PBL FAQ
What is Problem Based Learning?
The Problem Based Learning (PBL) track at the West Virginia School of Osteopathic Medicine allows for an exciting experience in medical education. Students in the PBL program will find themselves having early, extensive experiences to learn how to think like, act like, and BE an osteopathic physician.
PBL approaches medical learning as a continual process without separation between basic and clinical science. In this curriculum, students are exposed to basic sciences and clinical sciences on an integrated basis from the first day of studies. Each subject, from physiology to immunology to osteopathic practice, is treated as part of a sum total.
What are the basic tenets of problem based learning?
- Active participation in the learning process produces longer-lasting effects than passive absorption of information.
- Student-centered instruction facilitates capitalizing on student's experience and enhances motivation for self-directed learning.
- A problem-based approach to medical education facilitates the development of collaborative skills by the student without stifling his/her individual responsibility.
- The content of medicine is too vast to be completely learned through formal means of lectures and compartmentalized courses. By using clinical problems to approach that content, students can learn the critical thinking: problem-solving, self-directed skills that will help them keep up with the knowledge necessary for a competent professional career as physicians.
- The PBL curriculum fosters undifferentiated reasoning strategies and the ability to handle uncertainty and multiplicity of possibilities, characteristics of the day-to-day practice of the osteopathic physician. Such emphasis enhances the hypothetical-deductive skills of learners as they approach problems without preconceived ideas concerning their causes, symptoms, and treatments. A generalist mind is open to explore a clinical problem in all of its possibilities, thus being able to seek information regarding that problem in as many sources as there are available.
Will I spend less time in the classroom?
The PBL approach to medical instruction greatly reduces "formal" hours in a classroom setting. Clinical case studies function as the focus of learning. Students meet regularly with a faculty facilitators in a small group (6-9) to discuss a clinical case study; each case study incorporates basic and clinical science. The training is supplemented by formal courses in Gross anatomy, Osteopathic Principles and Practices, and Clinical Skills. With the reduced number of lecture and laboratory hours, students have large blocks of time for individual and group study.
The PBL approach emphasizes individual and group direction in study. The students' responsibility in the learning process is greatly increased by active learning and critical thinking. This approach to learning provides several opportunities. First, students will be challenged with actual problems encountered by the physician. Second, students will learn to integrate essential information from a variety of sources. Third, students will begin to develop clinical reasoning skills on the first day of medical school, the same skills that will be used throughout their career as a physician.
The problem-based approach advocates that learning occurs best when associated with concrete clinical problems. Students explore the basic science content by discussing and hypothesizing about clinical problems. Immersing students in clinical problems from the beginning offers a logical approach to emulate and develop the types of skills, attitudes, and applied knowledge that will help physicians accomplish the goals of their medical education.
What Small-Group Process is used in the PBL Program?
The small group experience is the centerpiece of the PBL curriculum. Small groups are specifically useful for developing higher order cognitive skills such as evaluation, problem-solving, interpretation of complex concepts, and application of principles and basic information to practical problems. In addition, small group activities are much more conducive to promoting collaboration, development of interpersonal skills, and affective changes than the traditional classroom lecture. These characteristics of small groups are essential to medical education wherein the development of competent professionals with the ability to care humanely and sensitively for individuals and families is one of its major goals.
The PBL curriculum at WVSOM starts with small groups of approximately seven students. Small groups usually have two facilitators, a basic scientist and a clinician. The groups are the setting for discussion geared toward exploring issues pertinent to the basic science and clinical disciplines in the context of a clinical case. Each group member is encouraged to participate freely through brainstorming, challenging ideas and hypotheses, opening himself/herself to critical questions as he/she looks for learning issues raised during the discussion. The PBL group composition will change throughout the year (every nine or ten weeks), in order to allow for interaction among all PBL students.
For the small group process to work effectively, students are required to attend and participate fully. Preparation entails studying the learning issues during the independent study periods and actively contributing to the understanding of the case. The success of the program depends on student involvement.
The cases are based on patient information distributed over several pages. The facilitators will present the information progressively during the group discussion, in a sequence similar to that available to the physician. The first page, for instance, contains only the information available to the physician at the beginning of the visit: name, sex, age, and chief complaint. The subsequent pages provide data that will answer the probable questions concerning patient history, physical exam, results of laboratory tests, and ultimately, diagnosis and treatment. The process attempts to emulate the interaction between physician and patient in the course of exploring the problem presented by the patient. Students are stimulated to generate questions, ideas, and hypotheses which will help them address specific clinical situations. This allows for a free exploration of alternatives in the process of solving the patient problem. The ultimate goal of the discussion is not the solution of the problem, but to identify learning issues students need to address in order to arrive at that solution.
How is case analysis done?
The small-group process regarding each case may be divided into three phases. In the first phase the group is presented with the case and starts to identify learning issues needed to understand the presented problem. One student reads the case; while another-the scribe-writes information on a dry-erase board. In order to facilitate the discussion, the information is organized as facts, questions, ideas, hypotheses, and learning issues. The group evaluates the information regarding its relevance to the case and attempts to provide explanations for the clinical picture presented. Students are encouraged to participate freely in the generation of ideas and hypotheses regarding the case as well as to question, challenge, and probe into each others ideas and hypotheses. The basic assumption is that the collective thinking process is beneficial to the solution of the problem and to the identification of areas of inquiry students need to explore.
As students raise and test hypotheses, they identify learning issues they need to pursue. These learning issues are topics for which their current level of knowledge is insufficient to understand the clinical picture or to test the hypotheses. At the end of the session, students prioritize and select the learning issues they will collectively pursue. Although the discussion is based on a clinical case, students do not need to be concerned with making a diagnosis or selecting the treatment for the patient. The ultimate goal is to help students understand the basic mechanisms responsible for clinical signs and symptoms. The final activity of each session is for the group to evaluate its efforts in this regard and to make recommendations for improvement of the groups performance.
The second phase is for independent study of the issues identified during the group session. Students are encouraged to utilize any resources available (textbooks, journals, x-rays, audio-visual materials, resource faculty, etc.) in order to obtain the information they need to understand the clinical case. Students may meet outside the group, work individually, communicate with members of other groups or take any steps that may assist them during this phase.
During the third phase, the students reconvene to discuss the results of their independent study on their understanding of the clinical case. They repeat the process of the first phase, now applying their new knowledge in order to formulate new hypotheses and identify additional learning issues. Again, at the end of the session, they evaluate the group performance and launch another period of independent study. The process may have several iterations until the students are satisfied with the knowledge they gained in order to understand the basic mechanisms underlying the clinical picture of the case. At this time, a final self-evaluation occurs and the group summarizes what it has learned.
What "Learning Contract" is made with PBL students?
The PBL is highly student directed and provides students with an education that will help them beyond medical school as life-long learners. Students need to take the responsibility to follow a contract for the small group. This contract serves as the basis for the development of Content exams. The students agree to:
- Be actively involved in the group discussions and attend all sessions
- Come prepared
- Learning issues that are turned in should truly reflect your group study
How are students in the PBL track assessed?
Students in the PBL are assessed throughout the year and in different ways. The cornerstone "Problems in Osteopathic Medicine" course will usually meet in small groups three days each week for two hours each day, and will be supplemented by "problem sets" which may be up to two additional hours each week. Student assessment in this course will include:
- Content Examination: to assess content knowledge. The students will take content exams in the Problems in Osteopathic Medicine course (ten weeks). The exam may include board-type multiple choice questions, essay, and short answer questions. The questions will be written by various faculty members, both basic scientists and clinicians, and will be based on the common and unique learning issues developed in the small groups. (~70% of final block grade)
- Facilitator/Self Assessment: to assess the performance, progress, and participation of students in their small group, as part of the Problems in Osteopathic Medicine course. The first evaluation will be primarily to advise students of their progress. The end of the quarter evaluation will be used for grading purposes. Evaluations will be in narrative as well as numerical form. Student self assessments should be completed at the same time as the Facilitator assessment. (~30% of final block grade)
- Self-Assessment: to allow the student to scrutinize his or her learning progress and identify strengths and weaknesses. This process also allows the student to identify specific actions for further growth and improvement. Self-assessment is utilized in different ways throughout all PBL courses. (Self-assessment is not a part of final block Course grade)
Is all learning done within this small group?
The small-group "POM" courses are complemented by other courses. In Fall of Year 1 of this program, courses shared with the Systems-Based students include a Clinical Skills course, an Osteopathic Principles and Practice course, and a Gross Anatomy course (including a complete dissection). In Year 2 of the program, PBL students will complete the same Clinical Skills courses and Osteopathic Principles and Practice courses as the Systems-Based students. Additional structured learning activities (such as a segment on Medical Ethics) may be added in Year 2, to meet all program objectives.
Will I learn enough of the right things?
If you have not had experience with Problem Based learning, it is normal for you to have questions. It is very common for some students to be a little nervous in the beginning because they are not accustomed to being empowered to chart their own course of study. Common questions are: Am I learning the right things? Am I covering enough material? Will I be prepared for boards? These questions are not asked after the first couple of courses. Generally as students prepare for their end of course content exams, they suddenly realize how much they have learned! By being empowered to choose what and when to study specific topics, students have ownership of their education. This ownership provides the drive! Research shows that PBL students do as well on modern boards as students in traditional programs.
To what extent will PBL students and Systems curricula students interact?
The WVSOM leadership is committed to providing students the opportunity to interact with all students in their class, in either curriculum track. Students in the PBL program will complete Osteopathic Principles and Practices, Clinicall Skills, and Gross Anatomy courses with students in the Systems curriculum. Students from both curricula will complete the entire Year 2 Clinical Skills program (including labs and the Objective Structured Clinical Evaluation) together. They will also work together in extracurricular activities, such as school organizations and intramural sports. Furthermore, students in the two tracks will be treated identically in the 3rd and 4th years of the program.
My question wasn't answered here. Who can tell me more about this program?
For more information, please contact Malcolm Modrzakowski, Ph.D., Associate Dean for PBL, at mmodrzakowski@wvsom.edu or call him at 1-800-356-7836, ext. 302, or contact Donna Varney, Director of Admissions at dvarney@wvsom.edu or call her at 1-800-356-7836, ext. 373.
