Number Twelve • February 2005

Office for Faculty Developmentand Educational Support

855 West 10th Avenue, Third FloorVancouver, B.C. V5Z 1L7Tel: 604-875-4396Fax: 604-875-5370Email: facdev@interchange.ubc.caWebsite: www.facdev.med.ubc.ca

Editor: Dr. Leslie SadownikDesign: Yan Huang

This newsletter is distributed to facultymembers in the Faculty of Medicine. We aimto make Education Matters as relevant andinformative as possible. To achieve this,we welcome articles, photographs, letters,feedback and other submissions. Pleasesend submissions tofacdev@interchange.ubc.ca.

www.facdev.med.ubc.ca 604.875.4396

Spotlight on Problem Based Learning

CALENDAR CORNER:UPCOMING EVENTS

Congratulations to our recentgraduates of The ABC Educational

Primer for Clinicians!Linda GrasswickAlaraji, Adnan - NeurologyEllis, Cathryn -MidwiferyHunte, Garth - Family PracticeMoney, Phyllis - Anesthesiavan Niekerk, Dirk - Path & Lab MedWatson, David - EmergencyWilkins-Ho, Mike - PsychiatryWong, Eileen - Family PracticeWong, Kenny - PediatricsYousif, Amal - Pediatrics ERMohammed Al-Othman - ERHashim Balubaid - MedicineMichelle Belanger - OB/GYNTerence Chang - Family PracticeMark Crossman - MedicineDouglas Drummond - Family PracticeLisa Dyke - PediatricsSarah Finlayson - Gyn/OncNelson Greidanus - OrthopedicsAvi Lemberg - PediatricsKenneth Madden - MedicineTracy Pressey - Maternal-Fetal MedKelly Saran - MedicineJuit Spence - Physical TherapySanjeev Vohra - GeriatricsKaren Zahn - MedicineScott Markey - Family PracticeLori Laughland -Family PracticeDavid Page - Family PracticeJeevyn Chahal - Family PracticeSean Larsen - Family Practice

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

February 2005

Educational Primer for CliniciansModule B (I): Framework for Clinical

ReasoningDrs. David Fairholm & Richard Cohen

Thursday February 17, 200518:30 – 20:00 Code 205B1

VGH, JPP, 2nd Floor, Lauener Room

Medical Education Grand Rounds: Standard Setting in Assessment

Dr. George PachevFriday February 18, 2005 10:00 - 11:00

VGH, JPP, 2nd Floor, Lauener Room

Medical Education Journal ClubFriday February 18, 2005 11:15 - 12:30

VGH, JPP 2nd Floor, Lauener Room

Educational Primer for Clinicians(Full)

Drs. Leslie Sadownik, David Fairholm, JanetKushner Kow, Richard Cohen & Rose Hatala

Module A: Thursday February 24, 200509:00 - 12:00 Code 203A

Module B: Thursday February 24, 200513:00 - 16:00 Code 203B

Module C: Friday February 25, 200509:00 - 12:00 Code 203C

VGH, 855 West 10th Avenue, 3rd Floor, FacultyDevelopment Library

March 2005

Educational Primer for CliniciansModule B (II): Questioning SkillsDrs. David Fairholm & Richard Cohen

Thursday March 3, 200518:30 – 20:00 Code 205B2

VGH, JPP 2nd Floor, Lauener Room

PBL Tutor Training WorkshopTuesday March 08

& Thursday March 10, 200508:00 – 12:00 Code 209

VGH, JPPN 3rd Floor, Rm 3353

Assessing Medical Professionalismin the Undergraduate Curriculum

Drs. Bert Cameron, David Fairholm& Barry Kassen

Thursday March 17, 200514:30 – 16:30 Code 214

VGH, JPP 2nd Floor, Lauener Room

Medical Education Grand Rounds:Friday March 18, 2005 10:00 - 11:00

BCCW, Chan Education Centre, Rm 3113

Medical Education Research Group:Friday March 18, 2005 11:15 - 12:30

BCCW, Chan Education Centre, Rm 3113

Educational Primer for CliniciansModule C (I): Feedback

Dr. Leslie SadownikThursday March 31, 200518:30 – 20:00 Code 205C1

VGH, JPP 2nd Floor, Lauener Room

April 2005

Educational Primer for CliniciansModule C (II): Assessment of Clinical

PerformanceDr. Leslie Sadownik

Thursday April 07, 200518:30 – 20:00 Code 205C2

VGH, JPP 2nd Floor, Lauener Room

Medical Error as a LearningOpportunity

Drs. Edward Etchells (Director PatientSafety Services, University of Toronto)

Thursday April 14, 200515:00 - 17:00 Code 215

VGH, JPP 2nd Floor, Lauener Room

Medical Education Grand Rounds:Learning from Medical Error

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

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

The Essentials of TeachingRecognition and Reward Wednesday April 20, 2005

15:00 - 17:00 Code 219VGH, JPP 2nd Floor, Lauener Room

The William Webber Lecture in Medical EducationPlease join the community of UBCmedical educators to celebrate the FirstAnnual William Webber Lecture inMedical Education.

Dr. Webber (or Bill as he is known tomost) has spent a career spanning 50years in medical education. Bill receivedhis medical degree at UBC in 1958. Aftera period as a post-doctoral fellow atCornell Medical College, he joined theDepartment of Anatomy in 1961 with aresearch interest in the structure andfunction of the kidney. Over the yearshe taught gross anatomy,

neuroanatomy, histology andembryology. From 1971 to 1996, he washeavily involved in administration asAssociate Dean and Dean of Medicine(1977-1990), as Coordinator of HealthSciences from 1990 to 1996, and asAssociate Vice-President Academic.These administrative positions did notinterfere with his interest and love forteaching. He has received the highestteaching awards including an HonoraryDegree (LLD) from UBC. He has beenthe driving force behind manyeducational initiatives - not only in theFaculty of Medicine but widely

throughout our University. Perhaps whatis most striking about Bill is not justwhat he brings to educational programsbut what he brings to individual learners.His longstanding interest in educationgoes far beyond “the act of teaching”.Bill is sincerely interested in hiscolleagues and his learners asindividuals. He characteristically bringsa human face to the educationalendeavour. The William Webber Lecturein Medical Education will celebrate thishumanistic approach to medicaleducation. Our guest lecturer this yearwill be a long standing friend andcolleage of Bill’s - Dr. Charles Slonecker.

Call for Posters

Posters are invited for presentation atthe 2005 Medical Education Day.Posters may cover any topic in medicaland healthcare professional educationand may relate to undergraduate,postgraduate, or continuing professionaldevelopment. Please submit an abstractincluding your name and contactinformation, title of presentation, nameof all authors, and abstract (maximum200 words) to the Faculty Development

Office by May 6, 2005. For moreinformation visit our website.

AgendaUBC Life Sciences Centre

10:00 – 12:00Facilitated Poster session (Rm 1410)

12:00 – 13:00Lunch (Rm 1416)

13:00 – 14:30

Friday May 20, 2005 Medical Education DayRSVP required for the event by Friday May 6, 2005

William Webber Lecture in MedicalEducation - Guest Lecture Dr. CharlesSlonecker (LSC3 Theatre)

For More Information

Visit our website, call our office or emailto facdev@interchange.ubc.ca for:

• Directions to the Life SciencesCentre

• RSVP for the event• Instructions for submitting

poster presentations

Editor’s note: This issue of our Faculty Development Newsletter starts off with a heart-felt tribute to Dr. Bill Webber. We inviteeveryone 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!

604-875-4111 local 68607 facdev@interchange.ubc.ca604-875-4111 local 68607 facdev@interchange.ubc.cafffffacdeacdeacdeacdeacdev@interv@interv@interv@interv@interccccchanghanghanghanghangeeeee.ubc.ubc.ubc.ubc.ubc.ca.ca.ca.ca.ca

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P2P1A AND THE MEANING OF LIFE

Dr. Bill WebberFaculty of Medicine

The still relatively new curriculumfeaturing problem based learning (PBL)has provided a variety of interestingexperiences for both faculty andstudents.

One of the more importantobservations is that not all tutors, notall students and not all groups arethe same.

I have now tutored in the initial block,P2P1a, for eight consecutive yearssince its inception. I believe it has someunique characteristics which are worththinking about. For most students, itis their first experience with PBL. Theycome with some apprehension abouthow it will work both in general and forthem personally. Their experience inthis block will set the tone for theirimpression of the program as a wholeand for their behavior in future blocks.

There are a number of factors whichmake the block unique. The studentsusually do not know each other. Theyare often apprehensive about their ownability to function in medical school, letalone in a format with which they areunfamiliar. They are concerned aboutboth their academic preparation,particularly those with atypicalacademic backgrounds, and theirinterpersonal skills. They are also likelyto be concerned about the attitude andexpectations of their first tutor. Willthose expectations be reasonable andwill they be able to meet them? Thetutors, particularly if they are new, maybe similarly apprehensive about theirabilities to function effectively. Typically,the group is heterogeneous in terms ofculture, academic background and lifeexperience.

My experience suggests that the tutorshould have several fairly limited

objectives in terms of the functioningof the group. The most important ofthese is that the experience should beenjoyable for all. It should be made clearthat if any of the students is not lookingforward to coming to tutorialssomething is not working right and theissue should be raised with the group.The students should be encouraged toregard it as “their” group and feel thatthey can suggest changes in format orfunctioning. It is worth trying out studentsuggestions even if the tutor feels highlyskeptical about them. Individualstudents are usually quite insightfulabout their strengths and weaknessesand should be encouraged todemonstrate their strengths and workon the areas they feel they need toimprove. To achieve these goals thereneeds to be early opportunity for thegroup to review its own functioning andfor individuals to describe their strengthsand weaknesses. Feedback should beprovided by both the tutor and by othergroup members. The tutor can modelthese interactions by describing his orher own strengths and weaknesses asa tutor and seeking the student’sfeedback.

If you have no weaknesses, youshouldn’t be wasting your timetutoring.

It is important to emphasize that thereare many ways of contributing to groupfunctioning and there is not astandardized set of behaviors which isrequired.Early in the block the tutor may need tobe more directive with a transfer ofownership as it were, to the studentsas they become more sophisticated.Assessment should begin early. I havefound it useful to begin with oralinteraction including self-assessmentsand responses from colleagues. By theend of the second week I move toproviding brief written assessments.Writing comments down forces the tutorto think carefully about the specificwords used and how they will beinterpreted by the students. In mygroups, students hear everything that issaid about the other students and havea chance to agree with or temper what Ihave said or to provide supplementaryassessment.

By the end of P2P1a I think the studentsshould be comfortable and, indeed,enjoying the tutorial process. Theyshould be able to participate in a varietyof ways including initiating discussion,adding information, using the board,listening respectfully, and disagreeing orcorrecting positively. They should beworking on being in control of their inputand being able to vary it deliberately andappropriately. They should be able toself-assess, receive and respond to theassessment of others and to provideconstructive feedback to others. If theblock has gone well they should leavewith the feeling about PBL that, “I cando this” and “I can help my next groupto function effectively.”

FACULTY OF MEDICINE 2004-2005 CALL FOR NOMINATIONS

Lifetime Achievement Award

The New Faculty Lifetime AchievementAward will recognize extraordinarymembers of the Faculty of Medicinewho have had sustained distinguishedcareers at UBC in the areas ofresearch, teaching and/or service asdefined by the guidelines for promotionin the UBC Guide.

These awards are open to Professors,Professors Emeritus/Emerita, ClinicalProfessors and Clinical ProfessorsEmeritus/Emerita in celebration of anoutstanding career. Nominees musthave held an appointment at UBC for atleast 15 years. At the time ofnomination, the recipient must be anactive member of the UBC Faculty ofMedicine.

Nominations will be made by any threeProfessors or Clinical Professors in theFaculty of Medicine. A nomination formshould be accompanied by a letter fromthe nominators, the curriculum vitae/publication list of the candidate, and upto 4 external arms-length letters ofreference addressing the criteria of theAward. Referees should be individualsof stature in the Nominee’s area ofinterest. Nominators will complete alldocumentation and submit thecompleted nomination package to theDean. After checking for eligibility andcompleteness, the Dean will forwarddossiers to the Adjudication Committee.

The deadline for submitting Nominationsis Monday February 21, 2005.Questions regarding the nominationprocess or guidelines should be directedto the Chair of the Faculty of MedicineAwards Committee, Dr. RossMacGillivray at 604 822-3027 orross.macgillivray@ubc.ca Please returncompleted nomination packages to Dr.Gavin Stuart, Dean.

Clinical Faculty Award forExcellence in Teaching

Since 2001, the Faculty of Medicine hasprovided three annual awards torecognize clinical faculty who excel inclinical teaching. The “Clinical FacultyAward for Excellence in Teaching” isintended to provide recognition andencouragement to excellent teachers.The award will be presented at anoccasion to be identified by the Dean. ACommittee comprised of the SpecialAdvisor for Clinical Faculty Affairs,Assistant Dean, Faculty EducationalDevelopment, representatives from theAssociate Deans of Undergraduate andPost-Graduate Medical Education, andclinical faculty representatives will selectaward recipients from among nominees.The award consists of a financial prizeof $1,000 and membership in theCanadian Association for MedicalEducation.

Candidates for this award will possess aClinical Faculty appointment within theFaculty of Medicine in one of the ClinicalDepartments or Professional schools.Candidates should have a sustainedrecord over several years of effectiveteaching performance. The awards willbe based upon excellence in teachingas evidenced by evaluations of studentsand/or residents and/or peers.Consideration will be given to a record ofthe development of effective teachingmethods or materials for clinical teachingand involvement in curricular or coursedevelopment.

Career Award for Excellencein Clinical Teaching

The Career Clinical Faculty teachingAward is intended to provide recognitionand encouragement to senior clinical

teachers of the Faculty. The purpose isto recognise long-time members of theFaculty who, over their career, have asustained record and reputation forexcellence in clinical teaching. Theseare teachers who typically function insmall groups or on a one-on-one basiswith residents and students and whohave had a major impact on theacquisition of clinical knowledge, skillsand judgment and on career choices.The award consists of a financial prizeof $2,500.

Candidates for this award are seniorclinical teachers who are full time, parttime, or clinical members of the Faculty.Candidates should have a sustainedrecord over several years of effectiveteaching performance as evidenced byevaluations of students and/or residentsand/or peers. Some teachers providerole models and life-long inspiration tostudents and have a profound effect ontheir motivation to learn in particularareas or pursue a particular career.Some stimulate students’ clinicalproblem solving or critical appraisalskills, some are most influential instudents’ acquisition of clinicalknowledge and skills, and othersemploy highly innovative teachingmethods.

The deadlines for submittingnominations for both Clinical FacultyAward for Excellence in Teaching andCareer Award for Excellence in ClinicalTeaching are Friday February 25, 2005.

For a nomination form and moreinformation, visit our websitewww.facdev.med.ubc.ca

Please return nominations to:Dr. Gavin Stuart, Dean

Faculty of Medicine317 - 2194 Health Sciences Mall

Vancouver, BC V6T 1Z3

Dr. Bill Webber

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PROMOTING LIFE-LONG LEARNING SKILLS THROUGH PROBLEM BASED LEARNINGDr. Amanda Bradley

Instructor, Medical Undergraduate Program

Q: Why is life-long learningimportant?

A: Physicians must keep up-to-datewith medical advances in order tomeet the changing needs ofpatients. Physicians that continueeducating themselves will realizewhen their skills require updatingand will have the knowledge to actin accordance with evidence basedpractice.

Q: What skills must life-long learnerspossess?

A: Life-long learners:are self-directed

determine their learning needs andformulate goals

exercise self-awarenessknow when and how to acquire

new information and skillsthink critically

Q: What can a tutor do to promotestudents acquisition of life-longlearning skills?

A: Tutors should nurture a safeenvironment where students will beopen to learning how to assessthemselves and how to recognizeand admit when their knowledge isnot adequate. A safe environmentcan be promoted by ensuring thatgroup members agree on a set ofground rules, showing respect for thegroup, admitting to our own

Amanda (middle) tutoring students

ignorance and encouraging studentsto openly exchange ideas andopinions. Once safe, students canbe challenged by the tutor’squestions and encouraged to gainexperience with choosing andappraising resources.

Q: What kinds of questions arehelpful?

A: Questions that prompt students tosubstantiate their hypotheses,challenge their thinking, determine

their learning needs and practiceevidence based medicine include:

Why do you think this is true?Does the new data strengthen,

weaken or eliminate any of thehypotheses?

What more information do youneed? Why?

What is the depth of studyrequired for this learning issue?

Why would you order this test?How sensitive and specific is it?

Q: How do we promote the use ofappropriate resources?

A: We should encourage students toshare resource information and toevaluate their sources. Usefulquestions include:

Is this source reliable for the typeof information we are seeking? Is itcurrent?

Can anyone verify thatinformation using another source?

Are there any limitations for theapplication of this information?

Are you satisfied with theinformation?

We should also gauge the students’skills so as to provide an appropriatelevel of guidance. Early on, students willrequire more guidance. Then, as theybecome increasingly experienced andresponsible for their own learning, tutorsshould allow students to carry on theprocess by themselves and shouldenter the discussion only whenguidance is indicated. Importantly,tutors should provide open, honest,constructive feedback on the students’reasoning processes and on theirperformance as self-directed learners.

As PBL tutors, we must remember thatthe skills our students acquire willimpact their abilities to meet newproblems and to keep contemporary intheir knowledge. By careful facilitation,we can help our students acquire theskills and attitudes they will need tosucceed.

Need more information about ProblemBased Learning? Consider this excellentresource - “Problem-Based LearningApplied to Medical Education (RevisedEdition)” by Howard S. Barrows, 2000,published by Southern Illinois UniversitySchool of Medicine, Illinois.

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The new UBC Certificate in PracticeEducation is a comprehensive programthat will demonstrate how to integratecore educational, interpersonal andteam building skills with your existingexpertise as a health professional.

Who should take this program?This certificate is designed forprofessionals in the health and humanservices who are already working with,or planning educational experiences forstudents and peers.

What are the benefits?

UBC CERTIFICATE IN PRACTICE EDUCATION FOR HEALTH AND HUMAN SERVICES

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THE UBC FACULTY CERTIFICATE PROGRAM ONTEACHING AND LEARNING IN HIGHER EDUCATION (FCP)

Dr. Amanda Bradley has a PhD in basicsciences from UBC (Dept ofExperimental Pathology). She is aclinical associate professor and aresearch associate for the CanadianBlood Services. In March 2004, shejumped to a full time teaching positionas an instructor in the medicalundergraduate program. She has beenan active PBL tutor since 2000 and hasto date tutored in 11 blocks.

Amanda is one of seven “instructors” inthe medical undergraduate program whowere hired in anticipation of theexpansion of the medical school. Theseinstructors are dedicated to tutoring(PBL and DPAS), curriculumdevelopment, faculty and studentsupport, primarily in the first 2 years ofthe curriculum.

Why did Amanda decide to shift hercareer focus?

Amanda replied, “I decided to jumpat this full time teaching opportunitybecause as much as I loved basicscience research, I love teaching evenmore. I am thoroughly enjoying theopportunity to reflect, focus on, andimprove my teaching and to be involvedin improving the quality of our students’medical education.”

PROBLEM-BASED LEARNING APPLIED TO MEDICAL EDUCATION (REVISED EDITION)

This book is a compact 147 pages.Chapters explore topics such as:

Authentic PBL and its developmentChallenges of the patient problemThe physician’s reasoning processSelf-directed learningCurriculum support needed for PBLThe “Authentic” PBL process

Assessment in PBLPBL in the Clerkship yearsEvaluation of the effectiveness of PBLCriteria for analyzing a PBLcurriculum

The Office for Faculty Development haslimited copies of the book. Pleasecontact us for more information.

There is a growing recognition of theincreasing complexity of academicwork, as well as the need for universityteachers to develop a scholarlyapproach toward their teaching. TheUBC Faculty Certificate Program onTeaching and Learning in HigherEducation (HE) was initiated in 1998.

This innovative certificate program hasbeen designed to adapt to the curriculaand pedagogical needs of universityteachers from multidisciplinary settings.The certificate program integrates theorywith practice and is developed around acohort model. The primary goal of this

program is to enhance the scholarshipof teaching and learning at UBC.Furthermore, the certificate programprepares faculty for leadership roles inbroader curricula and pedagogicalmatters. Many faculty participate in theprogram to investigate criticalpedagogical issues within theirdepartment (e.g.,curriculum re-design,evaluation of curricula, PBL, staffdevelopment, web-based learning,clinical teaching practices), othersembark on this program for personalreasons to improve course design,teaching scholarship, learningstrategies and assessment practices.

Faculty graduates of the programinclude Killam and 3M teaching awardwinners and professors from a widerange of disciplines and academic ranks.Each year, President Martha Piperawards certificates to graduating facultymembers at Green College. There are alimited number of faculty participantplaces available in this program. EachFaculty on campus is allocated twoplaces. Further details about thisprogram and the teaching scholarshipscheme for the September 2005-06cohort can be accessed at http://w w w . t a g . u b c . c a / p r o g r a m s /facultycertificate/

This certificate offers you an opportunityto build on your skills as an educator,become part of a supportive andexperienced network, to discover theexcitement inherent in teaching others,and to spark passion in your studentsand peers.

Program FormatThis part-time program offers a balanceof theory and practice, with courses thatare delivered in a combination of in-classand online formats. Participants takefive courses for a total of 150 hours ofstudy over approximately 11 months.

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 informationFor details about the course modules,costs and dates, please visitwww.cstudies.ubc.ca/health, call 604-822-8098 or email info-health@ubc.ca

604-875-4111 local 68607 facdev@interchange.ubc.ca604-875-4111 local 68607 facdev@interchange.ubc.cawwwwwwwwwwwwwww.f.f.f.f.facdeacdeacdeacdeacdevvvvv.med.ubc.med.ubc.med.ubc.med.ubc.med.ubc.ca.ca.ca.ca.ca fffffacdeacdeacdeacdeacdev@interv@interv@interv@interv@interccccchanghanghanghanghangeeeee.ubc.ubc.ubc.ubc.ubc.ca.ca.ca.ca.ca

4 5

One of the draws of UBC Faculty ofMedicine was the new problem basedlearning (PBL) curriculum. I remembertrying to convey my anticipation forlearning in small groups and workingthrough clinical cases “like a detective”during my medical school interview.Now that I have nearly completed mylong-sought-after MD degree – havingPBL’d my way through the initial twopre-clinical years and applied thoselessons learned to my experiences onthe wards – I can definitely say that PBLplayed an instrumental part in enrichingmy medical training.

I was quite lucky to have actually knownwhat the new buzzword, PBL, meanteven prior to starting medical school.During my undergrad science degree, Ivolunteered to be one of the guinea pigstudents for the development of the PBLcases and for tutor training. It was greatfun interacting with the other students,building on each others’ knowledge,asking questions, and best of all, findingout that I knew more than I thought!There is a fine sense of accomplishmentand gratification when you figure outthat all the clues from the case point tosome condition called Tetralogy of Fallotthat you found on Page 498 of anobscure text from the musty stacks ofWoodward Library.

But it was really the “process” of PBLthat brought the rewards andtribulations. At first, PBL was novel andall of the medical students were veryenthusiastic about following up onlearning issues. We used textbooks, theinternet, journals… anything we couldget our hands on to uncover theanswers. We had an incredible appetitefor finding more details. This led ustoward more questions, opening up aPandora’s box of knowledge that wesometimes found overwhelming. Webecame especially adept at finding orconstructing flow charts to present at

the next PBL session, making timelinesto summarize case details, gatheringinformation in systematic ways fromhistory, physical investigations, totreatment and management, andpresenting our researched information tothe rest of the group. In fact, 77% ofmy class during their first year of PBLfelt that PBL helped them to learn ratherthan being a waste of time.

Yolanda (middle)

Despite these new skills we gained fromPBL, there were frustrating times. Weoften left on Fridays and Case Wrap-Upsessions still unclear on the final detailsof the case, or whether we, asindividuals or as a group or even as aclass, covered the exact objectives ofthe week. We sometimes felt as if wewere guarded from the “answers.” That,paradoxically, even though PBL wasintended for us to learn in a self-directedway, we were hindered from accessingthe knowledge that was so close andyet so far and concealed in the Tutor’sGuide or a summary lecture. Time wasalso an unfair limit on the extent of whatwe learned. We were exacerbated bythe amount of time we had to take tofind what we identified as learning

issues. And the limitations onproceeding further than therecommended sheets per PBL sessionor sharing information from the Tutor’sGuide were frustrating. I must admit Ilearned the most from groups where wedecided as a group on how many sheetswe felt we could accomplish that dayand “illegally” did an extra page a dayto be able to have time on Fridays touse creative learning techniques suchas PBL Jeopardy or made-up questionsout of a hat to review the week. PBL isa dynamic process and should have theflexibility to accommodate the differentpersonalities of the groups.

On reflection, my most significantmemories of PBL are of the charactersthat made up the small groups and theircontributions. Individuals such as theradiologist-tutor who took the time toprovide an approach to chest x-rays inthe respirology block, or groups suchas the relationally-dysfunctional buthighly productive members of myObGyne group left an indelible mark onmy training. During clerkship, I oftenaccessed these synapses to recall thelearning issues we covered that are nowassociated with these people. And if Ididn’t remember the actual outcome ofour discussion on hand-foot-mouthdisease – covered in HDI week of firstyear because K.D. from our group hadthe disease last spring – at least I knewwhere to turn in my binder to find thedetails.

The incredible sense of camaraderie andinteraction between classmates was themost valuable aspect of PBL. Our classshared information and web links overemail, we brought food to celebrateFridays, we learned who was hard-working and who was slack, wenetworked with future attending staff.Had we not spent 3 days a week over 2

PROBLEM BASED LEARNING: A “FORWARD” STEP

Yolanda ButtMedical Student, Class of 2005

As teachers, we undergo facultydevelopment so that we are fullyeducated in our role as facilitativeteachers or ‘tutors’ in the PBL process.But what about the learner? Given thatthis is a learner centered educationalactivity, how are the learners educatedas to their roles and responsibilities inthis learning environment? And how dowe monitor their acquisition of the skillsthey are expected to learn in the problembased learning (PBL) environment?Furthermore, should they demonstratea weakness in the acquisition of theseskills, how do we help them overcomethis weakness?

Skills which the learner is being askedto develop in the problem based learningenvironment include skills associatedwith:

• their approach to knowledgeand learning;

• problem solving ability;• teamwork;• self-awareness; and,• reflective practice.

The acquisition of these skills is througha process of experimental learningaccompanied by feedback. At the endof every 5 week PBL block the studentsreceive a report from their tutor givingthem narrative feedback under theheadings ‘Preparation’ for PBL,

‘Participation’ in PBL, and‘Professionalism’ displayed in the PBLsetting. It is through these narratives,nicknamed the three Ps, that a tutorcommunicates to an individual studenttheir level of competence in the skill setoutlined above.

So, what if a student is incompetent inone or another of these skills? Whatshould the tutor do? And what help isavailable to the student in improvingtheir acquisition of these skills? Thetutor communicates that a student‘requires improvement’ in a skill area bygiving them a P- rating in one of the threePs, accompanied by a well-writtennarrative describing the specificweakness and recommendations toguide the student’s improvement. A

HOW DOES THE LEARNING HAPPEN IN PROBLEM BASED LEARNING?Dr. Niamh Kelly

Associate Professor, Department of Pathology and Laboratory Medicine

committee has been established, calledthe Student Support and DevelopmentCommittee (SSDC), which monitorstutors’ evaluations and steps in to offersupport to any student assigned a P-.Once a student has been assigned a P-the committee reviews the students fileto gain a more complete picture of thestudent’s developing skill set, based onprevious PBL tutors’ reports along withreports from some of the other tutoredcourses such as communication skills,clinical skills, and Doctor Patient andSociety. The student is sent a Reflectionand Remediation form prompting themto comment on their perceived strengthsand weaknesses with regard to the skillset which has been identified as requiringimprovement. The SSDC committeeworks with the student in establishing aplan for improving the necessary skill set,and monitors their progress in thisregard.

The Student Support and DevelopmentCommittee works with about 20 to 30first year students and less than 10second year students each year. It isthrough this process of experimentallearning accompanied by feedback, witha remediation step when required, thatthe majority of our students attain a levelof competence in the skill set associatedwith problem based learning by the timethey enter their clinical years.

Dr. Niamh Kelly

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years in random groups as teammembers, we would not have been ableto share knowledge and experienceswith students. We otherwise would nothave gotten to know if we had just beensitting in class all day in a didacticmodel.

Problem based learning was a superbmedical learning model and I can Continued on page 5

Continued from page 4 imagine no other way than PBL toprepare for the wards and beyond. Thepairing of PBL with complementarylectures related to the week’s topicmade for comprehensive learning. Itappealed to most students – those whowere motivated to self-direct and assesstheir learning as well as those who learndidactically. Clerkship provided ampleopportunity to read and practice clinicalmanagement, and our preparation forthe LMCC will be an appropriate review

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