and interests. In addition, students who tended to study beyond the generated learning issues spent more time on individual study and achieved better on both tests. CONCLUSIONS: Students in a problem-based curriculum seem to become better self-directed learners during the years of training.     

''I found myself to be a down to earth Dutch girl'': a qualitative study into learning outcomes from international traineeships

OBJECTIVE: To explore learning outcomes from international traineeships for undergraduate medical students. METHODS: In-depth interviews were conducted with 24 undergraduate medical students at Maastricht University Medical School, The Netherlands. The 24 subjects were selected by purposeful sampling. RESULTS: Students reported meaningful learning outcomes in 6 domains: medical knowledge; skills; international health care organisation; international medical education; society and culture, and personal growth. DISCUSSION: International traineeships appear to provide good opportunities for students to meet the requirements of globalisation as well as some of the generic objectives of undergraduate medical education. The tentative findings of this study need to be confirmed by further studies.     

Embolization to treat pelvic congestion syndrome and vulval varicose veins

ObjectiveTo evaluate the efficacy of embolization for treating the symptoms of pelvic congestion syndrome (PCS).MethodsTwenty-one women with PCS who were treated with embolization at Radboud University Nijmegen Medical Centre between 2003 and 2008 were sent a questionnaire about their symptoms before embolization, 2 months after the first embolization, and at the time the survey was conducted.ResultsAll patients completed the questionnaire. Two months after the first embolization, 14 (66.7%) women had some degree of improvement of symptoms. Nine (42.9%) patients underwent a second embolization. At the time the survey was conducted, 16 (76.2%) patients had some degree of improvement of symptoms. In addition to improvements in varicose veins and pelvic pain, there was improvement of hemorrhoids.ConclusionEmbolization of pelvic varicosities may be an effective treatment in a well-selected group of patients with PCS. If there is no improvement of symptoms after initial embolization, a second procedure is unlikely to be effective.