Problem-based learning outcomes: ten years of experience at the University of Missouri-Columbia School of Medicine.

PURPOSE: To add to a previous publication from the University of Missouri-Columbia School of Medicine (UMCSOM) on students' improvement in United States Medical Licensing Examination (USMLE) Step 1 and Step 2 scores after the implementation of a problem-based learning (PBL) curriculum by studying the performance of ten PBL class cohorts at the UMCSOM. METHOD: Characteristics of graduating classes matriculating in both traditional and PBL curricula, 1993-2006, were compared for Medical College Admission Test component scores, undergraduate grade point averages, performance on the USMLE Step 1 and Step 2 exams, faculty contact hours, and residency directors' evaluations of UMCSOM graduates' performance in the first year of residency. RESULTS: Mean scores of six of the ten comparisons for USMLE Step 1 and six of nine comparisons for USMLE Step 2 are significantly higher (p < .01) for UMCSOM PBL students than for first-time examinees nationally. These differences cannot be accounted for by preselection of academically advantaged students, increased time on task, or reduced class size. Gains in performance continue into residency, as evidenced by program directors' perceptions of superior performance of UMCSOM PBL graduates. CONCLUSIONS: The PBL curricular changes implemented with the graduating class of 1997 resulted in higher performances on USMLEs and improved evaluations from residency program directors. These changes better prepare graduates with knowledge and skills needed to practice within a complex health care system. Outcomes reported here support the investment of financial and human resources in our PBL curriculum.     

Problem-based learning in the surgery clerkship: A change in philosophy

In the academic year 1989–1990, the Department of Surgery at the University of Kentucky College of Medicine introduced a modified third-year surgery clerkship. Its goals were to eliminate the lecture method of instruction, to involve students actively in the educational process, and to emphasize decision-making and problem-solving skills in the third year of medical school. Hands-on training in patient care procedures would be offered in a fourth-year acting internship after students had learned both problem-solving and life-long learning skills while concurrently developing a medical knowledge base. Students were removed from the traditional surgical service teams, since it was decided that team duties might be detrimental to educational goals. Problem-based tutorial sessions were designed, and a block of unscheduled time was provided for students to use in obtaining, exploring, and reflecting on medical information. Informal comparisons of students in the previous clerkships with those in the modified clerkship have noted positive changes in the students' intellectual maturity, motivation, enthusiasm, and time-management skills. Faculty and students have responded positively to the programs which are part of this innovative clerkship.     

Problem-based learning with gross anatomy specimens: One year trial

A problem-based learning experience was implemented at the University of Florida College of Medicine during the Fall, 1989 gross anatomy course for first year medical and dental students. A problem for deliberation was selected by students at one dissecting table (two medical and two dental) that related to the cadaver they were dissecting. Each member of the group picked a single topic and researched that subject either through use of the library or personal contacts with basic science or clinical faculty. Specific times within the course were established for the problem-based sessions. Each student gave a 5 to 10 minute oral presentation to a faculty member and one or two other groups of students. The overall rating for the sessions by the students was positive (72.5% ranked them either outstanding or above average). Eighty-two percent of the students felt that these sessions were a useful method of providing clinical correlations with gross anatomy and 81.6% stated they thought the program should be continued next year. Conversely, approximately 20% of the students responded that they could have been doing something more productive with their time and several felt it was unfair that their sessions were scheduled just prior to an examination. Overall, the opinion of the faculty was that the sessions were a positive experience, encouraged cooperation between medical and dental students, and generated additional interest in the dissecting experience.     

Problem-based learning: an assessment of its feasibility and cost

As our knowledge of human biology becomes more complex and the medical school applicant pool declines, there is ample reason to consider an alternative to the conventional medical curriculum. Many authorities feel that a format incorporating problem-based learning (PBL) would be more appropriate and effective. The problem-based medical curriculum is one in which facts and principles are learned in the context of a clinical problem. Problem-based medical education began as a revision of the McMaster University medical curriculum in 1969 and was instituted in the United States as a problem-based experimental track at the University of New Mexico School of Medicine in 1979. The first completely integrated, totally problem-based, McMaster-type, medical curriculum in the United States began operation in 1982 with the establishment of Mercer University School of Medicine. Many years of experience at these three institutions have shown that the problem-based curriculum works well. Several medical schools throughout the world are either practicing PBL or investigating the feasibility of adopting it. A comparison of the costs (in faculty time) of problem-based and conventional pathology programs suggests that the PBL curriculum is quite feasible for schools with a class size of 60 or less and may be so for many schools and programs with classes of less than 100.     

PBL教学法在口腔正畸学教学中的应用

为了提口腔专业本科生口腔正畸学的教学质量,温州医学院口腔医学院正畸教研室尝试将PBL教学法引入理论课教学中.并取得了初步的成功.本文对PBL教学法在口腔正畸学教学中的应用及所面临的问题进行了分析和探讨.     

Problem-based learning in medical informatics for undergraduate medical students: an experiment in two medical schools

PURPOSE: The objective of this work was to assess problem-based learning (PBL) as a method for teaching information and communication technology in medical informatics (MI) courses. A study was conducted in the Schools of Medicine of Rennes and Rouen (France) with third-year medical students. METHODS: The "PBL-in-MI" sessions included a first tutorial group meeting, then personal work, followed by a second tutorial group meeting. A problem that simulated practice and was focused on information technology was discussed. In Rouen, the students were familiar with PBL, and they enrolled on a voluntary basis, while in Rennes, the students were first-ever participants in PBL courses, and the program was mandatory. One hundred and seventy-seven students participated in the PBL-in-MI sessions and were given a questionnaire in order to evaluate qualitatively the sessions. RESULTS AND DISCUSSION: The response rate was 92.1%. The overall opinion of the students was good. 69.8% responded positively to the program. In Rouen, where the students participated in PBL-in-MI sessions on a voluntary basis, the students were significantly more enthusiastic about PBL-in-MI. Moreover, attitudes and opinions of students are plausibly related to differences in previous PBL skills. The fact that the na?ve group had two tutors, one trained and one na?ve as the students, has been investigated. Teacher naivety was an explanatory factor for the differences between Rennes and Rouen.     

以问题为基础的教学法在儿科腹泻病液体疗法临床见习中的应用

目的评价问题为基础的教学法（Problem Based Learning，PBL）在儿科临床见习中的应用效果。方法随机选择2004级五年制临床医学专业在我院儿科见习的4个见习小组为PBL组，实行PBL教学法；随机选择另三个3个见习小组为传统组，实行传统教学法。进行问卷调查，比较学生对PBL教学和传统教学的态度，比较两组学生理论考试成绩。结果PBL组92．31％以上学生对PBL教学持肯定态度，而传统组仅46．86％学生对传统教学持肯定态度。结论PBL模式教学效果优于传统教学方法，可用于儿科临床见习教学。     

What students value: learning outcomes in a required third-year ambulatory primary care clerkship.

PURPOSE: To determine learning outcomes from the students' perspective on the clinical portion of a third-year primary care ambulatory clerkship. METHOD: Over 18 months (December 1994 to June 1996), students at the Medical College of Wisconsin identified what they had learned during the clerkship in each of seven learning settings. Responses were transcribed and a coding dictionary developed. Response frequencies were compared by logistic regression analysis over time and between rural and urban sites. Course goals set by faculty were compared to learning outcomes reported by students. RESULTS: The authors coded 3,030 student outcomes into 48 categories. The top ten learning outcomes by frequency are reported. Logistic regression analysis revealed no significant difference by time of year or by rural versus urban clerkship experiences. Twenty-six of 29 original course goals were congruent with the student-generated outcomes. CONCLUSION: Basic professional knowledge, skills, and attitudes were the learning outcomes most valued throughout the year. Being alone with patients and working with their preceptors were the students' most valued learning settings.     

Using "concept sorting" to study learning processes and outcomes.

PURPOSE: First, to evaluate "concept sorting" as a tool for assessing knowledge organization in the memories of first-year medical students, and second, to study the relationship between knowledge organization and examination performance. METHOD: During 2001, first-year medical students taking the Renal Course at the University of Calgary Faculty of Medicine were given a questionnaire on scheme use and were given a concept-sorting task in the domain of metabolic alkalosis. The sophistication of their concept sorting was graded using the number of physiology-based groups they formed. Review of the course's examination scores allowed correlation with concept-sorting scores. Statistical analyses used Fisher's exact test and the two-sample t-test. Pearson's correlation coefficient and the kappa statistic were used for correlation between raters. RESULTS: A total of 81 of 99 students completed the study. The concept-sorting score (mean +/- SEM) for students who used the scheme was higher than was the score for students who did not (2.5 +/- 0.14 versus 1.91 +/- 0.12, p =.016). Students who scored higher in the concept-sorting task, referred to as "deep learners," scored higher than did "surface learners" on exam questions on metabolic alkalosis (2.81 versus 2.29, p =.02). There was no difference in the overall examination performances between the two groups. CONCLUSIONS: Concept sorting may be a useful tool for studying the learning process. Scheme use by students produces a positive outcome on examination performance.     

Prehension of half-full and half-empty glasses: time and history effects on multi-digit coordination

We explored how digit forces and indices of digit coordination depend on the history of getting to a particular set of task parameters during static prehension tasks. The participants held in the right hand an instrumented handle with a light-weight container attached on top of the handle. At the beginning of each trial, the container could be empty, filled to the half with water (0.4 l), or filled to the top (0.8 l). The water was pumped in/out of the container at a constant, slow rate over 10 s. At the end of each trial, the participants always held a half-filled container that has just been filled (Empty-Half), emptied (Full-Half) or stayed half-filled throughout the trial (Half-Only). Indices of covariation (synergy indices) of elemental variables (forces and moments of force produced by individual digits) stabilizing such performance variables as total normal force, total tangential force, and total moment of force were computed at two levels of an assumed control hierarchy. At the upper level, the task is shared between the thumb and virtual finger (an imagined digit with the mechanical action equal to that of the four fingers), while at the lower level the action of the virtual finger is shared among the actual four fingers. Filling or emptying the container led to a drop in the safety margin (proportion of grip force over the slipping threshold) below the values observed in the Half-Only condition. Synergy indices at both levels of the hierarchy showed changes over the Full-Half and Empty-Half condition. These changes could be monotonic (typical of moment of force and normal force) or non-monotonic (typical of tangential force). For both normal and tangential forces, higher synergy indices at the higher level of the hierarchy corresponded to lower indices at the lower level. Significant differences in synergy indices across conditions were seen at the final steady state showing that digit coordination during steady holding an object is history dependent. The observations support an earlier hypothesis on a trade-off between synergies at the two levels of a hierarchy. They also suggest that, when a change in task parameters is expected, the neural strategy may involve producing less stable (easier to change) actions. The results suggest that synergy indices may be highly sensitive to changes in a task variable and that effects of such changes persist after the changes are over.