Problem Based Learning and organ / system based integration

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Problem Based Learning and organ / system based
integration

• Dr. Md. Ekhlasur Rahman
• Associate Professor of paediatrics
• Mymensingh Medical College

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Spoon feeding in the long run teaches us nothing
but the shape of the spoon - E M Forrester
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Learning objectives

• At the end of the session, the participants will
  be able to
• list innovations in ME
• describe the changing medical education in South
  - East Asia Region
• describe a health problem
• list goals of PBL
• narrate the clinical reasoning process
• describe the role of a facilitator

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Preamble

• Many Medical schools globally place too much
  emphasis on memorization of facts too little on
  problem solving of self directed learning
• WHO promoting ROME to address the needs of the
  community by inclusion of innovations of Medical
  Education in South-East Asia region, since mid
  seventies.

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Innovations in Medical education

• Innovations in Medical education include
• Behavioral Sciences
• Community orientation
• Problem Based learning
• Self directed learning
• Integrated teaching
• Educational media
• Assessment and information technology

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Changing Medical Education in South -East Asia
Region

• Thailand Curriculum Development
• 1. Traditional curriculum (1974) Knowledge
  Clinical sk ills
• 2. MESRAP (1978) COME PBL ? Attitude, Problem
  solving?
• 3. CTPB (1988) COMEPBL, Problem solving ?,
  Attitude?
• 4. CT LB PB (1993) 1 2 3
• COME covers 16 of curriculum time. CU (1947),
  a regional training center

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Changing Medical Education in South -East Asia
Region...

• India
• The CHAD program in CMC Vellore provides
  integrated community based, Problem oriented
  Medical Education, and using block posting. A
  regional training center. COME covers 12 of
  curriculum.
• Myanmar
• Introduced COME 15 years back, and PBL into an
  established curriculum in premedical course (1st
  year) since 1987. COME and PBL covers 15 of
  curriculum.

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Changing Medical Education in South -East Asia
Region ...

• Nepal
• Foreign Consultants developed curriculum. COME
  and PBL introduced COME is effective, but PBL is
  on the verge of failure. COME covers 23 of
  curriculum.
• Indonesia
• COME is practiced. Little PBL has been
  introduced, little chance of success

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Changing Medical Education in South -East Asia
Region ...

• Srilanka
• The whole island is well covered, down to the
  grass root level, by health services.
• Developed a system of post-graduate medical
  education -PGIM began to function properly since
  1980. It provides degrees and training on
  different specialities including Medical
  Education and Community Medicine since 1993.

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Changing Medical Education in South -East Asia
Region ...

• Bangladesh
• 1988 undergraduate medical curriculum was made
  community oriented by incorporating Community
  Medicine from 1st year to the 5th year MBBS
  course. Topic specific integrated teaching had
  also been recommended. The newer curriculum
  developed under the auspices of FIMC has been
  made more community and problem oriented.
• WHO recently has selected Mymensingh Medical
  College, for the first time in Bangladesh, to
  pilot PBL.

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One change always leaves the way open for the
introduction of others - N Machiavelli
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Health problem

• A health problem is a situation about which the
  learner knows some information, and by seeking in
  some prescribed way, can find more.
• Health problems should satisfy Some or all of the
  following Criteria
• 1. Prevalence
• 2. Life threatening
• 3. Prototypically
• 4. Professional skills
• 5. Interdisciplinary nature
• 6. usefulness of illustrating basic mechanism

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Patterns of health problems

• Stage 1 Introductory problems with emphasis on
  basic concepts
• for example injury response, Immunization,
  electrolyte regulation.
• Stage 2 Problem desgined around organ / systems
  for example Congestive Heart failure,
  Hypertension (CVS), Hematuria, Acute renal
  failure (Renal system).
• Stage 3 Multi-system Problems
• for example Convulsion, Anasarca, Dyspnoea,
  Abdominal pain.

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Health problems...

• Health problems may be presented as
• Scenario ( paper problems),
• real patient,
• video recordings of
• a real patient
• or simulated by an actor
• Health problems are usually presented to a
  student with a learning guide tutor guide is
  prepared by the teacher.

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Problem based learning (PBL)

• PBL is an educational format that is based on
  discussion and learning about a clinically -based
  problem.

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Goals of PBL

• 1. To improve the motivation of the students
• 2. To stimulate integration of disciplines
• 3. To stimulate small group learning and
  development of interpersonal communication skills
• 4. To improve self directed and long term
  learning
• 5. To improve critical thinking, clinical
  reasoning, decision making and problem solving
• 6. To make education more student oriented
• 7. To stimulate formative evaluation.

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You can not teach a man anything, you can only
help him find it within himself - Galileo
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Outline of the clinical reasoning process
Identify problems
General Hypothesis of causes (D/D)
Rank hypothesis
Test hypotheses a. Current data and knowledge b
New Data and knowledge
Re-rank hypothesis (most likely hypothesis is the
provisional diagnosis) Make hypothesis of
mechanism - how problems occur
Treat (to manage problems
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Role of a tutor

• 1. Follow problem based learning concept (using
  tutor guide)
• 2. Identify resources
• 3. Stimulate thinking
• 4. Keep discussion on track, facilitate
  discussion
• 5. Assist student to achieve objectives
• 6. Give information (if necessary by
  non-directed answers, can contribute)
• 7. Feedback and evaluation

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Nothing can be taught, everything can be
learnt. Chinese proverb