Page 1

CALENDAR CORNER: UPCOMING EVENTS

Assessing Medical Professionalism in the Undergraduate Curriculum

To register, please download a registration form from www.facdev.med.ubc.ca

Drs. Bert Cameron, David Fairholm & Barry Kassen Thursday March 17, 2005 14:30 – 16:30 Code 214 VGH, JPP 2nd Floor, Lauener Room

February 2005

Medical Education Grand Rounds:

Educational Primer for Clinicians Module B (I): Framework for Clinical Reasoning

Friday March 18, 2005 10:00 - 11:00 BCCW, Chan Education Centre, Rm 3113

Medical Education Research Group:

Drs. David Fairholm & Richard Cohen Thursday February 17, 2005 18:30 – 20:00 Code 205B1 VGH, JPP, 2nd Floor, Lauener Room

Friday March 18, 2005 11:15 - 12:30 BCCW, Chan Education Centre, Rm 3113

Medical Education Grand Rounds: Standard Setting in Assessment

Dr. Leslie Sadownik Thursday March 31, 2005 18:30 – 20:00 Code 205C1 VGH, JPP 2nd Floor, Lauener Room

Dr. George Pachev Friday February 18, 2005 10:00 - 11:00 VGH, JPP, 2nd Floor, Lauener Room

Medical Education Journal Club Friday February 18, 2005 11:15 - 12:30 VGH, JPP 2nd Floor, Lauener Room

Educational Primer for Clinicians (Full) Drs. Leslie Sadownik, David Fairholm, Janet Kushner Kow, Richard Cohen & Rose Hatala Module A: Thursday February 24, 2005 09:00 - 12:00 Code 203A Module B: Thursday February 24, 2005 13:00 - 16:00 Code 203B Module C: Friday February 25, 2005 09:00 - 12:00 Code 203C VGH, 855 West 10th Avenue, 3rd Floor, Faculty Development Library

Educational Primer for Clinicians Module C (I): Feedback

April 2005 Educational Primer for Clinicians Module C (II): Assessment of Clinical Performance Dr. Leslie Sadownik Thursday April 07, 2005 18:30 – 20:00 Code 205C2 VGH, JPP 2nd Floor, Lauener Room

Drs. Edward Etchells (Director Patient Safety Services, University of Toronto) Thursday April 14, 2005 15:00 - 17:00 Code 215 VGH, JPP 2nd Floor, Lauener Room

Medical Education Grand Rounds: Learning from Medical Error

Educational Primer for Clinicians Module B (II): Questioning Skills

Dr. Edward Etchells Friday April 15, 2005 10:00 - 11:00 VGH, JPP 2nd Floor, Lauener Room

PBL Tutor Training Workshop Tuesday March 08 & Thursday March 10, 2005 08:00 – 12:00 Code 209 VGH, JPPN 3rd Floor, Rm 3353

Linda Grasswick Alaraji, Adnan - Neurology Ellis, Cathryn -Midwifery Hunte, Garth - Family Practice Money, Phyllis - Anesthesia van Niekerk, Dirk - Path & Lab Med Watson, David - Emergency Wilkins-Ho, Mike - Psychiatry Wong, Eileen - Family Practice Wong, Kenny - Pediatrics Yousif, Amal - Pediatrics ER Mohammed Al-Othman - ER Hashim Balubaid - Medicine Michelle Belanger - OB/GYN Terence Chang - Family Practice Mark Crossman - Medicine Douglas Drummond - Family Practice Lisa Dyke - Pediatrics Sarah Finlayson - Gyn/Onc Nelson Greidanus - Orthopedics Avi Lemberg - Pediatrics Kenneth Madden - Medicine Tracy Pressey - Maternal-Fetal Med Kelly Saran - Medicine Juit Spence - Physical Therapy Sanjeev Vohra - Geriatrics Karen Zahn - Medicine Scott Markey - Family Practice Lori Laughland -Family Practice David Page - Family Practice Jeevyn Chahal - Family Practice Sean Larsen - Family Practice

Medical Error as a Learning Opportunity

March 2005

Drs. David Fairholm & Richard Cohen Thursday March 3, 2005 18:30 – 20:00 Code 205B2 VGH, JPP 2nd Floor, Lauener Room

Congratulations to our recent graduates of The ABC Educational Primer for Clinicians!

Medical Education Journal Club Friday April 15 2005 12:30 - 14:00 VGH, JPP 2nd Floor, Lauener Room

The Essentials of Teaching Recognition and Reward Wednesday April 20, 2005 15:00 - 17:00 Code 219 VGH, JPP 2nd Floor, Lauener Room

Number Twelve •

Spotlight on Problem Based Learning Editor’s note: This issue of our Faculty Development Newsletter starts off with a heart-felt tribute to Dr. Bill Webber. We invite everyone to participate in our Medical Education Day in May and attend the First William Webber Lecture in Medical Education. The articles in this issue share different perspectives about Problem Based Learning in our curriculum. Enjoy!

The William Webber Lecture in Medical Education Please join the community of UBC medical educators to celebrate the First Annual William Webber Lecture in Medical Education. Dr. Webber (or Bill as he is known to most) has spent a career spanning 50 years in medical education. Bill received his medical degree at UBC in 1958. After a period as a post-doctoral fellow at Cornell Medical College, he joined the Department of Anatomy in 1961 with a research interest in the structure and function of the kidney. Over the years he taught gross anatomy,

Editor: Dr. Leslie Sadownik Design: Yan Huang This newsletter is distributed to faculty members in the Faculty of Medicine. We aim to make Education Matters as relevant and informative as possible. To achieve this, we welcome articles, photographs, letters, feedback and other submissions. Please send submissions to facdev@interchange.ubc.ca.

neuroanatomy, histology and embryology. From 1971 to 1996, he was heavily involved in administration as Associate Dean and Dean of Medicine (1977-1990), as Coordinator of Health Sciences from 1990 to 1996, and as Associate Vice-President Academic. These administrative positions did not interfere with his interest and love for teaching. He has received the highest teaching awards including an Honorary Degree (LLD) from UBC. He has been the driving force behind many educational initiatives - not only in the Faculty of Medicine but widely

throughout our University. Perhaps what is most striking about Bill is not just what he brings to educational programs but what he brings to individual learners. His longstanding interest in education goes far beyond “the act of teaching”. Bill is sincerely interested in his colleagues and his learners as individuals. He characteristically brings a human face to the educational endeavour. The William Webber Lecture in Medical Education will celebrate this humanistic approach to medical education. Our guest lecturer this year will be a long standing friend and colleage of Bill’s - Dr. Charles Slonecker.

Friday May 20, 2005 Medical Education Day

Office for Faculty Development and Educational Support 855 West 10th Avenue, Third Floor Vancouver, B.C. V5Z 1L7 Tel: 604-875-4396 Fax: 604-875-5370 Email: facdev@interchange.ubc.ca Website: www.facdev.med.ubc.ca

February 2005

RSVP required for the event by Friday May 6, 2005 Call for Posters Posters are invited for presentation at the 2005 Medical Education Day. Posters may cover any topic in medical and healthcare professional education and may relate to undergraduate, postgraduate, or continuing professional development. Please submit an abstract including your name and contact information, title of presentation, name of all authors, and abstract (maximum 200 words) to the Faculty Development

Office by May 6, 2005. For more information visit our website.

William Webber Lecture in Medical Education - Guest Lecture Dr. Charles Slonecker (LSC3 Theatre)

Agenda UBC Life Sciences Centre

For More Information

10:00 – 12:00 Facilitated Poster session (Rm 1410) 12:00 – 13:00 Lunch (Rm 1416) 13:00 – 14:30

www.facdev.med.ubc.ca

Visit our website, call our office or email to facdev@interchange.ubc.ca for: • Directions to the Life Sciences Centre • RSVP for the event • Instructions for submitting poster presentations

604.875.4396


2

P2P1A

AND THE

MEANING

7 OF

LIFE

FACULTY OF MEDICINE 2004-2005 CALL FOR NOMINATIONS

Dr. Bill Webber Faculty of Medicine The still relatively new curriculum featuring problem based learning (PBL) has provided a variety of interesting experiences for both faculty and students.

If you have no weaknesses, you shouldn’t be wasting your time tutoring.

One of the more important observations is that not all tutors, not all students and not all groups are the same. I have now tutored in the initial block, P2P1a, for eight consecutive years since its inception. I believe it has some unique characteristics which are worth thinking about. For most students, it is their first experience with PBL. They come with some apprehension about how it will work both in general and for them personally. Their experience in this block will set the tone for their impression of the program as a whole and for their behavior in future blocks. There are a number of factors which make the block unique. The students usually do not know each other. They are often apprehensive about their own ability to function in medical school, let alone in a format with which they are unfamiliar. They are concerned about both their academic preparation, particularly those with atypical academic backgrounds, and their interpersonal skills. They are also likely to be concerned about the attitude and expectations of their first tutor. Will those expectations be reasonable and will they be able to meet them? The tutors, particularly if they are new, may be similarly apprehensive about their abilities to function effectively. Typically, the group is heterogeneous in terms of culture, academic background and life experience. My experience suggests that the tutor should have several fairly limited

604-875-4111 local 68607

Dr. Bill Webber objectives in terms of the functioning of the group. The most important of these is that the experience should be enjoyable for all. It should be made clear that if any of the students is not looking forward to coming to tutorials something is not working right and the issue should be raised with the group. The students should be encouraged to regard it as “their” group and feel that they can suggest changes in format or functioning. It is worth trying out student suggestions even if the tutor feels highly skeptical about them. Individual students are usually quite insightful about their strengths and weaknesses and should be encouraged to demonstrate their strengths and work on the areas they feel they need to improve. To achieve these goals there needs to be early opportunity for the group to review its own functioning and for individuals to describe their strengths and weaknesses. Feedback should be provided by both the tutor and by other group members. The tutor can model these interactions by describing his or her own strengths and weaknesses as a tutor and seeking the student’s feedback.

It is important to emphasize that there are many ways of contributing to group functioning and there is not a standardized set of behaviors which is required. Early in the block the tutor may need to be more directive with a transfer of ownership as it were, to the students as they become more sophisticated. Assessment should begin early. I have found it useful to begin with oral interaction including self-assessments and responses from colleagues. By the end of the second week I move to providing brief written assessments. Writing comments down forces the tutor to think carefully about the specific words used and how they will be interpreted by the students. In my groups, students hear everything that is said about the other students and have a chance to agree with or temper what I have said or to provide supplementary assessment. By the end of P2P1a I think the students should be comfortable and, indeed, enjoying the tutorial process. They should be able to participate in a variety of ways including initiating discussion, adding information, using the board, listening respectfully, and disagreeing or correcting positively. They should be working on being in control of their input and being able to vary it deliberately and appropriately. They should be able to self-assess, receive and respond to the assessment of others and to provide constructive feedback to others. If the block has gone well they should leave with the feeling about PBL that, “I can do this” and “I can help my next group to function effectively.”

facdev@interchange.ubc.ca

www .f acde v.med.ubc .ca www.f .facde acdev .med.ubc.ca

Lifetime Achievement Award The New Faculty Lifetime Achievement Award will recognize extraordinary members of the Faculty of Medicine who have had sustained distinguished careers at UBC in the areas of research, teaching and/or service as defined by the guidelines for promotion in the UBC Guide. These awards are open to Professors, Professors Emeritus/Emerita, Clinical Professors and Clinical Professors Emeritus/Emerita in celebration of an outstanding career. Nominees must have held an appointment at UBC for at least 15 years. At the time of nomination, the recipient must be an active member of the UBC Faculty of Medicine. Nominations will be made by any three Professors or Clinical Professors in the Faculty of Medicine. A nomination form should be accompanied by a letter from the nominators, the curriculum vitae/ publication list of the candidate, and up to 4 external arms-length letters of reference addressing the criteria of the Award. Referees should be individuals of stature in the Nominee’s area of interest. Nominators will complete all documentation and submit the completed nomination package to the Dean. After checking for eligibility and completeness, the Dean will forward dossiers to the Adjudication Committee. The deadline for submitting Nominations is Monday February 21, 2005. Questions regarding the nomination process or guidelines should be directed to the Chair of the Faculty of Medicine Awards Committee, Dr. Ross MacGillivray at 604 822-3027 or ross.macgillivray@ubc.ca Please return completed nomination packages to Dr. Gavin Stuart, Dean.

604-875-4111 local 68607

Clinical Faculty Award for Excellence in Teaching Since 2001, the Faculty of Medicine has provided three annual awards to recognize clinical faculty who excel in clinical teaching. The “Clinical Faculty Award for Excellence in Teaching” is intended to provide recognition and encouragement to excellent teachers. The award will be presented at an occasion to be identified by the Dean. A Committee comprised of the Special Advisor for Clinical Faculty Affairs, Assistant Dean, Faculty Educational Development, representatives from the Associate Deans of Undergraduate and Post-Graduate Medical Education, and clinical faculty representatives will select award recipients from among nominees. The award consists of a financial prize of $1,000 and membership in the Canadian Association for Medical Education. Candidates for this award will possess a Clinical Faculty appointment within the Faculty of Medicine in one of the Clinical Departments or Professional schools. Candidates should have a sustained record over several years of effective teaching performance. The awards will be based upon excellence in teaching as evidenced by evaluations of students and/or residents and/or peers. Consideration will be given to a record of the development of effective teaching methods or materials for clinical teaching and involvement in curricular or course development.

Career Award for Excellence in Clinical Teaching The Career Clinical Faculty teaching Award is intended to provide recognition and encouragement to senior clinical

teachers of the Faculty. The purpose is to recognise long-time members of the Faculty who, over their career, have a sustained record and reputation for excellence in clinical teaching. These are teachers who typically function in small groups or on a one-on-one basis with residents and students and who have had a major impact on the acquisition of clinical knowledge, skills and judgment and on career choices. The award consists of a financial prize of $2,500. Candidates for this award are senior clinical teachers who are full time, part time, or clinical members of the Faculty. Candidates should have a sustained record over several years of effective teaching performance as evidenced by evaluations of students and/or residents and/or peers. Some teachers provide role models and life-long inspiration to students and have a profound effect on their motivation to learn in particular areas or pursue a particular career. Some stimulate students’ clinical problem solving or critical appraisal skills, some are most influential in students’ acquisition of clinical knowledge and skills, and others employ highly innovative teaching methods. The deadlines for submitting nominations for both Clinical Faculty Award for Excellence in Teaching and Career Award for Excellence in Clinical Teaching are Friday February 25, 2005. For a nomination form and more information, visit our website www.facdev.med.ubc.ca Please return nominations to: Dr. Gavin Stuart, Dean Faculty of Medicine 317 - 2194 Health Sciences Mall Vancouver, BC V6T 1Z3

facdev@interchange.ubc.ca

f acde v@inter c hang e .ubc .ca acdev@inter hange .ubc.ca


6

MEDICAL EDUCATION (REVISED EDITION)

This book is a compact 147 pages. Chapters explore topics such as: ƒ Authentic PBL and its development ƒ Challenges of the patient problem ƒ The physician’s reasoning process ƒ Self-directed learning ƒ Curriculum support needed for PBL ƒ The “Authentic” PBL process

ƒ ƒ ƒ ƒ

Assessment in PBL PBL in the Clerkship years Evaluation of the effectiveness of PBL Criteria for analyzing a PBL curriculum

The Office for Faculty Development has limited copies of the book. Please contact us for more information.

○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○

THE UBC FACULTY CERTIFICATE PROGRAM ON TEACHING AND LEARNING IN HIGHER EDUCATION (FCP) There is a growing recognition of the increasing complexity of academic work, as well as the need for university teachers to develop a scholarly approach toward their teaching. The UBC Faculty Certificate Program on Teaching and Learning in Higher Education (HE) was initiated in 1998. This innovative certificate program has been designed to adapt to the curricula and pedagogical needs of university teachers from multidisciplinary settings. The certificate program integrates theory with practice and is developed around a cohort model. The primary goal of this

program is to enhance the scholarship of teaching and learning at UBC. Furthermore, the certificate program prepares faculty for leadership roles in broader curricula and pedagogical matters. Many faculty participate in the program to investigate critical pedagogical issues within their department (e.g.,curriculum re-design, evaluation of curricula, PBL, staff development, web-based learning, clinical teaching practices), others embark on this program for personal reasons to improve course design, teaching scholarship, learning strategies and assessment practices.

Faculty graduates of the program include Killam and 3M teaching award winners and professors from a wide range of disciplines and academic ranks. Each year, President Martha Piper awards certificates to graduating faculty members at Green College. There are a limited number of faculty participant places available in this program. Each Faculty on campus is allocated two places. Further details about this program and the teaching scholarship scheme for the September 2005-06 cohort can be accessed at http:// www. ta g . u b c . c a / p r o g r a m s / facultycertificate/

○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○

UBC CERTIFICATE

IN

PRACTICE EDUCATION

The new UBC Certificate in Practice Education is a comprehensive program that will demonstrate how to integrate core educational, interpersonal and team building skills with your existing expertise as a health professional. Who should take this program? This certificate is designed for professionals in the health and human services who are already working with, or planning educational experiences for students and peers. What are the benefits? 604-875-4111 local 68607

FOR

HEALTH

This certificate offers you an opportunity to build on your skills as an educator, become part of a supportive and experienced network, to discover the excitement inherent in teaching others, and to spark passion in your students and peers. Program Format This part-time program offers a balance of theory and practice, with courses that are delivered in a combination of in-class and online formats. Participants take five courses for a total of 150 hours of study over approximately 11 months.

AND

HUMAN SERVICES

Five Courses • Learning in a Clinical Practice Setting • Clinical Educator Roles and Competencies • Program Development and Delivery • Strategies for Interaction • Applications for Collaborative Education For more information For details about the course modules, costs and dates, please visit www.cstudies.ubc.ca/health, call 604822-8098 or email info-health@ubc.ca facdev@interchange.ubc.ca

www .f acde v.med.ubc .ca www.f .facde acdev .med.ubc.ca

THROUGH

PROBLEM BASED LEARNING

Dr. Amanda Bradley Instructor, Medical Undergraduate Program Dr. Amanda Bradley has a PhD in basic sciences from UBC (Dept of ○ ○ ○ Pathology). ○ ○ ○ ○ ○ ○ ○ ○She is a Experimental clinical associate professor and a research associate for the Canadian Blood Services. In March 2004, she jumped to a full time teaching position as an instructor in the medical undergraduate program. She has been an active PBL tutor since 2000 and has to date tutored in 11 blocks. ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○

Need more information about Problem Based Learning? Consider this excellent resource - “Problem-Based Learning Applied to Medical Education (Revised Edition)” by Howard S. Barrows, 2000, published by Southern Illinois University School of Medicine, Illinois.

TO

PROMOTING LIFE-LONG LEARNING SKILLS

○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○

PROBLEM-BASED LEARNING APPLIED

3

○ ○ ○ ○ ○ ○ ○ ○ ○ Amanda is ○one of seven “instructors” in the medical undergraduate program who were hired in anticipation of the expansion of the medical school. These instructors are dedicated to tutoring (PBL and DPAS), curriculum development, faculty and student support, primarily in the first 2 years of the curriculum.

9 determine their learning needs and formulate goals 9 exercise self-awareness 9 know when and how to acquire new information and skills 9 think critically Q: What can a tutor do to promote students acquisition of life-long learning skills? A: Tutors should nurture a safe environment where students will be open to learning how to assess themselves and how to recognize and admit when their knowledge is not adequate. A safe environment can be promoted by ensuring that group members agree on a set of ground rules, showing respect for the group, admitting to our own

Why did Amanda decide to shift her career focus? Amanda replied, “I decided to jump at this full time teaching opportunity because as much as I loved basic science research, I love teaching even more. I am thoroughly enjoying the opportunity to reflect, focus on, and improve my teaching and to be involved in improving the quality of our students’ medical education.” Q: Why is life-long learning important? A: Physicians must keep up-to-date with medical advances in order to meet the changing needs of patients. Physicians that continue educating themselves will realize when their skills require updating and will have the knowledge to act in accordance with evidence based practice. Q: What skills must life-long learners possess? A: Life-long learners: 9 are self-directed 604-875-4111 local 68607

Amanda (middle) tutoring students ignorance and encouraging students to openly exchange ideas and opinions. Once safe, students can be challenged by the tutor’s questions and encouraged to gain experience with choosing and appraising resources. Q: What kinds of questions are helpful? A: Questions that prompt students to substantiate their hypotheses, challenge their thinking, determine

their learning needs and practice evidence based medicine include: 9 Why do you think this is true? 9 Does the new data strengthen, weaken or eliminate any of the hypotheses? 9 What more information do you need? Why? 9 What is the depth of study required for this learning issue? 9 Why would you order this test? How sensitive and specific is it? Q: How do we promote the use of appropriate resources? A: We should encourage students to share resource information and to evaluate their sources. Useful questions include: 9 Is this source reliable for the type of information we are seeking? Is it current? 9 Can anyone verify that information using another source? 9 Are there any limitations for the application of this information? 9 Are you satisfied with the information? We should also gauge the students’ skills so as to provide an appropriate level of guidance. Early on, students will require more guidance. Then, as they become increasingly experienced and responsible for their own learning, tutors should allow students to carry on the process by themselves and should enter the discussion only when guidance is indicated. Importantly, tutors should provide open, honest, constructive feedback on the students’ reasoning processes and on their performance as self-directed learners. As PBL tutors, we must remember that the skills our students acquire will impact their abilities to meet new problems and to keep contemporary in their knowledge. By careful facilitation, we can help our students acquire the skills and attitudes they will need to succeed. facdev@interchange.ubc.ca

f acde v@inter c hang e .ubc .ca acdev@inter hange .ubc.ca


4

5

PROBLEM BASED LEARNING: A “FORWARD” STEP Yolanda Butt Medical Student, Class of 2005 One of the draws of UBC Faculty of Medicine was the new problem based learning (PBL) curriculum. I remember trying to convey my anticipation for learning in small groups and working through clinical cases “like a detective” during my medical school interview. Now that I have nearly completed my long-sought-after MD degree – having PBL’d my way through the initial two pre-clinical years and applied those lessons learned to my experiences on the wards – I can definitely say that PBL played an instrumental part in enriching my medical training. I was quite lucky to have actually known what the new buzzword, PBL, meant even prior to starting medical school. During my undergrad science degree, I volunteered to be one of the guinea pig students for the development of the PBL cases and for tutor training. It was great fun interacting with the other students, building on each others’ knowledge, asking questions, and best of all, finding out that I knew more than I thought! There is a fine sense of accomplishment and gratification when you figure out that all the clues from the case point to some condition called Tetralogy of Fallot that you found on Page 498 of an obscure text from the musty stacks of Woodward Library. But it was really the “process” of PBL that brought the rewards and tribulations. At first, PBL was novel and all of the medical students were very enthusiastic about following up on learning issues. We used textbooks, the internet, journals… anything we could get our hands on to uncover the answers. We had an incredible appetite for finding more details. This led us toward more questions, opening up a Pandora’s box of knowledge that we sometimes found overwhelming. We became especially adept at finding or constructing flow charts to present at 604-875-4111 local 68607

the next PBL session, making timelines to summarize case details, gathering information in systematic ways from history, physical investigations, to treatment and management, and presenting our researched information to the rest of the group. In fact, 77% of my class during their first year of PBL felt that PBL helped them to learn rather than being a waste of time.

Yolanda (middle) Despite these new skills we gained from PBL, there were frustrating times. We often left on Fridays and Case Wrap-Up sessions still unclear on the final details of the case, or whether we, as individuals or as a group or even as a class, covered the exact objectives of the week. We sometimes felt as if we were guarded from the “answers.” That, paradoxically, even though PBL was intended for us to learn in a self-directed way, we were hindered from accessing the knowledge that was so close and yet so far and concealed in the Tutor’s Guide or a summary lecture. Time was also an unfair limit on the extent of what we learned. We were exacerbated by the amount of time we had to take to find what we identified as learning

HOW

DOES THE LEARNING HAPPEN IN

PROBLEM BASED LEARNING?

Dr. Niamh Kelly Associate Professor, Department of Pathology and Laboratory Medicine issues. And the limitations on proceeding further than the recommended sheets per PBL session or sharing information from the Tutor’s Guide were frustrating. I must admit I learned the most from groups where we decided as a group on how many sheets we felt we could accomplish that day and “illegally” did an extra page a day to be able to have time on Fridays to use creative learning techniques such as PBL Jeopardy or made-up questions out of a hat to review the week. PBL is a dynamic process and should have the flexibility to accommodate the different personalities of the groups.

As teachers, we undergo faculty development so that we are fully educated in our role as facilitative teachers or ‘tutors’ in the PBL process. But what about the learner? Given that this is a learner centered educational activity, how are the learners educated as to their roles and responsibilities in this learning environment? And how do we monitor their acquisition of the skills they are expected to learn in the problem based learning (PBL) environment? Furthermore, should they demonstrate a weakness in the acquisition of these skills, how do we help them overcome this weakness?

On reflection, my most significant memories of PBL are of the characters that made up the small groups and their contributions. Individuals such as the radiologist-tutor who took the time to provide an approach to chest x-rays in the respirology block, or groups such as the relationally-dysfunctional but highly productive members of my ObGyne group left an indelible mark on my training. During clerkship, I often accessed these synapses to recall the learning issues we covered that are now associated with these people. And if I didn’t remember the actual outcome of our discussion on hand-foot-mouth disease – covered in HDI week of first year because K.D. from our group had the disease last spring – at least I knew where to turn in my binder to find the details.

Skills which the learner is being asked to develop in the problem based learning environment include skills associated with: • their approach to knowledge and learning; • problem solving ability; • teamwork; • self-awareness; and, • reflective practice.

The incredible sense of camaraderie and interaction between classmates was the most valuable aspect of PBL. Our class shared information and web links over email, we brought food to celebrate Fridays, we learned who was hardworking and who was slack, we networked with future attending staff. Had we not spent 3 days a week over 2 Continued on page 5 facdev@interchange.ubc.ca

www .f acde v.med.ubc .ca www.f .facde acdev .med.ubc.ca

The acquisition of these skills is through a process of experimental learning accompanied by feedback. At the end of every 5 week PBL block the students receive a report from their tutor giving them narrative feedback under the headings ‘Preparation’ for PBL,

Dr. Niamh Kelly ‘Participation’ in PBL, and ‘Professionalism’ displayed in the PBL setting. It is through these narratives, nicknamed the three Ps, that a tutor communicates to an individual student their level of competence in the skill set outlined above. So, what if a student is incompetent in one or another of these skills? What should the tutor do? And what help is available to the student in improving their acquisition of these skills? The tutor communicates that a student ‘requires improvement’ in a skill area by giving them a P- rating in one of the three Ps, accompanied by a well-written narrative describing the specific weakness and recommendations to guide the student’s improvement. A

committee has been established, called the Student Support and Development Committee (SSDC), which monitors tutors’ evaluations and steps in to offer support to any student assigned a P-. Once a student has been assigned a Pthe committee reviews the students file to gain a more complete picture of the student’s developing skill set, based on previous PBL tutors’ reports along with reports from some of the other tutored courses such as communication skills, clinical skills, and Doctor Patient and Society. The student is sent a Reflection and Remediation form prompting them to comment on their perceived strengths and weaknesses with regard to the skill set which has been identified as requiring improvement. The SSDC committee works with the student in establishing a plan for improving the necessary skill set, and monitors their progress in this regard. The Student Support and Development Committee works with about 20 to 30 first year students and less than 10 second year students each year. It is through this process of experimental learning accompanied by feedback, with a remediation step when required, that the majority of our students attain a level of competence in the skill set associated with problem based learning by the time they enter their clinical years.

○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○

Continued from page 4 years in random groups as team members, we would not have been able to share knowledge and experiences with students. We otherwise would not have gotten to know if we had just been sitting in class all day in a didactic model. Problem based learning was a superb medical learning model and I can 604-875-4111 local 68607

imagine no other way than PBL to prepare for the wards and beyond. The pairing of PBL with complementary lectures related to the week’s topic made for comprehensive learning. It appealed to most students – those who were motivated to self-direct and assess their learning as well as those who learn didactically. Clerkship provided ample opportunity to read and practice clinical management, and our preparation for the LMCC will be an appropriate review

of our undergraduate medical education. Like cutting through the layers of an onion, there would sometimes be tears, but the end result was worth it.

facdev@interchange.ubc.ca

f acde v@inter c hang e .ubc .ca acdev@inter hange .ubc.ca

Education Matters Feb 2005  

Spotlight on Problem Based Learning