Testing a Causal Model for Learning in a Problem-based Curriculum

The aim of this study was to identify the relationship between elements that are important for the tutorial group process and the individual learning process in a problem-based curriculum. The variables under investigation were student-generated learning issues, individual learning process, reporting in the tutorial group, and achievement. A questionnaire containing 22 items was developed. Data were collected in the first year (N = 195) of the Medical School of the Maastricht University in the Netherlands during the academic year 1997–1998. The data were analysed using a structural modelling approach. The results indicate that the model fitted the data well. The path coefficients were moderately high, particular between the explanation-oriented approach and the depth of the reporting in the tutorial group. High path coefficients were also found between the depth of the reporting and achievement. In sum, the model gives insight into how important variables are related and it is recommended that data should be collected to test the model repeatedly. This revised version was published online in August 2006 with corrections to the Cover Date.     

Influence of Learning Resources on Study Time and Achievement Scores in a Problem-based Curriculum

Many aspects of the problem-based learning cycle aim at stimulating students to elaborate on their knowledge. This elaborative process is considered to be one of the most effective study aids for learning and applying information. One of the opportunities to stimulate this elaboration process is by offering students more, and more diverse, learning resources. Under laboratory conditions, increasing the richness and diversity of the learning materials has often been shown to support students in learning, remembering and applying information. In this study, a curricular perspective was adopted on the question whether students would benefit from more learning resources. Mean study times and achievement scores for 28 problem-based courses were calculated and included in the analyses. Independent variables in both analyses were the number of primary learning resources (i.e., resources students were recommended to study) and the number of supplementary resources (i.e., related, but non-essential resources). Results showed a significant increase in achievement scores for courses with more primary learning resources, but the effect of supplementary resources was limited.     

Achievement of Students in a Conventional and Problem-Based Learning (PBL) Curriculum

This study compared student performance in problem-based (PBL) and conventional curricula on: 1) basic science knowledge following two preclinical years; 2) the Medical Council of Canada Qualifying Examination (MCC) Part I, written upon completion of the four year MD, and 3) Part II of the MCC Qualifying Examination, an assessment of clinical performance after 17 months of postgraduate education. Students in the conventional class of 1995 (n = 81) and the PBL classes of 1996 (n = 84) and 1997 (n = 78) participated. The 1995 conventional class scored significantly higher on the knowledge test than did the 1996 PBL class. The 1997 PBL class performed similarly to the 1995 class. The MCC Part I total examination scores of the three classes were similar. However, the PBL classes of 1996 and 1997 outperformed the class of 1995 in Psychiatry (p = 0.01); also, the PBL class of 1997 outscored the classes of 1995 and 1996 in Preventive Medicine and Community Health (p = 0.001). Two classes have completed the Part II examination. The 1995 and 1996 classes scored similarly in data-gathering, problem-solving and overall. The 1995 class scored significantly higher in communication skills (p = 0.01). We conclude that the performance of PBL and conventional classes is equivalent after medical school, and during postgraduate education, and that knowledge differences found in the first PBL class after two preclinical years have disappeared at the end of fourth year. Basic science knowledge may continue to grow throughout the clinical experience. Differences in communication skills, which favoured the conventional class, require further study. This revised version was published online in June 2006 with corrections to the Cover Date.     

Learning in a problem-based medical curriculum: students' conceptions

The purpose of this study was to examine students' conception of their learning in a problem-based learning medical curriculum. A multiple case study design was used with two units of analyses: two PBL lab groups; and 15 individual students within each lab group. Data collected included weekly journals by students, video-tapes of PBL sessions, focus group interviews with students, two open-ended questionnaires completed by students, and interviews with the PBL tutors. Three thematic categories of students' conceptions of their learning emerged: (1) awareness of PBL goals and expectations; (2) efficiency and expertise; and (3) the role of the tutor.     

Problem-based medical education: development of a theoretical foundation and a science-based professional attitude

Problem-based learning, combined with early patient contact, integration between different subject areas, elements of multiprofessional education, and special emphasis on the development of communications skills has become the basis for the medical curriculum at the Faculty of Health Sciences in Linköping. Critics have questioned the depth of the scientific and theoretical aspects of the curriculum. Through a series of specific measures in the organization of the curriculum and examinations, and due to the pedagogical principles involved per se , our claim is that students graduating at Linköping do possess the required theoretical knowledge and a scientific attitude to the practice of medicine, at least equivalent to that obtained in a more conventional medical curriculum. One such specific measure is that all students perform one field study and two scientific studies during the course of the curriculum. An investigation of student opinions regarding the value of performing scientific projects of their own have shown that these projects have had a positive impact on the students' general scientific attitude and their willingness to engage in future scientific work. The specific skills acquired, as confirmed by oral examinations, were largely determined by the scientific nature of the chosen field of study. Our graduates have not yet progressed far enough in their careers for comparisons to be made on the basis of the Swedish Licensing Board Internship Examinations, but continuing evaluations of students, graduates and licensed doctors emerging from the curriculum will provide future evi-dence as to whether our present evaluation is correct.     

Students' Perceptions of Assessment Practices in a Traditional Medical Curriculum

This study examines advanced medical students' perceptions of assessment practices and their ways of studying for examinations as related to their approaches to learning. This study further validates a cluster model obtained in a previous study through medical students' interviews. In this cluster model students were divided into four groups on the basis of their approaches to learning. The subjects (N = 35) were advanced medical students who volunteered to be interviewed. The interviews focused on learning strategies, study behaviour and perceptions of the learning environment. The results indicated that there were no differences in students' perceptions of the examination procedures. Students in all four groups criticised quite similarly the examination practices. However, the results showed that students in the four groups reported different ways ofpreparing for examinations and, furthermore, had different views of the most functional ways to study for them. This study brought into light problems that arise in a traditional medical curriculum, particularly concerning traditional assessment practices. This revised version was published online in August 2006 with corrections to the Cover Date.     

'You Can't Have a Cake Unless It's Written Down': Semiotic Activity and Authentic Learning in Play as a Potential Tool for Analysis

Mark-making is increasingly seen as a means of offering insights into early literacy and to a lesser degree to early mathematical representation. Rarely are comparison made between the child's developing understandings of sign and of the symbol systems by which the adult world classifies them. To begin to consider the ways in which children learn 'to sort it all out' we need to focus on the contexts in which the mark making occurs and the authenticity of the learning events in which the children act as participants. The context is that of imaginative role-play within the nursery. The central theme is that semiotic activity is a vital, but often overlooked process. This paper reflects on the practical application of the work of Van Oers and Wardekker (1999) to the analysis of early mark-making samples. It suggests that this approach, taken with other considerations, offers a means by which comparisons might be made between samples gathered in a way that respects the integrity of the children's spontaneous play.     

Performance of Academically at-Risk Medical Students in a Problem-Based Learning Programme: A Preliminary Report

Introduction Racially segregated schooling, a legacy of Apartheid policies, continues to hamper education in South Africa. Students entering university from suboptimal circumstances are at significant risk of demonstrating poor academic performance and dropping out of their programmes. Attempts to address the educational needs of these students have included the introduction of extended medical programmes at several universities. Such a programme, the Academic Development Programme (ADP), was implemented at the University of Cape Town in 1991. Over the past decade the programme has graduated more than 100 students. Upon implementation of a new problem-based learning (PBL) programme in 2002, the ADP was discontinued and all students were entered directly into the new PBL programme. Students who demonstrate a need for additional academic support by the end of the first semester enter the Intervention Programme for 1 year before proceeding to the second semester of the PBL programme. An interim analysis was performed to compare the retention rates and academic performance of academically at-risk students in the new PBL programme and the ADP. Methods The records of all academically at-risk students entering the ADP (1991–2000) and the new PBL programme (2002) were reviewed. Retention rates for all years of study, and academic performance in the fourth year clerkship courses of the respective programmes were compared. Results A total of 239 academically at-risk students in the ADP and 43 at-risk students in the new PBL programme were studied. The median retention rates, per year of study, for at-risk students in the PBL programme was significantly better than for at-risk students in the ADP (p<0.02). Academic performance of the at-risk students in all the fourth year clinical clerkship courses of the PBL programme was significantly better than the mean performance over 10 years for at-risk students in the same fourth year courses in the ADP. Conclusion The introduction of PBL at the University of Cape Town has not had a deleterious effect on the performance of academically at-risk medical students. Interim analysis suggests that retention rates and academic performance in the PBL programme are better than those achieved in the extended traditional programme.     

Accuracy of Student Self-Assessment Ability Compared to Their Own Performance in a Problem-Based Learning Medical Program: A Correlation Study

Objective: The purpose of this study was to evaluate the accuracy of self-assessment ability of students enrolled in a Problem-based Learning program. Methods: Seventy students enrolled in their third year of a four-year program were invited to voluntarily participate in the study. Self-assessment questionnaire was used to measure the students' self-assessment ability on two different occasions: 1) prior to standardised oral examination in predicting their performance, and 2) following the examination estimating their performance. The accuracy of the self-assessment was investigated by the relation between self-assessment and performance of the students. Results: Our study showed that self-assessment pre-examination was not accurate compared to performance at the oral examination (r ranging from 0.042 to 0.243).However, accuracy is slightly better when the student self-assesses his performance a posteriori, but the relation stays very low (r ranging from 0.257 to 0.334). Conclusion:According to our results, the students in the third year of a self-directed Problem-based Learning medical four year program demonstrated poor accuracy of the self-assessment when compared to their own performance. This revised version was published online in June 2006 with corrections to the Cover Date.     

学习《中药现代化及其关键技术》教程的体会

本文为笔者学习《中药现代化及其关键技术》课程的一点体会。文章分三部分,分别论述了中药现代化的内涵中药现代化与中医现代化的关系和对实现中药现代化的一些看法。国家加大资金,将中药标准化和现代化作为攻关目标,这是中药走向世界的关键,也应同时重视中医现代化的进程,两者应相互促进,共同提高。     

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 as an Effective Learning Tool in Community Medicine: Initiative in a Private Medical College of a Developing Country

Background:Knowledge of community medicine is essential for health care professionals to function as efficient primary health care physicians. Medical students learning Community Medicine as a subject are expected to be competent in critical thinking and generic skills so as to analyze community health problems better. However, current teaching by didactic lectures fails to develop these essential skills. Problem-based learning (PBL) could be an effective strategy in this respect. This study was hence done to compare the academic performance of students who were taught Community Medicine by the PBL method with that of students taught by traditional methods, to assess the generic skills of students taught in a PBL environment and to assess the perception of students toward PBL methodology.Results:A total of 77 students took part in the brainstorming session of PBL. The correlation between self-assigned scores of the participants and those assigned by the tutor in the brainstorming session of PBL was significant (r = 0.266, P = 0.05). Out of 54 students who took part in the presentation session, almost all 53 (98.1%) had good perception toward PBL. Demotivational scores were found to be significantly higher among males (P = 0.024). The academic performance of students (P < 0.001) and success rates (P = 0.05) in the examination were higher among students who took part in PBL compared to controls.Conclusion:PBL helped improve knowledge of students in comparison to those exposed only to didactic lectures. As PBL enabled students to identify the gaps in their knowledge and enhanced their group functioning and generic skills, we recommend PBL sessions: They would help optimize the training in Community Medicine at medical schools. Good correlation of tutor and self-assessment scores of participants in the brainstorming session suggests that the role of tutors could be restricted to assessment in presentation sessions alone. Demotivation, which hinders group performance in PBL, needs to be corrected by counselling and timely feedback by the tutors.     

A Comparison of Problem-Based and Conventional Curricula in Nursing Education

The purpose of this study was to compare graduating baccalaureate students in a problem-based curriculum with those in a conventional nursing program with regard to perceived preparation for clinical practice, clinical functioning, knowledge and satisfaction with their education. Prior tograduation, students completed a self-report questionnaire that consisted of five sections and took about 45 minutes to complete. Following graduation, their pass rates on the National Nursing Registration Examination (RN Exam) were also compared. The findings indicated no significant differences in their perceived preparation for nursing practice, although the conventional students scored higher in all areas. There were also no significant differences between the two groups in their perceived clinical functioning, although there was a trend toward higher function in the areas of communication and self-directed learning in the PBL group. There were no statistically significant differences in RN scores. The PBL students scored significantly higher on perceptions of their nursing knowledge, particularly in the areas of individual, family and community health assessment, communication, teaching/learning, and the health care system. The students undertaking the PBL program were more satisfied with their educational experience than their counterparts in the conventional program, indicating higher satisfaction with tutors, level of independence, assessment and program outcomes, but no difference in relation to workload orclarity of expectations This study contributes to our understanding of the relationship between different educational approaches and student outcomes. It suggests that PBL is an effective approach for educating nurses. Furthermore, it indicates that nursing students in the PBL program, like their counterparts in PBL medical programs, report higher levels of satisfaction. Future studies that are longitudinal in design and rely less on self-report measures would contribute further to our understanding of the benefits and limitations of PBL in nursing education. This revised version was published online in June 2006 with corrections to the Cover Date.     

A lesson from the introduction of a problem-based, graduate entry course: the effects of different views of self-direction

OBJECTIVES: Difficulties in the early years of a new curriculum are to be expected as staff and students come to terms with new structures, and with different approaches to teaching and learning. During the first year of implementation of the Graduate Medical Course at the Graduate School of Medicine, The University of Queensland, we experienced our share of 'teething troubles'. One source of difficulty was different interpretations of the concept of 'self-directed learning' as it was to be applied in the new course. This paper presents an analysis of the effects of these differences on the development of the curriculum. DESIGN: An orientation programme was designed to introduce students to staff, facilities and the PBL process. SETTING: The University of Queensland. SUBJECTS: Problem-based learning (PBL) tutors, medical students. RESULTS: The overall effect was to place in jeopardy the achievement of student self-direction and commitment to lifelong learning as a goal of the course. To counter the undesirable effects of different interpretations, we have developed a conceptual framework to promote an agreed understanding of the meaning of self-direction, and to guide review and further development of the curriculum. A further paper describes the framework. CONCLUSIONS: Consistency in interpretation of key concepts is an important factor in the success of problem-based curricula.     

Effectiveness of problem-based learning curricula: theory, practice and paper darts

In a recent review article, Colliver concluded that there was no convincing evidence that problem-based learning was more effective than conventional methods. He then went on to lay part of the blame on cognitive psychology, claiming that 'the theory is weak, its theoretical concepts are imprecise. the basic research is contrived and ad hoc'. This paper challenges these claims and presents evidence that (a) cognitive research is not contrived and irrelevant, (b) curriculum level interventions are doomed to fail and (c) education needs more theory-based research.     

Integration of health and social care: a case of learning and knowledge management

This paper considers integration of health and social care as an exercise in learning and knowledge management (KM). Integration assembles diverse actors and organisations in a collective effort to design and deliver new service models underpinned by multidisciplinary working and generic practice. Learning and KM are integral to this process. A critical review of the literature is undertaken to identify theoretical insights and models in this field, albeit grounded mainly in a private sector context. The findings from a research study involving two integrated services are then used to explore the role of, and approach to, learning and KM. This case study research was qualitative in nature and involved an interrogation of relevant documentary material, together with 25 in-depth interviews with a cross-section of strategic managers and professionals undertaken between March and May 2011. The evidence emerging indicated no planned strategies for learning and KM, but rather, interventions and mechanisms at different levels to support integration processes. These included formal activities, particularly around training and appraisal, but also informal ones within communities of practice and networking. Although structural enablers such as a co-location of facilities and joint appointments were important, the value of trust and inter-personal relationships was highlighted especially for tacit knowledge exchange. The infrastructure for learning and KM was constructed around a collaborative culture characterised by a coherent strategic framework; clarity of purpose based on new models of service; a collaborative leadership approach that was facilitative and distributed; and, a focus on team working to exploit the potential of multidisciplinary practice, generic working and integrated management. The discussion and conclusion use Nonaka's knowledge conversation model to reflect on the research findings, to comment on the absence of an explicit approach to learning and KM, and to develop a template to assist policy-makers with the design of planned strategies.     

Pairing Feeding Content With a Nutrition Education Curriculum: A Comparison of Online and In-Class Delivery

ObjectiveTo develop a childhood obesity prevention program, Food, Feeding and Your Family (FFYF), which encourages eating self-regulation in young children. This article describes the research methods for FFYF. Activities that will be used to guide the development of the program are illustrated in a logic model.DesignA randomized control trial will be conducted with participant groups randomized into 1 of 3 conditions: (1) in-class delivery of feeding content and nutrition education, (2) online delivery of feeding content and in-class delivery of nutrition education, and (3) nutrition education only. Assessments will be collected at baseline, program completion, and 6 and 12 months after completion of the program.SettingStudy will be conducted through the Expanded Food and Nutrition Education Program in Colorado and Washington State.ParticipantsParents with 2- to 8-year-old children will be recruited from affiliated community agencies, 540 participants across both states.InterventionsFFYF derives content from an empirically validated parental feeding program, Strategies for Effective Eating Development, and will be administered with Eating Smart • Being Active, an evidence-based, nutrition education curriculum.Main Outcome MeasuresParents will report on feeding practices, child eating behaviors, feeding styles, and acculturation.AnalysisBecause of the nested nature of the data, multilevel analyses will be used: time points, within parents, and within groups.