PBL LEARNING:

An inspiration for working as a single teacher

with a large student number

JP Bourguignon & S Gelaes CDS 16/04/07

The setting

Course title: « Pediatric aspects of child and adolescent disorders with multidisciplinary

management »

JPB in charge of this course since 1990 while PBL in medicine started in 2000

Students (n~60) at the master level in psychology or speech therapy

The course is an option made by most students

PBL fundamentals

Contextualized problem

Small group work

Students as actors analyze problem and reactivate previous acquisitions (90 min)

Teacher as a facilitator

Motivation stimulated by feedback (peers, tutor)

Autonomy reinforced by individual search of information

Contextualized short scenario to begin with

Small group work: 6-10 students convene around the tables in the lecture room

They interact in clarifying new terms, identifying and discussing key messages (20 min)

Teacher collects questions, opinions and stimulate student answers (20 min)

Lecture (interactive) with reference to student productions where relevant (90 min)

PBL inspired lecture

The scenario

A mother seek advice about her 13.5 yr old twin son possibly repeating grade due to recent collapse of schoolnotes while her twin daughter is brilliant and successful.

The twin sister started pubic hair at 7, breast budding at 9 and she grew very fast at 10. She got her first periods at 11 and now, she looks like an adult woman with a height of 167 cm. Mother was concerned by her precocity because she heard that growth could stop prematurely.

The twin brother is 142 cm tall and feels behind. He went to a doctor who explained that his puberty just started based on an increase in testicular volume. He predicted peak height velocity to occur between 15 and 16. This was consistent with a delayed bone age (11 yrs). He wants hormonal therapy to speed up development but mother is reluctant.

Contextualized short scenario

Small group work: 6-10 convene around the tables in the lecture room: clarification, meaning, discussion (15 min)

PBL inspired lecture

20 short scenarios including different aspects across the lectures; given ahead to the students and briefly commented

Written preparation (30 min) of a randomly allocated scenario: clarification, meaning, discussion

Oral presentation and reflexive discussion

Consistent evaluation

A girl of 13 who is mad about dancing has no pubertal signs except pubic hair. She practises dance 12h a week and is committed to control her weight. BMI is between centiles 3 and 10 for age.

The father worries about possible short adult stature and the mother fears her daughter plan: to move abroad where she could find a high level dancing school.

How could this adolescent and her parents be accompanied ?

A question

Knowing 50 %

Reasoning, arguing 20 %

Linking, integrating 20 %

Communicating 10 %

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Student notes (/20) at evaluation

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The students participated actively when working on the clinical scenarios

- - 2 13 12 4

The scenarios contributed to motivation towards learning - 2 2 12 10 5

The scenarios increased the quality of learning 1 - 1 10 13 6

The teacher took the student production into account - - - 6 12 13

The learning conditions

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The modalities are consistent with the learning conditions - - 1 4 11 15

I prefer an evaluation based on a clinical scenario to a classical exam (MCQ,…)

- - 3 11 11 6

The discussion of the evaluation scenarios by the teacher helped in preparing the examination

- - - 6 12 13

The evaluation

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To succeed at an evaluation based on a clinical scenario requires skills beyond knowledge

- - 4 9 12 6

An evaluation based on a clinical scenario allows the student to better show his/her skills

1 3 4 12 7 3

An evaluation based on a clinical scenario is a modality equitable for the student

1 4 5 7 8 6

The evaluation

The biases: factors unrelated to PBL

Students: they are motivated for this particular course since they elected to follow it even before the PBL inspired format was used

Students: they are enthusiastic when hearing about patients after so many years of

mainly theoretical teaching

Students: they have few or no experience of group work and self-expression in a large group

Teacher: as a PBL- or lecture- motivated person, motivation may be the key instead of the PBL or lecture format

Dunnington G et al. Surgery 1987, 102: 291-6

Active learning in problem-oriented small group sessions OR passive learning in didactic lectures

POL: tend to better perform

Schwartz PL.Medical Teacher 1989, 11: 81-6

After preparatory reading, problem working in small self-selected groups in lecture theater (30 min) and discussion (20 min) without lecture

Well received

Leclercq D et al 1998

RQA PST: Reading– Questions- Answers- Problem solving- Synthesis- Test;

Haidet P et al.Academic Med 2002, 77: 40-4

Team working: class division into groups of 5 students cooperating to solve a task and report during a constructively controversial discussion; no lecture

Greater learning, more accurate retention

Haidet P et al.Adv Health Sci Educ 2004, 9: 1-3

Didactic lecture (60 min) vs short lecture (30 min) after student interaction session

More active engag.of learners

Johnson JP & Mighten A. J Nursing Educ 2005, 44: 319-22

Structured group discussion on lecture notes OR lecture only

Increasedperform. at exam

Conclusion In a traditional lecture setting, it is possible to introduce

some components of PBL through an initial student activity in small groups around a short scenario and subsequent sharing of their reflexion with the whole class

The evaluation modalities should be consistent with the learning conditions

Overall, such an initiative is well received by the students though it is hard to separate the contribution of specific PBL components from others (novelty, practicality, motivation)

A long-term impact could be expected based on student comments: « was in; made links; had to think about; had to take a position; discovered other perspectives; too much medicine but so great to touch professional realities,… »