Problem-based learning: a case study in providing e-health education using the Internet

The current trend among many universities is to increase the number of courses available online. However, there are fundamental problems in transferring traditional education courses to virtual formats. Delivering current curricula in an online format does not assist in overcoming the negative effects on student motivation which are inherent in providing information passively. Using problem-based learning (PBL) online is a method by which computers can become a tool to encourage active learning among students. The delivery of curricula via goal-based scenarios allows students to learn at different rates and can successfully shift online learning from memorization to discovery. This paper reports on a Web-based e-health course that has been delivered via PBL for the past 12 months. Thirty distance-learning students undertook postgraduate courses in e-health delivered via the Internet (asynchronous communication). Data collected via online student surveys indicated that the PBL format was both flexible and interesting. PBL has the potential to increase the quality of the educational experience of students in online environments.     

Problem-based learning in medical education: Developing a research agenda

While the use of problem-based learning (PBL) methods continues to increase in medical education, three literature reviews of PBL have appeared in the past several years which come to different opinions about their merits. This analysis summarizes the research evidence regarding PBL by examining how well it has met its originators' goals, what we know about how PBL works, and how PBL fares in a goal-free comparison with conventional curricula. A research agenda is suggested to refine our understanding of well-documented effects of PBL, to probe for other possible longer term PBL outcomes, and to examine if and how PBL affects knowledge acquisition and retention. Consistency of evidence from a variety of PBL implementations can help decide whether the effects seen can be attributed to PBL or are the results of other curricular features unique to one setting.     

Problem-based learning in distance education: a first exploration in continuing medical education

The Wellcome Tropical Institute has assisted countries in the tropics to establish viable systems of continuing medical education, particularly for young doctors practising in rural areas. As part of this strategy the Institute has developed material for use in distance learning. The first attempt to apply the problem-based learning approach to written material for use by an individual learner in the absence of a tutor led to a trial in Ghana, Kenya and Pakistan to compare a conventionally designed module with a problem-based learning module on the same topic for their respective acceptability, effectiveness and efficiency. The design, implementation and results of these three comparative trials are presented.     

Problem-based learning versus lecture-based learning in postgraduate medical education

OBJECTIVES: The objective of this study was to investigate the effectiveness of problem-based learning in comparison with lecture-based learning in a postgraduate medical training program concerning the management of mental health problems for occupational health physicians. METHODS: A randomized controlled trial in 1999, with a mean follow-up of 14 months after the educational intervention, was used involving postgraduate medical education and training for occupational health physicians in The Netherlands, with 118 physicians in training as occupational health physicians. The experimental program was based on the principles of problem-based learning; the control program used the traditional lecture-based approach. Both programs were aimed at improving knowledge of and performance in the occupational management of work-related mental health problems. As the main outcome measures, knowledge tests consisting of true-or-false and open-answer questions and performance in practice based on self-reports and performance indicators were used. Satisfaction with the course was rated by the participants. RESULTS: In both groups, knowledge had increased equally directly after the programs and decreased equally after the follow-up. The gain in knowledge remained positive. The performance indicator scores also increased in both groups, but significantly more so in the problem-based group. The problem-based group was less satisfied with the course. CONCLUSIONS: Both forms of postgraduate medical training are effective. In spite of less favorable evaluations, the problem-based program appeared to be more effective than the lecture-based program in improving performance. Both programs, however, were equally effective in improving knowledge levels.     

Problem-based learning: an approach toward reforming allied health education.

Problem-based learning (PBL) is presented as a useful way to educate allied health practitioners for the future. The essential characteristics of problem-based learning include: curricular organization around problems rather than disciplines; an integrated curriculum rather than one separated into clinical and theoretical components; and an inherent emphasis on cognitive skills as well as on knowledge. Long-term advocates of PBL stress that it is the only known method for preparing future professionals to be able to adapt to change, learning how to reason critically, enabling a holistic approach to health, and attaining integrated, cumulative learning.     

Problem-based learning versus lecture-based learning in a course of basic pharmacology: a controlled, randomized study

Since its first implementation in a medical programme at McMaster University, Canada, problem-based learning (PBL) has become a well-established means of teaching and learning medicine. Extensive research has been conducted and a number of strengths of the method are well supported. Several items, however, remain unclear although there is evidence that no relevant difference exists in factual knowledge among students from PBL and traditional curricula, a controlled, randomized study has not been conducted to address this issue. The Medical Faculty of the University of Cologne is in the process of integrating elements of PBL into its curriculum. In the spring term of 1997, after seven semesters of experience with PBL supplementing the traditional course of basic pharmacology, we did for the first time use PBL instead of the lecture-based course (LBL) and conducted a controlled prospective study to determine the effects of this intervention. One-hundred and twenty-three students were randomly assigned to either PBL (n = 63), with tutorial groups of up to nine students, or to the traditional, lecture-based course (n = 60). Analysis of the results of both groups in the examination of basic pharmacology, consisting of multiple-choice and short-essay questions, revealed similar scores with a tendency favouring PBL students in the category of short-essay questions. Hence, it seems clear that PBL does not imply a disadvantage in terms of factual knowledge. Students considered PBL to be an effective learning method and favoured it over the lecture format. Furthermore, students reported positive effects of PBL in terms of use of additional learning resources, interdisciplinarity, team work and learning fun.     

Problem-based learning: measurable outcomes

Problem-based learning (PBL) could potentially contribute to four key objectives in the education of doctors. (1) Motivating learning. Three studies show that students studying PBL problems choose fewer topics to study than those identified by the faculty, but one study of a critical care rotation showed that students were motivated to learn over a wider range of basic science topics than had been included in the basic science curriculum. (2) Developing clinical reasoning. One study compared methods of solving problems in PBL and conventional track curricula and suggested that PBL students work backwards from clinical information to theory, while conventional curriculum students tend to reason forward from theory. One study showed that computer searches provide knowledge for helping solve some PBL problems, and another study showed that specific knowledge in emergency medicine correlated with test scores. (3) Structuring knowledge in clinical contexts. A few studies show that PBL students perform less well on basic science examinations but better on clinical examinations. Educational outcomes, however, have been assessed quantitatively mainly by the U.S. National Boards of Medical Examiners Examinations or by clinical examinations with small samples. Only one study includes a power computation to assess type II error. There are no studies that examine how much variance occurs between PBL programmes in their curricular methods and outcomes. (4) Developing self-learning skills. PBL students use a much wider range and number of resources than conventional track students. There is only one study comparing the knowledge of doctors trained by PBL and conventional curricula after the doctors have been in practice for a substantial number of years, and no studies of patient outcomes. Patient outcomes need to be assessed with randomized controlled trials, and sample sizes should be determined by power computations to avoid Type II error. Four possible methods of improving PBL would be to derive national and internationally accepted PBL curricula; to organize internationally accepted and psychometrically validated methods of evaluation; to develop attitudes among students and tutors to facilitate co-operative PBL teamwork; and to teach group process diagnostic skills.     

A regulatory framework for pervasive e-health: A case study

To facilitate superior healthcare delivery and address current challenges faced by healthcare today, a plethora of pervasive e-health solutions are emerging. However, existing regulatory regimes are ill-equipped for dealing with them. This not only causes frustration to various stakeholders including patients, providers, healthcare organizations and payers, not to mention vendors but also means that the most appropriate solution cannot be accessed and used. Hence this exploratory study serves to investigate institutional regulatory factors that can impact the adoption of such pervasive e-health solutions. These factors are important as they can shape both the nature of these solutions and their diffusion trajectory. We argue that co-regulation, a mixture of direct monitoring and intervention of regulators through legislation and complete industry self-regulation, can be an effective approach especially in view of the complex and dynamic nature of this industry, co-regulation can minimize monitoring costs and enhance compliance. We illustrate with a case vignette.     

Problem-based learning of psychopathology in a traditional curriculum using multiple conceptual models

A course in basic psychopathology is described in which problem-based learning is implemented in small groups in a traditional medical school curriculum. Simulated patients are utilized to provide the problem data and to allow for practice in medical interviewing. The problem-based portion of the course focuses on the explanation of various psychiatric disorders using an integration of four conceptual models: the medical/biological; the behavioural/learning; the sociocultural; and the psychodynamic. Reception of the course, based on student evaluations as well as teachers' enthusiasm and participation, has been positive for the 6 years the course has existed in this format, lending support to the conclusion that problem-based methods can be successfully integrated into a traditional lecture-based curriculum.