An experiment in problem-based learning

Summary: Problem-solving skills are important for medical students and problem-based learning (PBL) is especially suited to general practice. Therefore an experiment using a form of PBL was introduced into a new 4-week course in general practice for final rotation students at the University of Glasgow in the session 1992–93. The experiment aimed to introduce students to an alternative method of learning to the traditional one previously used by them in their course, to encourage teamwork and to encourage the use of alternative methods of obtaining information. The method, centred around allowing the students to investigate problems they choose themselves, is described. The evaluation of the course by written standard form, free written comments and audiotape recorded interviews with a one in four sample of the class is presented.
Summary: The students selected many interesting problems and used many different and unusual sources of information in researching them. This method of learning was compared with the parallel lecture course and was thought by the students to be more interesting but less relevant than the lecture course.
Summary: The experiment showed that it is possible to introduce a problem-based form of learning into a new course in parallel with more traditional methods of teaching and for it to be at least partially successful for students much more used to a traditional didactic curriculum. Ways of improving the course in the future to make it more sensitive to the students' learning needs are discussed.     

Teaching student-centred educational approaches to general practice teachers

Summary. The people responsible for undergraduate medical education are being urged to devise curricula which are more learner centred and community oriented. This has huge implications for teacher training. A project is reported aimed at helping general practice teachers develop learner-centred educational approaches through one-day workshops, themselves arranged on learner-centred lines. An evaluation indicates these workshops met their aim, and seem most useful when participants have an opportunity to practise newly acquired skills as soon afterwards as possible.     

Teaching clinical skills to medical students: the use of simulated patients and videotaping in general practice

This paper describes the use of simulated patients in a problem-based teaching programme designed to develop the clinical skills of medical students during a 5-week course in general practice in the University of Leicester. The logistics of training and the advantages of using simulated patients are discussed. Simulated patients are practicable and acceptable in a United Kingdom medical school, and the reaction of students to their use is favourable.     

Audit: teaching medical students in general practice

Summary. Audit is being seen as an increasingly important topic for medical students. Many departments of general practice in the UK now incorporate audit as part of their course work. It remains controversial as to whether this is perceived to be worthwhile by the students. Following an introductory seminar final-year medical students at the University of Glasgow were asked to perform a case-note review of 10 randomly chosen diabetic patients for a number of process and outcome measures during their practice attachments. Feedback was given in their final teaching session. 128/153 (84%) students completed an evaluation of the course on their knowledge and attitudes to audit. Unsurprisingly, 39% found the data collection boring or very boring; however, 60% found the feedback session very interesting or interesting. Both the data collection and the feedback were considered relevant by the majority of students (57% and 70% respectively). Students' self-reported knowledge also dramatically increased (P < 0.0001 ).     

Advanced training in general practice in the UK for overseas postgraduates

The strengths of general practice in the UK as a training environment for overseas doctors intending to implement the World Health Organization strategy 'Health for All by the Year 2000' in primary care are identified. A course of advanced training for teachers and administrators of primary care is described and evaluated in terms of participants' academic achievements and wider issues, including influence upon the development of primary care in their countries of origin.     

A combined course of primary health care practice and family medicine at the University of Gezira

The community-based course presented is a longitudinal course running through four semesters in the Faculty of Medicine, University of Gezira, Sudan. Students combine their regular work in primary health care centres with attachments to a number of families in Wad Medani town. They continue to visit these families regularly throughout their entire medical course with the aim of studying them and helping them with some of their medical and psychosocial problems.     

Foundations of problem-based learning: some explanatory notes

Summary. The present article elaborates on cognitive effects of problem-based learning put forward by Schmidt, De Volder, De Grave, Moust & Patel (1989) and Norman & Schmidt (1992) . Its purpose is to discuss, in some detail, the theoretical premises of this approach to learning and instruction. It is argued that problem-based learning, above all, promotes the activation of prior knowledge and its elaboration. Evidence is reviewed demonstrating that these processes actually occur in small-group tutorials and that the processing of new information is indeed facilitated by discussion of a relevant problem. These effects must be attributed to a reorganization taking place in the knowledge structures of students as a result of problem-oriented study. In addition, a cognitive process called epistemic curiosity (or intrinsic interest) is enabled. Some directions for further research are outlined. The contribution starts, however, with a discussion of the philosophical and pedagogical roots of problem-based learning.     

Tutoring in problem-based learning: a teacher development process

Summary: Summary . Undergraduate medical curricula have become increasingly innovative in order to better prepare their graduates to enter practice, with the most notable innovation being the introduction of problem-based learning (PBL). This paper describes Dalhousie University's transition to PBL, from a teacher development perspective.
The paper reinforces the need for a well-designed teacher development process that is carefully implemented and evaluated in order to ensure a successful curriculum change. A seven-stage process for teacher development of tutors at Dalhousie is described, and programme evaluation data are reported from both students' and teachers' points of view. The results from the evaluation are very positive and suggest ways of improving the teacher development process. These improvements are described, as well as future plans in this area.     

The construction of a ''topic tree'': a way of familiarizing a teaching staff to problem-oriented learning in a master''s programme in public health

At the planning stage of a community-oriented and problem-based learning master's programme in public health it is indispensable to build a network of teachers, experts in specific fields, willing to guide the students in acquiring new competencies and ready to facilitate the experimental learning process. We discuss in this paper the construction and the utilisation of the 'topic tree'. In addition we show how the teaching staff get acquainted with that educational methodology by experimenting with it themselves (prior to the students). About 10 experts, each one a specialist in a given field, have conceptualized their approach in building a topic tree (concept tree); such a tree makes it possible to schematize the topics to be understood in order to solve a given problem and the relationship existing between actions to be undertaken. The experiment, meant to initiate the teaching staff in experimental learning procedures, was appreciated by all the experts, who considered it a creative and stimulating method. It also permitted the construction of a bibliography including key documents concerning each identified priority health problem. We discuss the utility and the relevance of our approach in the perspective of initiating teachers in experiential learning based on problem-solving.     

Pre-registration posts in general practice

Though the UK Medical Act of 1978 made the creation of pre-registration house officer posts in general practice in the UK a serious proposition there have been few attempts to explore the possibility. The absence of agreed educational objectives for the year makes it impossible to conduct the properly evaluated experiments that might assuage existing doubts about the appropriateness of introducing general practice as a setting in an objective way. Experience so far shows that carefully designed schemes are both feasible and worthwhile in the opinion of those involved. The implications for general practice are explored, the need for new educational thinking is discussed and suggestions about criteria for the approval of practices are put forward.     

Active and problem-based learning: two years'' experience in physiology at the Medical School of the University of Barcelona

Traditional educational methods are used in most medical schools. The introduction of new methods including active and problem-solving learning in traditional medical schools is difficult. The aims of this experiment were: (1) to introduce a self-learning system with a problem-solving approach in physiology; (2) to promote active student participation; (3) to introduce early clinical exposure; (4) to evaluate the response of the students to this experiment; and (5) to evaluate the feasibility and usefulness of a self-learning and problem-solving approach in only one discipline. Our experience has shown that it is possible to change the learning system in a traditional medical school, with good acceptance by the students and with a high level of satisfaction on the part of the teachers.     

Family attachments and medical sociology: a valuable partnership for student learning

This paper reports association within a curriculum of a theoretical programme in medical sociology for undergraduate medical students with a practical family attachment. These two components constitute the 'sociology' element of a course in behavioural science, and have equal weight for assessment purposes. Recognition of, on one hand, the mutuality of the two elements, and on the other, their similar but distinct theoretical underpinnings, suggests that such an association has the benefit of retaining the individual contributions of each component to student learning, while enabling theoretical and practical components to inform each other. Both are administered from the Department of General Practice of the University of Sheffield, UK. The consequences of such an educational provision are discussed.     

Teaching medicine in general practice: the Guy''s experience

The development of teaching in general practice at Guy's Hospital Medical School is described. Important features of the current programme (a new programme for the United Schools of Guy's and St Thomas' Hospitals will come into effect this year) are the emphasis on learning directly from patients and the active role and responsibility given to clinical students. Students welcome the opportunities to see patients first, to deal with undifferentiated problems, to work with one clinical teacher, to put to use knowledge and skills and to test themselves as clinicians. In these circumstances they gain confidence and display the human qualities required of doctors. An acceptable service to patients, the essential basis for effective clinical teaching, requires the general practitioner teachers devote more of their time to service than to clinical teaching.     

Techniques used by "expert" and "non-expert" tutors to facilitate problem-based learning tutorials in an undergraduate medical curriculum

BACKGROUND: There is inconclusive debate within the literature as to whether the best problem-based learning (PBL) tutors are subject experts or not. The debate hinges on whether knowledgeable tutors are tempted to intervene too often in PBL discussions compared to non-expert tutors, and whether the latter may not be able to sufficiently challenge the students' level of understanding. PURPOSE: To describe approaches used by tutors in PBL tutorials and to identify differences between tutors from medical and non-medical backgrounds. METHODS: The research reported in this paper was undertaken during the academic session 1999-2000 at the University of Liverpool Faculty of Medicine. A qualitative exploratory case study method was used and two PBL groups were observed. One of these groups had a medically qualified tutor and the other had a tutor from a humanities background. The focus of the observation was the discourse between tutor and students, which was analysed using a framework drawn from linguistics. Results were fed back to both the tutors and the students to check their perceptions of the interactions. RESULTS: Analysis of the tutorial group interaction revealed that tutors from both backgrounds used similar techniques to raise students' awareness, facilitate the group process and direct students' learning. Differences were noted between the two tutors: the medical tutor set out to raise students' awareness by using questioning techniques herself, whereas the non-medical tutor expected students to question each other. The non-medical tutor was observed to facilitate the group process more often than the medical tutor. CONCLUSIONS: Qualitative analysis of spoken discourse in PBL tutorials provides valuable insights into the processes involved in PBL, thereby generating material which is useful for both training of and giving feedback to PBL tutors.     

Educational assessment of general practice experience for psychiatric trainees

Eighteen psychiatric trainees spent 6 months each as general practice trainees. The educational impact of the experience was assessed by a self-assessment questionnaire, a semi-structured interview and a videotaped interview with a psychiatric patient. Each assessment was conducted at baseline and after 12 months. A control group of 14 trainees was recruited from the same rotation. On the self-assessment questionnaire, the study registrars rated their abilities to solve general medical problems significantly improved compared to controls. They had also acquired greater understanding of the limitations of their knowledge and their legal responsibilities towards their patients. The semi-structured interview failed to distinguish between the two groups. Videotapes for rating at baseline and follow-up were available for only 17 of the trainees. Assessment of the tapes used the Maguire Scale and the Interview Behaviour Scale. Neither scale demonstrated any intervention effect. The interviews were all characterized by a preponderance of 'closed psychological' and 'checking-out' questions. It appears that psychiatric trainees' interviewing styles had not been influenced by the experience. This study suggests that psychiatric trainees gain greater confidence in their role as a doctor and greater understanding of the scope and nature of general practice by such an attachment. It is unclear whether or not supplementary interviewing skills had been acquired which were not utilized in the taped interview, which conforms very much to traditional psychiatric examination behaviour. Trainees were reassured that they had increased their knowledge without losing any of their specific professional skills.     

Approaches to learning in a problem-based medical programme: a developmental study

In this study we investigate how the introductory phase of the problem-based medical programme in Maastricht affects the study methods of students. On the first day of the academic year, 142 men and women medical students completed the Short Inventory of Study Approaches and again at the end of the introductory period. The study indicates that these study methods are fostered by training in problem-based learning given during the introductory period.     

Assessment of undergraduate general practice teaching

Final-year medical students at the University of Bristol were asked to outline a plan of management for an elderly female patient who presented with several problems. These problems were presented in the form of a 'patient management questionnaire'. This questionnaire was completed before and again after a 9-week course that included a 3-week attachment to two general practitioners. The patterns of answers were compared to look for modifications in the plan of management that could be attributed to the teaching. The results indicate a broader plan of management after the course with more students considering the physical, social and family needs of the patient, rather than the clinical problems alone. Nevertheless, further experience of this method of assessment is needed before the technique can be considered a useful tool in the evaluation of general practice teaching.     

Objectives and Students' learning in general practice

Student views of objectives and learning, during 4 weeks spent in general practice in the fifth year, are compared to those of the GPs to whom they were attached. Relationships between these views are discussed, together with their implications, for the wider contributions made by general practitioners to the undergraduate curriculum.     

Improving the psychiatric skills of the general practice trainee: an evaluation of a group training course

Fourteen general practice trainees took part in a course specifically designed to improve their psychiatric interviewing skills. The trainees were instructed in the problem-based model and were taught in a group setting with the use of videotape feedback. A significant improvement was demonstrated in the trainees' ability to identify psychiatric illness accurately, and there were significant changes in their interview behaviours after training. Those who were below average before training showed the greatest improvement. The implications of these findings are discussed. Group video feedback training is as effective as one-to-one video feedback training in improving the psychiatric interviewing skills of GP trainees, and could be more widely employed in general practice vocational training.